Glasbrenner B, Schön A, Klatt S, Beckh K, Adler G
Department of Internal Medicine I, University of Ulm, Germany.
Eur J Gastroenterol Hepatol. 1996 Nov;8(11):1117-20. doi: 10.1097/00042737-199611000-00016.
To test the diagnostic accuracy of faecal elastase (FE), a new test of exocrine pancreatic function, in a large prospective population of patients with abdominal complaints.
Between January 1994 and December 1995, 131 patients (age range 17-82 years) were submitted for exocrine pancreatic function testing. Sixty-three patients had a firm diagnosis of chronic pancreatitis (CP) at stage I-III according to endoscopic retrograde cholangiopancreatography (ERCP). Twenty patients suffered from other pancreatic diseases (PD), and 48 patients had various other gastrointestinal diseases (GD). Fifty-seven healthy controls (HC) were also investigated. Stool specimens were analysed for FE by enzyme-linked immunosorbent assay (ELISA) and for faecal chymotrypsin (FC). The pancreolauryl serum test (PLT) was also performed in 97 patients and 23 healthy controls.
FE was 200; 45-500 micrograms/g (median; range) in CP-I (n = 19), 94; 0-400 micrograms/g in CP-II (n = 14) and 38; 0-135 micrograms/g in CP-III patients (n = 30). With a cutoff of 200 micrograms/g, abnormal test results were found in 47% of CP-I, 79% of CP-II and 100% of CP-III patients; in 30% of PD patients, in 38% of GD patients and in 7% of HC. Sensitivity of abnormal FE in diagnosing CP was 79% (FC: 48%; PLT: 71%). The specificity of only 62% (FC: 73%; PLT: 67%) in the GD group increased to 78% (FC: 81%; PLT: 77%) when patients with small bowel diseases and diarrhoea (n = 22) were excluded.
Faecal elastase is more sensitive than chymotrypsin and comparable to the pancreolauryl test in the diagnosis of chronic pancreatitis. Indirect exocrine pancreatic function tests are not helpful to differentiate between pancreatic and small bowel diseases in a prospective population of patients with abdominal complaints.
在一大群有腹部不适症状的前瞻性研究患者中，测试粪便弹性蛋白酶（FE）这一外分泌胰腺功能新检测方法的诊断准确性。
1994年1月至1995年12月期间，131例患者（年龄范围17 - 82岁）接受了外分泌胰腺功能检测。根据内镜逆行胰胆管造影（ERCP），63例患者被确诊为I - III期慢性胰腺炎（CP）。20例患者患有其他胰腺疾病（PD），48例患者患有各种其他胃肠道疾病（GD）。还对57名健康对照者（HC）进行了研究。通过酶联免疫吸附测定（ELISA）分析粪便标本中的FE以及粪便糜蛋白酶（FC）。97例患者和23名健康对照者还进行了胰月桂基血清试验（PLT）。
CP - I期（n = 19）患者的FE为200；45 - 500微克/克（中位数；范围），CP - II期（n = 14）患者为94；0 - 400微克/克，CP - III期患者（n = 30）为38；0 - 135微克/克。以200微克/克为临界值，47%的CP - I期、79%的CP - II期和100%的CP - III期患者检测结果异常；30%的PD患者、38%的GD患者和7%的HC检测结果异常。FE异常在诊断CP时的敏感性为79%（FC：48%；PLT：71%）。GD组中仅62%（FC：73%；PLT：67%）的特异性在排除小肠疾病和腹泻患者（n = 22）后升至78%（FC：81%；PLT：77%）。
在慢性胰腺炎的诊断中，粪便弹性蛋白酶比糜蛋白酶更敏感，与胰月桂基试验相当。在前瞻性研究的有腹部不适症状的患者群体中，间接外分泌胰腺功能检测无助于区分胰腺疾病和小肠疾病。
