Nealon W H, Beauchamp R D, Townsend C M, Boyd G, Shabot M, Thompson J C
Ann Surg. 1986 Oct;204(4):430-7. doi: 10.1097/00000658-198610000-00011.
Thirty-three patients with chronic pancreatitis were studied in an effort to correlate release of gastrointestinal hormones (GIH) with the degree of pancreatic insufficiency. A prospective examination was conducted of fat-stimulated release of pancreatic polypeptide (PP), cholecystokinin (CCK), and neurotensin. Seventy-two-hour fecal fat determination, endoscopic retrograde pancreatography (ERP), and the bentiromide-PABA test were used to correlate the clinical stage of disease. The ERP was classified as positive only if the changes were advanced (or "marked") according to the Cambridge Classification. Five patients were defined to have mild disease, 13 moderate, and 15 severe. Any patient with clinical evidence of chronic pancreatitis and ERP changes that were less than advanced and had normal fecal fat and bentiromide tests received a grade of mild. Patients with one abnormal test were graded moderate, and those with two or three abnormal results were graded severe. In the 33 patients, the integrated 60-minute release of pancreatic polypeptide (PP) was 37.4 +/- 6.1 ng-60 min/ml in those five patients with mild disease, 102.3 +/- 10.3 ng-60 min/ml in the 13 patients with moderate disease, and 7.6 +/- 2.2 ng-60 min/ml in the 15 patients with severe disease. The integrated 60-minute release of neurotensin was 3.8 +/- 0.4 ng-60 min/ml in mild disease, 2.0 +/- 0.3 ng-60 min/ml in moderate disease, and 0.2 +/- 0.1 ng-60 min/ml in severe disease. CCK release did not correlate with the severity of disease. Enhanced release of PP appeared to correlate well with moderate stage of chronic pancreatitis, and depressed PP release with severe disease. Stimulated levels of PP and neurotensin appear to be useful in the diagnosis and staging of chronic pancreatitis. It is concluded that measurement of fat-stimulated release of PP and neurotensin may be useful to assess severity of disease in patients with chronic pancreatitis.
对33例慢性胰腺炎患者进行了研究，旨在将胃肠激素（GIH）的释放与胰腺功能不全的程度相关联。对脂肪刺激后胰多肽（PP）、胆囊收缩素（CCK）和神经降压素的释放进行了前瞻性检查。采用72小时粪便脂肪测定、内镜逆行胰胆管造影（ERP）和苯替酪胺-对氨基苯甲酸（PABA）试验来关联疾病的临床分期。仅当根据剑桥分类法变化为进展期（或“显著”）时，ERP才被分类为阳性。5例患者被定义为轻度疾病，13例为中度，15例为重度。任何有慢性胰腺炎临床证据且ERP变化未达进展期、粪便脂肪和苯替酪胺试验正常的患者被评为轻度。一项检查异常的患者被评为中度，两项或三项检查结果异常的患者被评为重度。在这33例患者中，5例轻度疾病患者的胰多肽（PP）60分钟综合释放量为37.4±6.1 ng-60 min/ml，13例中度疾病患者为102.3±10.3 ng-60 min/ml，15例重度疾病患者为7.6±2.2 ng-60 min/ml。轻度疾病患者神经降压素的60分钟综合释放量为3.8±0.4 ng-60 min/ml，中度疾病患者为2.0±0.3 ng-60 min/ml，重度疾病患者为0.2±0.1 ng-60 min/ml。CCK释放与疾病严重程度无关。PP释放增强似乎与慢性胰腺炎的中度阶段密切相关，而PP释放降低与重度疾病相关。PP和神经降压素的刺激水平似乎对慢性胰腺炎的诊断和分期有用。结论是，测量脂肪刺激后PP和神经降压素的释放可能有助于评估慢性胰腺炎患者的疾病严重程度。
