Department of Clinical Medicine, University of Bergen, Norway; Hormone Laboratory, Haukeland University Hospital, Bergen, Norway; Department of Medicine, Haukeland University Hospital, Bergen, Norway.
Centre for Pancreatic Diseases, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.
Eur J Intern Med. 2019 Oct;68:18-22. doi: 10.1016/j.ejim.2019.07.021. Epub 2019 Aug 8.
The prevalence of pancreatic exocrine insufficiency (PEI) in diabetes mellitus (DM) varies widely between studies, which may be explained by methodological problems. We aimed to establish the prevalence of PEI in DM using the faecal elastase-1 (FE-1) assay as a screening test, and to further investigate these patients by the mixed C-triglyceride (C-MTG) breath test.
One hundred and thirty-three consecutive type 1 or type 2 DM patients without known exocrine pancreatic disorders were recruited. Demographic parameters, stool consistency, stool frequency, routine laboratory tests, and the presence of DM complications were registered. An FE-1 value <200 μg/g was used as the screening cut-off for PEI, and patients with FE-1 values below this level were referred for a C-MTG breath test.
One hundred and two patients returned faecal samples. The prevalence of PEI as measured by low FE-1 was 13%. Insulin usage, type 1 DM, and DM duration were associated with low FE-1. Stool habits were unaffected by low FE-1. Twelve out of 13 patients with low FE-1 performed the breath test, which was normal in all cases.
The prevalence of PEI defined by FE-1 was low in our mixed cohort of type 1 and 2 DM patients. Furthermore, there was a discrepancy between FE-1 and the breath test. Hence, the role of FE-1 in evaluating pancreatic exocrine function in DM should be evaluated in larger studies in order to clarify the association between low FE-1 and clinically relevant PEI.
不同研究中糖尿病（DM）患者胰腺外分泌功能不全（PEI）的患病率差异很大，这可能是由于方法学问题所致。我们旨在使用粪便弹性蛋白酶-1（FE-1）检测作为筛选试验来确定 DM 中 PEI 的患病率，并通过混合 C-三酸甘油酯（C-MTG）呼气试验进一步研究这些患者。
招募了 133 例连续的 1 型或 2 型 DM 患者，这些患者没有已知的胰腺外分泌疾病。记录了人口统计学参数、粪便稠度、粪便频率、常规实验室检查以及 DM 并发症的存在情况。FE-1 值<200μg/g 被用作 PEI 的筛查截止值，FE-1 值低于该水平的患者接受 C-MTG 呼气试验。
102 例患者返回粪便样本。FE-1 低值提示 PEI 的患病率为 13%。胰岛素使用、1 型 DM 和 DM 持续时间与 FE-1 低值相关。FE-1 低值对粪便习惯没有影响。13 例 FE-1 值低的患者中有 12 例进行了呼气试验，所有患者的呼气试验均正常。
FE-1 定义的 1 型和 2 型 DM 混合队列中 PEI 的患病率较低。此外，FE-1 和呼气试验之间存在差异。因此，FE-1 在评估 DM 中胰腺外分泌功能中的作用应在更大的研究中进行评估，以阐明 FE-1 低值与临床上相关的 PEI 之间的关联。
