Conwell Darwin L, Zuccaro Gregory, Morrow J Brad, Van Lente Frederick, Obuchowski Nancy, Vargo John J, Dumot John A, Trolli Patricia, Shay Steven S
The Pancreas Clinic, Section of Endoscopy and Pancreaticobiliary Diseases, Cleveland Clinic Foundation, Ohio, USA.
Am J Gastroenterol. 2002 Jun;97(6):1392-7. doi: 10.1111/j.1572-0241.2002.05675.x.
Hormonal stimulation with secretin or cholecystokinin (CCK) is the most sensitive means of assessing pancreatic function. Secretin is not available, and current CCK tests are cumbersome, requiring dual tube intubation and marker perfusion techniques. The aim of this study was to test the efficacy of a new CCK-stimulated pancreatic function test measuring peak lipase concentration.
A Dreiling gastroduodenal tube was inserted to the ligament of Treitz, and fluid was collected on ice for 80 min in four 20-min aliquots. CCK was infused i.v. at a constant rate of 40 ng/kg/h. Gastric aspirations were discarded. Duodenal aspirates were analyzed for volume and enzyme concentration with a clinical laboratory autoanalyzer.
Nineteen healthy volunteers and 18 chronic pancreatitis patients were studied. Lipase concentration and secretory volume showed a peak response by 40 min of stimulation, whereas amylase response was variable. The mean peak lipase concentrations (+/-SEM) for normal volunteers and mild, moderate, and advanced chronic pancreatitis patients were 16.9+/-1.9, 7.9+/-1.7, 3.7+/-1.2, and 2.1+/-0.6 x 10 5 IU/L, respectively. Lower peak lipase concentrations were significantly associated with more advanced chronic pancreatitis (p < 0.001). The receiver operating characteristic curve area for all chronic pancreatitis patients was 0.944 (95% CI = 0.825-0.985). A peak lipase concentration of 780,000 IU/L provided a sensitivity and specificity of 0.833 and 0.867, respectively. This CCK test was well tolerated and without complications.
Lipase concentration in duodenal fluid increases nearly 3-fold from baseline after CCK stimulation in healthy volunteers but is markedly reduced in patients with chronic pancreatic disease. Peak lipase concentration is a significant predictor of chronic pancreatitis and correlates with severity of pancreatic disease. Aspiration of duodenal drainage fluid with a Dreiling tube and analysis with a laboratory autoanalyzer are less cumbersome than marker perfusion and back titration techniques. Measurement of enzyme concentration instead of output could lead to the development of an endoscopic or through-the-scope screening method for assessing patients with suspected chronic pancreatitis or chronic abdominal pain.
用促胰液素或胆囊收缩素（CCK）进行激素刺激是评估胰腺功能最敏感的方法。促胰液素无法获取，且目前的CCK检测方法繁琐，需要双管插管和标记物灌注技术。本研究的目的是测试一种新的CCK刺激胰腺功能试验测量脂肪酶峰值浓度的有效性。
将一根德莱林胃十二指肠管插入屈氏韧带，在冰上收集液体80分钟，分4份，每份20分钟。以40 ng/kg/h的恒定速率静脉输注CCK。弃去胃抽吸物。用临床实验室自动分析仪分析十二指肠抽吸物的体积和酶浓度。
研究了19名健康志愿者和18名慢性胰腺炎患者。脂肪酶浓度和分泌量在刺激40分钟时出现峰值反应，而淀粉酶反应则各不相同。正常志愿者、轻度、中度和重度慢性胰腺炎患者的平均脂肪酶峰值浓度（±标准误）分别为16.9±1.9、7.9±1.7、3.7±1.2和2.1±0.6×10⁵ IU/L。较低的脂肪酶峰值浓度与更严重的慢性胰腺炎显著相关（p<0.001）。所有慢性胰腺炎患者的受试者工作特征曲线面积为0.944（95%可信区间=0.825-0.985）。脂肪酶峰值浓度为780,000 IU/L时，敏感性和特异性分别为0.833和0.867。该CCK检测耐受性良好，无并发症。
健康志愿者在CCK刺激后，十二指肠液中的脂肪酶浓度比基线水平增加近3倍，但在慢性胰腺疾病患者中明显降低。脂肪酶峰值浓度是慢性胰腺炎的重要预测指标，与胰腺疾病的严重程度相关。用德莱林管抽吸十二指肠引流液并用实验室自动分析仪进行分析，比标记物灌注和回滴定技术更简便。测量酶浓度而非酶输出量可能会促成一种用于评估疑似慢性胰腺炎或慢性腹痛患者的内镜或经内镜筛查方法的开发。
