Büchler M, Malfertheiner P, Schädlich H, Nevalainen T J, Friess H, Beger H G
Department of Surgery, University of Ulm, Federal Republic of Germany.
Gastroenterology. 1989 Dec;97(6):1521-6. doi: 10.1016/0016-5085(89)90398-3.
In a prospective clinical trial, 85 patients with acute pancreatitis, including 50 with acute interstitial-edematous pancreatitis and 35 with necrotizing pancreatitis, were recruited. Serum pancreatic immunoreactive phospholipase A2 (IR-PLA2), serum phospholipase A catalytic activity (CA-PLA), and serum phospholipase A2 catalytic activity (CA-PLA2) were determined daily between day 1 and day 10 after the onset of the disease. The serum course of IR-PLA2 values for patients with acute interstitial-edematous pancreatitis was comparable to that for patients with necrotizing pancreatitis. In contrast, the determination of CA-PLA and of CA-PLA2 specific activity in the serum revealed a high differentiation between patients with interstitial edematous and those with necrotizing pancreatitis. The overall accuracy for differentiating patients with necrotizing pancreatitis from those with the interstitial-edematous type was 79% for CA-PLA and 77% for CA-PLA2 (cut-off level: CA-PLA, 15 U/L, day 1-5; CA-PLA2, 3.5 U/L, day 1-5). Patients with pancreatitis-associated pulmonary complications showed significantly higher CA-PLA and CA-PLA2 values in the serum. This study demonstrates the role of serum catalytic phospholipase A2 in human acute pancreatitis where the development of pancreatic necrosis and pulmonary failure is concerned.
在一项前瞻性临床试验中，招募了85例急性胰腺炎患者，其中包括50例急性间质性水肿性胰腺炎患者和35例坏死性胰腺炎患者。在疾病发作后的第1天至第10天，每天测定血清胰腺免疫反应性磷脂酶A2（IR-PLA2）、血清磷脂酶A催化活性（CA-PLA）和血清磷脂酶A2催化活性（CA-PLA2）。急性间质性水肿性胰腺炎患者的IR-PLA2值血清变化过程与坏死性胰腺炎患者相当。相比之下，血清中CA-PLA和CA-PLA2比活性的测定显示，间质性水肿性胰腺炎患者与坏死性胰腺炎患者之间有高度差异。区分坏死性胰腺炎患者与间质性水肿型患者的总体准确率，CA-PLA为79%，CA-PLA2为77%（临界值：CA-PLA，第1 - 5天为15 U/L；CA-PLA2，第1 - 5天为3.5 U/L）。伴有胰腺炎相关肺部并发症的患者血清中的CA-PLA和CA-PLA2值显著更高。这项研究证明了血清催化磷脂酶A2在人类急性胰腺炎中与胰腺坏死和肺衰竭发生发展相关的作用。
