Diéguez-Castillo Carmelo, Jiménez-Luna Cristina, Martín-Ruiz Jose Luis, Martínez-Galán Joaquina, Prados José, Torres Carolina, González-Ramírez Amanda Rocío, Caba Octavio
Department of Gastroenterology, San Cecilio University Hospital, 18012 Granada, Spain.
Institute of Biopathology and Regenerative Medicine (IBIMER), University of Granada, 18100 Granada, Spain.
J Clin Med. 2020 Jun 26;9(6):2014. doi: 10.3390/jcm9062014.
Exocrine pancreatic insufficiency results from the destruction of the pancreatic parenchyma and is diagnosed by using direct or indirect tests, both of which have shortcomings. Chronic pancreatitis is the most frequent cause of this pathology in adults.
Patients meeting radiological or histological diagnostic criteria of chronic pancreatitis are enrolled and the stool elastase test is conducted, considering fecal elastase levels >200 µg/g to represent normal pancreatic function, and levels <200 μg/g to indicate the presence of exocrine pancreatic insufficiency. Additionally, we determine the body mass index of the patients and study their nutritional status and main biochemical and hematological variables, including their glucose and hemoglobin A1c (HbA1c) levels.
Exocrine pancreatic insufficiency is detected in 60% of the patients. Among these, 83.3% are severe cases, and 72% of the latter also are diagnosed with endocrine pancreatic insufficiency (diabetes mellitus). During the nutritional status study, HbA1c levels are significantly higher, and magnesium and prealbumin levels are significantly lower in patients with exocrine pancreatic insufficiency than in those without this disease.
Exocrine and endocrine pancreatic insufficiency are highly prevalent among patients with chronic pancreatitis and an early diagnosis of these diseases is vital to improve the clinical management of these patients and reduce their risk of mortality.
外分泌性胰腺功能不全由胰腺实质破坏引起，通过直接或间接检测进行诊断，这两种检测方法均存在缺陷。慢性胰腺炎是成人中这种病理状态最常见的病因。
纳入符合慢性胰腺炎放射学或组织学诊断标准的患者，并进行粪便弹性蛋白酶检测，将粪便弹性蛋白酶水平>200μg/g视为胰腺功能正常，<200μg/g则表明存在外分泌性胰腺功能不全。此外，我们测定患者的体重指数，研究其营养状况以及主要的生化和血液学指标，包括血糖和糖化血红蛋白（HbA1c）水平。
60%的患者检测出存在外分泌性胰腺功能不全。其中，83.3%为重症病例，后者中有72%还被诊断为内分泌性胰腺功能不全（糖尿病）。在营养状况研究中，外分泌性胰腺功能不全患者的HbA1c水平显著更高，而镁和前白蛋白水平显著低于无此疾病的患者。
外分泌性和内分泌性胰腺功能不全在慢性胰腺炎患者中高度普遍，对这些疾病的早期诊断对于改善这些患者的临床管理及降低其死亡风险至关重要。
