Sidhu S S, Shah P, Prasanna B M, Srikanta S S, Tandon R K
Department of Gastroenterology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi.
Diabetes Res Clin Pract. 1995 Feb;27(2):127-32. doi: 10.1016/0168-8227(94)01021-q.
The exocrine and endocrine pathophysiology of chronic calcific pancreatitis of the tropics (CCPT) remains elusive. The objective of this study was to evaluate the spectrum and correlates of the exocrine and endocrine pancreatic dysfunction in CCPT. Thirty-seven consecutive patients with a clinico-radiological diagnosis of CCPT were stratified into three subgroups: CCPT-normal glucose tolerance (NGT), CCPT-abnormal glucose tolerance (IGT) and CCPT-diabetes mellitus (DM). Ten ketosis resistant young diabetic (KRDY) patients, 10 classical insulin dependent diabetes mellitus (IDDM) patients and 18 healthy matched controls were included for comparison. Fecal chymotrypsin (FCT) levels and blood C-peptide levels (basal and post i.v. glucagon stimulation) were estimated for assessing the exocrine and endocrine pancreatic functions, respectively. Sonography was performed to evaluate the pancreatic size and ductal diameter. Pancreatic exocrine-endocrine correlation was examined by studying the C-peptide/fecal chymotrypsin ratio (CP/FCT) (CP/FCT of normal controls = 1). Mean FCT levels in all 3 subgroups of CCPT (NGT: 3.4 micrograms/g; IGT: 0.82 microgram/g; DM: 2.4 micrograms/g) were very low (87-96% reduction in exocrine pancreatic dysfunction; mean FCT in healthy controls was 22.8 micrograms/g) (P < 0.0001). In contrast, KRDY and IDDM patients displayed 50-54% reduction in pancreatic acinar function (P < 0.001). Basal and stimulated C-peptide levels progressively fell in the 3 CCPT subsets (NGT: 0.23 and 0.46 > IGT: 0.14 and 0.29 > DM 0.10 and 0.14) (P < 0.01). CCPT patients exhibited pancreatic atrophy and ductal dilation (> 3 mm).(ABSTRACT TRUNCATED AT 250 WORDS)
热带地区慢性钙化性胰腺炎（CCPT）的外分泌和内分泌病理生理学仍不清楚。本研究的目的是评估CCPT中外分泌和内分泌胰腺功能障碍的范围及相关因素。37例临床放射学诊断为CCPT的连续患者被分为三个亚组：CCPT-正常糖耐量（NGT）、CCPT-糖耐量异常（IGT）和CCPT-糖尿病（DM）。纳入10例抗酮症年轻糖尿病（KRDY）患者、10例经典胰岛素依赖型糖尿病（IDDM）患者和18例健康匹配对照进行比较。分别测定粪糜蛋白酶（FCT）水平和血C肽水平（基础及静脉注射胰高血糖素刺激后）以评估胰腺外分泌和内分泌功能。进行超声检查以评估胰腺大小和导管直径。通过研究C肽/粪糜蛋白酶比值（CP/FCT）（正常对照的CP/FCT = 1）来检查胰腺外分泌-内分泌相关性。CCPT的所有3个亚组中的平均FCT水平（NGT：3.4微克/克；IGT：0.82微克/克；DM：2.4微克/克）非常低（外分泌胰腺功能障碍降低87-96%；健康对照的平均FCT为22.8微克/克）（P < 0.0001）。相比之下，KRDY和IDDM患者的胰腺腺泡功能降低50-54%（P < 0.001）。3个CCPT亚组中基础和刺激后的C肽水平逐渐下降（NGT：0.23和0.46 > IGT：0.14和0.29 > DM 0.10和0.14）（P < 0.01）。CCPT患者表现出胰腺萎缩和导管扩张（> 3毫米）。（摘要截断于250字）
