Fabris C, Basso D, Del Favero G, Piccoli A, Angonese C, Di Mario F, Plebani M, Bonvicini P, Burlina A, Naccarato R
Istituto di Medicina Interna Cattedra di Malattie Apparato Digerente, Università degli Studi di Padova, Italia.
Nephron. 1989;51(1):56-60. doi: 10.1159/000185243.
Urinary excretion of alpha-glucosidase (AGL), gamma-glutamyltransferase (GGT) and ribonuclease (RNase), and serum amylase and immunoreactive trypsin (IRT) were determined in 38 control subjects, 48 patients with pancreatic cancer, 77 with chronic pancreatitis and 47 with extrapancreatic diseases in order to ascertain the presence of a renal tubular damage and to investigate its etiology. A significantly increased frequency of pathological results for all urinary enzymes was documented in the various groups of patients as compared to controls. Significant correlations were detected among AGL, GGT and RNase. Considering the subjects as a whole, GGT and RNase excretions correlated with serum IRT and amylase; the two urinary enzymes were found to be higher when jaundice was present. In chronic pancreatic disease enzymuria was related to increased serum pancreatic enzymes; in extrapancreatic diseases it was associated to hyperbilirubinemia. The vast majority of patients with pancreatic cancer and elevated urinary enzymes presented hepatic metastases and/or jaundice. We can conclude that an anatomical and functional tubular impairment is detectable in some patients with chronic pancreatic and extrapancreatic diseases. Tubular damage seems to least in part to be related to pancreatic inflammation and necrosis in chronic pancreatic disease, while jaundice may be found to play an important role in diseases of the hepatobiliary tract. In pancreatic cancer, liver dysfunction (presence of liver metastases and/or extrahepatic cholestasis) also appears to be involved in altering tubular cells.
对38名对照受试者、48名胰腺癌患者、77名慢性胰腺炎患者和47名胰腺外疾病患者测定了α-葡萄糖苷酶（AGL）、γ-谷氨酰转移酶（GGT）和核糖核酸酶（RNase）的尿排泄量，以及血清淀粉酶和免疫反应性胰蛋白酶（IRT），以确定是否存在肾小管损伤并研究其病因。与对照组相比，各患者组中所有尿酶的病理结果发生率均显著增加。在AGL、GGT和RNase之间检测到显著相关性。将所有受试者作为一个整体考虑，GGT和RNase排泄量与血清IRT和淀粉酶相关；当出现黄疸时，发现这两种尿酶水平更高。在慢性胰腺疾病中，酶尿与血清胰腺酶升高有关；在胰腺外疾病中，酶尿与高胆红素血症有关。绝大多数尿酶升高的胰腺癌患者出现肝转移和/或黄疸。我们可以得出结论，在一些慢性胰腺疾病和胰腺外疾病患者中可检测到解剖学和功能性肾小管损害。在慢性胰腺疾病中，肾小管损伤似乎至少部分与胰腺炎症和坏死有关，而黄疸可能在肝胆疾病中起重要作用。在胰腺癌中，肝功能障碍（肝转移和/或肝外胆汁淤积的存在）似乎也参与了肾小管细胞的改变。
