Kopáčová Marcela, Bureš Jan, Rejchrt Stanislav, Vávrová Jaroslava, Bártová Jolana, Soukup Tomáš, Tomš Jan, Tachecí Ilja
2nd Department of Medicine - Gastroenterology, Charles University, Faculty of Medicine in Hradec Králové, University Teaching Hospital, Hradec Králové, Czech Republic.
Institute of Clinical Biochemistry and Diagnostics, Charles University, Faculty of Medicine in Hradec Králové, University Teaching Hospital, Hradec Králové, Czech Republic.
Acta Medica (Hradec Kralove). 2016;59(3):84-90. doi: 10.14712/18059694.2016.95. Epub 2016 Sep 1.
Double balloon enteroscopy (DBE) was introduced 15 years ago. The complications of diagnostic DBE are rare, acute pancreatitis is most redoubtable one (incidence about 0.3%). Hyperamylasemia after DBE seems to be a rather common condition respectively. The most probable cause seems to be a mechanical straining of the pancreas. We tried to identify patients in a higher risk of acute pancreatitis after DBE. We investigated several laboratory markers before and after DBE (serum cathepsin B, lactoferrin, E-selectin, SPINK 1, procalcitonin, S100 proteins, alfa-1-antitrypsin, hs-CRP, malondialdehyde, serum and urine amylase and serum lipase). Serum amylase and lipase rose significantly with the maximum 4 hours after DBE. Serum cathepsin and procalcitonin decreased significantly 4 hours after DBE compared to healthy controls and patients values before DBE. Either serum amylase or lipase 4 hours after DBE did not correlate with any markers before DBE. There was a trend for an association between the number of push-and-pull cycles and procalcitonin and urine amylase 4 hours after DBE; between procalcitonin and alfa-1-antitrypsin, cathepsin and hs-CRP; and between E-selectin and malondialdehyde 4 hours after DBE. We found no laboratory markers determinative in advance those patients in a higher risk of acute pancreatitis after DBE.
双气囊小肠镜检查（DBE）于15年前被引入。诊断性DBE的并发症罕见，急性胰腺炎是最令人担忧的一种（发病率约0.3%）。DBE后的高淀粉酶血症似乎是一种相当常见的情况。最可能的原因似乎是胰腺的机械性牵拉。我们试图识别DBE后发生急性胰腺炎风险较高的患者。我们在DBE前后检测了几种实验室指标（血清组织蛋白酶B、乳铁蛋白、E-选择素、丝氨酸蛋白酶抑制剂Kazal型1、降钙素原、S100蛋白、α1-抗胰蛋白酶、高敏C反应蛋白、丙二醛、血清和尿淀粉酶以及血清脂肪酶）。血清淀粉酶和脂肪酶在DBE后4小时内显著升高，最高可达峰值。与健康对照组和DBE前患者的值相比，DBE后4小时血清组织蛋白酶和降钙素原显著降低。DBE后4小时的血清淀粉酶或脂肪酶与DBE前的任何指标均无相关性。DBE后4小时，推拉循环次数与降钙素原和尿淀粉酶之间；降钙素原与α1-抗胰蛋白酶、组织蛋白酶和高敏C反应蛋白之间；以及E-选择素与丙二醛之间存在关联趋势。我们没有发现能预先确定那些DBE后发生急性胰腺炎风险较高患者的实验室指标。
