Hardt P D, Fadgyas T, Kress O, Doppl W E, Weber H P, Bimler E A, Temme H, Klör H U
Med. Klinik III und Poliklinik, Justus-Liebig-Universität Giessen.
Z Gastroenterol. 1999 Aug;37(8):701-5.
Recently an ELISA using specific antibodies to detect elastase-1 in serum has become available. Earlier studies using a radioimmunoassay reported a prolonged elevation of serum elastase as compared to other pancreatic enzymes in acute pancreatitis. The aim of the present study was to compare the changes of serum levels of ELISA-elastase-1, lipase and amylase in acute pancreatic damage following ERCP. Blood samples were prospectively collected at five time points before and after the endoscopic procedures in 212 patients. Samples were analyzed for pancreatic serum enzymes, acute phase proteins and routine parameters. A pain score was used for clinical evaluation. Relevant post ERCP pancreatic damage was defined as CRP elevation from < 10 mg/l to > 10 mg/l in the presence of persistent abdominal pain without laboratory evidence of cholangitis and without clinical or laboratory signs of pancreatitis before the endoscopic procedures. Elastase-1 time course paralleled the courses of lipase and amylase peeking at six hrs. There was no prolonged elevation of elastase-1. Ten out of 204 patients (4.9%) were found to have relevant pancreatic damage. Depending on the cut off point used, sensitivity/specificity were as follows: lipase 80-100%/30.9-71.6%; amylase 70-90%/44.3-88.7%; elastase-1 60-90%/64.9-81.4%. In conclusion ELISA-elastase-1 is a marker of acute pancreatic damage similar to lipase and amylase. Although elastase-1 may show a better specificity than the other enzymes, this seems to be a matter of definition of the normal range. The determination of serum ELISA-elastase-1 does not provide additional information in acute pancreatic damage as compared to a combination of lipase and amylase.
最近，一种利用特异性抗体检测血清中弹性蛋白酶-1的酶联免疫吸附测定（ELISA）方法问世。早期使用放射免疫测定法的研究报告称，在急性胰腺炎中，血清弹性蛋白酶水平较其他胰腺酶升高的时间更长。本研究的目的是比较内镜逆行胰胆管造影术（ERCP）后急性胰腺损伤时ELISA弹性蛋白酶-1、脂肪酶和淀粉酶的血清水平变化。前瞻性地收集了212例患者在内镜操作前后五个时间点的血样。对样本进行胰腺血清酶、急性期蛋白和常规参数分析。使用疼痛评分进行临床评估。ERCP术后相关胰腺损伤定义为：在无胆管炎实验室证据且内镜操作前无胰腺炎临床或实验室体征的情况下，持续性腹痛患者的C反应蛋白（CRP）从<10mg/L升高至>10mg/L。弹性蛋白酶-1的时间进程与脂肪酶和淀粉酶相似，在6小时时达到峰值。弹性蛋白酶-1没有出现长时间升高。204例患者中有10例（4.9%）被发现有相关胰腺损伤。根据所使用的临界值，敏感性/特异性如下：脂肪酶80 - 100%/30.9 - 71.6%；淀粉酶70 - 90%/44.3 - 88.7%；弹性蛋白酶-1 60 - 90%/64.9 - 81.4%。总之，ELISA弹性蛋白酶-1是一种与脂肪酶和淀粉酶类似的急性胰腺损伤标志物。尽管弹性蛋白酶-1可能比其他酶表现出更好的特异性，但这似乎取决于正常范围的定义。与脂肪酶和淀粉酶联合检测相比，血清ELISA弹性蛋白酶-1的测定在急性胰腺损伤中并未提供额外信息。
