炎症性肠病患者血清中Ⅲ型前胶原氨基端肽（PIIINP）和层粘连蛋白水平升高提示肝胆和胰腺功能障碍。

Elevated serum PIIINP and laminin in inflammatory bowel disease indicate hepatobiliary and pancreatic dysfunction.

作者信息

Heikius B, Niemelä O, Niemelä S, Karttunen T J, Lehtola J

机构信息

Department of Internal Medicine, University Hospital of Oulu, Oulu, Finland.

出版信息

Hepatogastroenterology. 2002 Mar-Apr;49(44):404-11.

PMID:11995461

Abstract

BACKGROUND/AIMS: Levels of S-PIIINP (serum aminoterminal propeptide of type III procollagen) have been shown to be increased in patients with primary sclerosing cholangitis and inflammatory bowel disease. The aim of the study was to investigate the serum concentrations of PIIINP and laminin in inflammatory bowel disease patients, their relationship with inflammatory bowel disease-associated hepatobiliary and pancreatic dysfunction, and to correlate them with clinical, endoscopic, and histologic variables.

METHODOLOGY

S-PIIINP and S-laminin were measured in 222 consecutive inflammatory bowel disease patients, who were screened for abnormal liver and pancreatic enzymes and for pancreatic exocrine hypofunction with the p-aminobenzoic acid test (215 patients). The patients with abnormal screening results were further scheduled for endoscopic retrograde cholangiopancreatography, liver biopsy, secretin test and ultrasound.

RESULTS

S-PIIINP and S-laminin were abnormally high in 19% and 40% of all inflammatory bowel disease patients, respectively. The elevated levels of the fibrosis markers were associated with laboratory signs of either hepatobiliary or pancreatic disease. Hepatobiliary disease was found in 37 (17%) of inflammatory bowel disease patients, 15 of whom had primary sclerosing cholangitis. The median levels of S-PIIINP and S-laminin were significantly higher in patients with hepatobiliary disease than in those without (P < 0.0001 and P < 0.001, respectively), being most strikingly elevated in primary sclerosing cholangitis. Abnormal pancreatic screening tests were found in 67 (30%) patients. High levels of S-PIIINP and S-laminin were also significantly associated with low values in p-aminobenzoic acid (P < 0.001 and P < 0.005) and secretin (P < 0.01 and P < 0.05) tests, but not with inflammatory bowel disease category, endoscopic or histological disease extent, frequency of bowel resection or actual clinical activity.

CONCLUSIONS

In inflammatory bowel disease, increased S-PIIINP and S-laminin are associated with hepatobiliary and pancreatic disorders.

摘要

背景/目的：原发性硬化性胆管炎和炎症性肠病患者的血清III型前胶原氨基端前肽（S-PIIINP）水平已被证明升高。本研究的目的是调查炎症性肠病患者血清中PIIINP和层粘连蛋白的浓度，它们与炎症性肠病相关的肝胆和胰腺功能障碍的关系，并将它们与临床、内镜和组织学变量相关联。

方法

对222例连续性炎症性肠病患者进行S-PIIINP和S-层粘连蛋白检测，这些患者通过对氨基苯甲酸试验（215例患者）筛查肝酶和胰酶异常以及胰腺外分泌功能减退。筛查结果异常的患者进一步安排进行内镜逆行胰胆管造影、肝活检、促胰液素试验和超声检查。

结果

在所有炎症性肠病患者中，S-PIIINP和S-层粘连蛋白异常升高的比例分别为19%和40%。纤维化标志物水平升高与肝胆或胰腺疾病的实验室指标相关。在37例（17%）炎症性肠病患者中发现了肝胆疾病，其中15例患有原发性硬化性胆管炎。肝胆疾病患者的S-PIIINP和S-层粘连蛋白中位数水平显著高于无肝胆疾病患者（分别为P<0.0001和P<0.001），在原发性硬化性胆管炎中升高最为明显。67例（30%）患者的胰腺筛查试验异常。S-PIIINP和S-层粘连蛋白水平升高也与对氨基苯甲酸试验（P<0.001和P<0.005）和促胰液素试验（P<0.01和P<0.05）的低值显著相关，但与炎症性肠病类型、内镜或组织学疾病范围、肠道切除频率或实际临床活动无关。