Hahn Jan-Uwe, Kerner Wolfgang, Maisonneuve Patrick, Lowenfels Albert B, Lankisch Paul Georg
Clinic for Diabetes and Metabolic Diseases, Klinikum Karlsburg, Karlsburg, Germany.
Pancreas. 2008 Apr;36(3):274-8. doi: 10.1097/MPA.0b013e3181656f8.
On the basis of very low fecal elastase 1 and very high fecal fat estimations, it has been claimed that exocrine pancreatic insufficiency is frequent in diabetic patients, and that in up to 40% of the patients, pancreatic enzyme substitution would be indicated. Because this would affect millions of diabetic patients worldwide, we evaluated this suggestion by testing exocrine pancreatic function in type-1 diabetes using the criterion standard of exocrine pancreatic function tests, the secretin-cerulein test (SCT). The results of this test were then compared with those of fecal elastase 1 and fecal fat estimations.
Thirty-three patients with type-1 diabetes mellitus underwent an SCT, a fecal fat estimation, and 2 fecal elastase 1 tests (using both monoclonal and polyclonal antibodies) to evaluate their exocrine pancreatic function.
The SCT results were abnormal in 11 of the 33 patients, who showed only mild to moderate exocrine pancreatic insufficiency, and the stimulated lipase secretion was never less than 10% of the level where pancreatic steatorrhea first occurs. The correlation between fecal elastase 1 and SCT showed much lower sensitivity, specificity, and positive and negative predictive values than did the correlation between SCT and fecal fat. Nonpancreatogenic steatorrhea was present in two thirds of the patients and was probably caused by bacterial overgrowth.
Neither low fecal elastase 1 nor raised fecal fat levels reliably indicate exocrine pancreatic insufficiency in type-1 diabetes and therefore should not be used as an indicator for expensive pancreatic enzyme substitution.
基于极低的粪便弹性蛋白酶1水平和极高的粪便脂肪测定值，有人声称糖尿病患者中胰腺外分泌功能不全很常见，高达40%的患者需要进行胰酶替代治疗。由于这将影响全球数百万糖尿病患者，我们使用胰腺外分泌功能测试的标准方法即促胰液素-胰泌素试验（SCT）来评估1型糖尿病患者的胰腺外分泌功能，以验证这一说法。然后将该试验结果与粪便弹性蛋白酶1和粪便脂肪测定结果进行比较。
33例1型糖尿病患者接受了SCT、粪便脂肪测定以及两项粪便弹性蛋白酶1检测（分别使用单克隆抗体和多克隆抗体）以评估其胰腺外分泌功能。
33例患者中有11例SCT结果异常，这些患者仅表现为轻度至中度胰腺外分泌功能不全，且刺激后的脂肪酶分泌从未低于胰腺性脂肪泻首次出现时水平的10%。与SCT和粪便脂肪之间的相关性相比，粪便弹性蛋白酶1与SCT之间的相关性显示出更低的敏感性、特异性以及阳性和阴性预测值。三分之二的患者存在非胰腺源性脂肪泻，可能是由细菌过度生长引起的。
粪便弹性蛋白酶1水平低和粪便脂肪水平升高均不能可靠地表明1型糖尿病患者存在胰腺外分泌功能不全，因此不应将其用作昂贵的胰酶替代治疗的指标。
