Mann S T W, Stracke H, Lange U, Klör H U, Teichmann J
Department of Internal Medicine, Medical Clinic III and Polyclinic of the Justus-Liebig-University Giessen, Germany.
Dig Dis Sci. 2003 Mar;48(3):533-8. doi: 10.1023/a:1022540816990.
There are still too few conclusive reports about conspicuous vitamin D deficiency in patients with chronic pancreatitis, or any connection of the deficiency to the severity of the disease. Between October 1999 and September 2000, we investigated 42 patients at an average age of 53 years, suffering from chronic pancreatits, as well as 20 healthy male controls at an average age of 49 years. Serum levels of D3 vitamins, 1,25-(OH)2-vitamin D3 and 25-(OH)-vitamin D3, as well as the concentration of fecal elastase 1 were determined in patients and controls. Furthermore, the severity of chronic pancreatitis in patients was determined via endoscopic retrograde cholangiopancreatography (ERCP) into 3 grades, based on the Cambridge classification. Elastase 1 in feces revealed sensitivities of 14%, 87%, and 95% for Cambridge-grades I, II, and III, respectively, and correlated significantly with this classification of severity of chronic pancreatitis (P < 0.01). In patients with Cambridge-grade II and III 1,25-(OH)2-D3 was markedly decreased (26.7 +/- 7.7 pg/ml and 27.6 +/- 9.0 pg/ml) compared to those with Cambridge-grade I (38.0 +/- 10.5 pg/ml; between I and II P = 0.027, between I and III P = 0.033). 25-(OH)-D-3 did not differ significantly within the various Cambridge-grade groups (P = 0.07). Nevertheless, vitamin D3 and fecal elastase 1 in patients correlated significantly (P < 0.01) and, compared to controls, both were extremely low (means in patients: fecal elastase 1 140.7 +/- 75.7 microg/g, 1,25-(OH)2-D3 29.9 +/- 9.5 pg/ml, 25-(OH)-D3 26.7 +/- 9.7 nmol/liter; controls: fecal elastase 1 694.9 +/- 138.6 microg/g, 1,25-(OH)2-D3 67.5 +/- 4.3 pg/ml, 25-(OH)-D3 69.5 +/- 13.5 nmol/liter). The amounts of both D3 vitamins in patients were significantly lower when the content of fecal elastase 1 was under 200 microg/g compared to the others [for 1,25-(OH)2-D3 P < 0.01, for 25-(OH)-D3 P < 0.05]. Therefore, ERCP and fecal elastase 1 verify the severity grade of a chronic pancreatitis, and thus show a vitamin D3 deficiency, depending on the progress of the disease. There seems to be a connection between inflammatory pancreas destruction (Cambridge classification), exocrine insufficiency (fecal elastase 1), and perhaps even the characteristics of sterol-binding of pancreatic elastase 1, which seems to be relevant for vitamin D supply.
关于慢性胰腺炎患者明显维生素D缺乏的结论性报告仍然太少，或者缺乏与疾病严重程度的任何关联。在1999年10月至2000年9月期间，我们调查了42名平均年龄53岁的慢性胰腺炎患者以及20名平均年龄49岁的健康男性对照者。测定了患者和对照者血清中D3维生素、1,25-(OH)2-维生素D3和25-(OH)-维生素D3的水平，以及粪便弹性蛋白酶1的浓度。此外，根据剑桥分类法，通过内镜逆行胰胆管造影（ERCP）将患者慢性胰腺炎的严重程度分为3级。粪便弹性蛋白酶1对剑桥I级、II级和III级的敏感性分别为14%、87%和95%，并与慢性胰腺炎严重程度的这种分类显著相关（P < 0.01）。与剑桥I级患者（38.0 +/- 10.5 pg/ml）相比，剑桥II级和III级患者的1,25-(OH)2-D3明显降低（26.7 +/- 7.7 pg/ml和27.6 +/- 9.0 pg/ml；I级与II级之间P = 0.027，I级与III级之间P = 0.033）。25-(OH)-D-3在不同剑桥分级组之间无显著差异（P = 0.07）。然而，患者体内的维生素D3与粪便弹性蛋白酶1显著相关（P < 0.01），与对照者相比，两者均极低（患者的均值：粪便弹性蛋白酶1 140.7 +/- 75.7 microg/g，1,25-(OH)2-D3 29.9 +/- 9.5 pg/ml，25-(OH)-D3 26.7 +/- 9.7 nmol/l；对照者：粪便弹性蛋白酶1 694.9 +/- 138.6 microg/g，1,25-(OH)2-D3 67.5 +/- 4.3 pg/ml，25-(OH)-D3 69.5 +/- 13.5 nmol/l）。当粪便弹性蛋白酶1含量低于200 microg/g时，患者体内两种D3维生素的含量与其他情况相比显著降低[1,25-(OH)2-D3 P < 0.01，25-(OH)-D3 P < 0.05]。因此，ERCP和粪便弹性蛋白酶1可验证慢性胰腺炎的严重程度分级，从而显示出维生素D3缺乏，这取决于疾病的进展。炎症性胰腺破坏（剑桥分类）、外分泌功能不全（粪便弹性蛋白酶1）之间似乎存在关联，甚至可能与胰腺弹性蛋白酶1的固醇结合特性有关，而这似乎与维生素D供应相关。
