采用联合应用缩胆囊素和促胰液素刺激的内镜胰腺功能试验评估慢性胰腺炎。
Endoscopic pancreatic function test using combined secretin and cholecystokinin stimulation for the evaluation of chronic pancreatitis.
机构信息
Medicine Institute, The Cleveland Clinic, Cleveland, Ohio 44195, USA.
出版信息
Gastrointest Endosc. 2012 Apr;75(4):764-8. doi: 10.1016/j.gie.2011.11.011. Epub 2012 Jan 26.
BACKGROUND
Current endoscopic pancreatic function test (ePFT) methods use either secretin or cholecystokinin (CCK) to measure pancreatic function.
OBJECTIVE
To evaluate a novel ePFT protocol that includes both secretin and CCK stimulation and to assess which fluid parameters best discriminate patients with chronic pancreatitis (CP).
DESIGN
Prospective, cross-sectional diagnostic study.
SETTING
Single, tertiary-care institution.
PATIENTS
Healthy volunteers and patients evaluated for CP were included.
INTERVENTIONS
All patients underwent a combined secretin-CCK ePFT. Patients evaluated for CP also underwent EUS during the same endoscopic session.
MAIN OUTCOME MEASUREMENTS
Duodenal fluid bicarbonate, lipase, and amylase concentrations were measured after CCK and secretin stimulation. Results were compared based on the presence of CP detected by EUS (≥5 features).
RESULTS
Twenty healthy volunteers and 69 patients evaluated for CP completed the secretin and CCK ePFT. Patients with an EUS score of 5 or higher had significantly decreased peak bicarbonate concentrations (72 mmol) compared with patients with an EUS score lower than 5 (90 mmol) and healthy subjects (108 mmol) (P < .001). Peak concentrations of amylase and lipase and total fluid volume were not significantly different between patients with CP and controls. Receiver-operating characteristic analysis revealed that peak bicarbonate concentration had superior discrimination for CP (area under the curve [AUC] 0.738) compared with peak amylase (AUC 0.677) and peak lipase (AUC 0.627). The addition of enzyme concentration measurement did not improve discrimination compared with peak bicarbonate alone.
LIMITATIONS
Secretin and cholecystokinin endoscopic pancreatic function test (SC ePFT) results were not compared with those of single hormone ePFTs.
CONCLUSIONS
The addition of CCK infusion and enzyme concentration measurement to a standard secretin ePFT does not enhance the diagnosis of CP.
背景
目前的内镜胰腺功能测试（ePFT）方法使用促胰液素或胆囊收缩素（CCK）来测量胰腺功能。
目的
评估一种新的 ePFT 方案，该方案包括促胰液素和 CCK 刺激，并评估哪种液体参数能最好地区分慢性胰腺炎（CP）患者。
设计
前瞻性、横断面诊断研究。
设置
单一的三级医疗机构。
患者
纳入健康志愿者和接受 CP 评估的患者。
干预措施
所有患者均接受联合促胰液素-CCK ePFT。接受 CP 评估的患者也在同一内镜检查过程中接受 EUS。
主要观察测量
CCK 和促胰液素刺激后测量十二指肠液碳酸氢盐、脂肪酶和淀粉酶浓度。结果根据 EUS（≥5 个特征）检测到的 CP 存在情况进行比较。
结果
20 名健康志愿者和 69 名接受 CP 评估的患者完成了促胰液素和 CCK ePFT。EUS 评分≥5 的患者的碳酸氢盐峰值浓度明显低于 EUS 评分<5 的患者（90 mmol）和健康受试者（108 mmol）（P<0.001）。CP 患者和对照组之间的淀粉酶和脂肪酶峰值浓度和总液体量没有显著差异。受试者工作特征曲线分析显示，与峰值淀粉酶（AUC 0.677）和峰值脂肪酶（AUC 0.627）相比，峰值碳酸氢盐浓度对 CP 的鉴别能力更高（AUC 0.738）。与单独的碳酸氢盐峰值相比，添加酶浓度测量并不能提高鉴别能力。
局限性
促胰液素和胆囊收缩素内镜胰腺功能试验（SC ePFT）结果未与单一激素 ePFT 结果进行比较。
结论
在标准促胰液素 ePFT 中加入 CCK 输注和酶浓度测量并不能增强 CP 的诊断。
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