Testoni P A, Cicardi M, Bergamaschini L, Guzzoni S, Cugno M, Buizza M, Bagnolo F, Agostoni A
Institute of Internal Medicine, University of Milan, Italy.
Gastrointest Endosc. 1995 Oct;42(4):301-5. doi: 10.1016/s0016-5107(95)70126-5.
Hyperamylasemia after endoscopic sphincterotomy is a common event, occurring in about 70% of cases. Clinical acute pancreatitis may also develop in 1% to 6% of cases. Previous attempts to prevent this reaction with inhibitors of exocrine pancreatic secretion (somatostatin and octreotide) provided conflicting and often disappointing results. Kallikrein is one of the proteases that sustain the inflammatory process in acute pancreatitis; the C1 inhibitor is the only physiologic inhibitor of the first component of the human complement cascade and is a major inactivator of kallikrein and Factor XII. Therefore, we tested the C1 inhibitor in the prevention of hyperamylasemia in 40 consecutive patients undergoing endoscopic sphincterotomy for common bile duct stones or benign papillary stenosis. They were given either C1 inhibitor (20 cases) or placebo (20 cases) before the procedure. Serum amylase levels were determined at baseline and 2, 4, 8, and 24 hours thereafter. Significant differences in serum amylase levels between groups were observed at 2 hours (p < .01), 4 hours (p < .0005), and 8 hours (p < .005) after sphincterotomy. The differences in amylase levels were also significant among the 24 subjects with pancreatic ductal filling (2 hours, p < .05; 4 hours, p < .005; 8 hours, p < .01) and the 9 patients with previous episodes of acute pancreatitis (4 hours, p < .05; 8 hours, p < .05; 24 hours, p < .05). The infusion of C1-inhibitor plasma concentrate resulted in a 50% increase in functional levels of C1 inhibitor (in the 8 cases for whom they were assayed), which persisted throughout the observation period.
内镜括约肌切开术后高淀粉酶血症是常见情况，约70%的病例会出现。临床急性胰腺炎也可能在1%至6%的病例中发生。以往尝试用胰腺外分泌抑制剂（生长抑素和奥曲肽）预防这种反应，结果相互矛盾且常常令人失望。激肽释放酶是在急性胰腺炎中维持炎症过程的蛋白酶之一；C1抑制剂是人类补体级联反应第一成分的唯一生理性抑制剂，是激肽释放酶和因子XII的主要灭活剂。因此，我们对40例因胆总管结石或良性乳头狭窄接受内镜括约肌切开术的连续患者进行了C1抑制剂预防高淀粉酶血症的试验。术前给他们分别使用C1抑制剂（20例）或安慰剂（20例）。在基线以及此后2、4、8和24小时测定血清淀粉酶水平。括约肌切开术后2小时（p < 0.01）、4小时（p < 0.0005）和8小时（p < 0.005）观察到两组血清淀粉酶水平存在显著差异。在24例有胰管充盈的患者中（2小时，p < 0.05；4小时，p < 0.005；8小时，p < 0.01）以及9例既往有急性胰腺炎发作的患者中（4小时，p < 0.05；8小时，p < 0.05；24小时，p < 0.05），淀粉酶水平差异也很显著。输注C1抑制剂血浆浓缩物使C1抑制剂功能水平提高了50%（在8例进行检测的病例中），且在整个观察期内持续存在。
