Katschinski M, Schirra J, Bross A, Göke B, Arnold R
Department of Gastroenterology, Philipps-University, Marburg, Germany.
Pancreas. 1997 Aug;15(2):191-200. doi: 10.1097/00006676-199708000-00012.
Fecal elastase-1 is a candidate for a sensitive noninvasive test detecting chronic pancreatitis. This prospective study enrolled 10 healthy male controls and 23 patients referred for tube testing of pancreatic function. It was designed (a) to correlate duodenal outputs and fecal concentrations of elastase-1 with duodenal outputs of amylase, lipase, trypsin, and chymotrypsin in the fed state (duodenal perfusion of a mixed liquid meal at 2.5 kcal/min for 150 min), (b) to compare the diagnostic accuracy of fecal elastase-1 and fecal chymotrypsin, and (c) to characterize the cyclical pattern of postprandial pancreatic secretion in healthy subjects and patients with chronic pancreatitis. Based on their enzyme responses to duodenal meal perfusion and imaging procedures, 12 patients were classified as having normal pancreatic function and 11 patients as having chronic pancreatitis. Duodenal enzyme outputs of elastase-1 were markedly lowered in chronic pancreatitis (p < 0.0001) and correlated well with the outputs of the other four enzymes (r > 0.71, p < 0.00001). Fecal concentrations of elastase-1 were also clearly reduced in chronic pancreatitis (p < 0.0001). Fecal chymotrypsin was less strongly associated with duodenal enzyme outputs (r = 0.33 to r = 0.587), whereas fecal elastase-1 correlated more precisely with the duodenal outputs of all five enzymes (r = 0.637 to r = 0.830, p < 0.00001). Sensitivity and specificity in the detection of chronic pancreatitis amounted to 0.64 and 0.95 for fecal elastase-1 and 0.27 and 0.95 for fecal chymotrypsin, respectively. In the postprandial state, peaks of enzyme secretion occurred at a frequency of about 1 peak/150 min. The amplitude but not the frequency of secretory peaks was markedly reduced in chronic pancreatitis (p < 0.01). We conclude that fecal elastase-1 clearly exceeds the sensitivity of fecal chymotrypsin in the diagnosis of chronic pancreatitis but does not reliably detect all cases with mild to moderate disease. The pattern of postprandial pancreatic secretion is cyclical, even with minimal secretory outputs in chronic pancreatitis.
粪便弹性蛋白酶-1是一种用于检测慢性胰腺炎的敏感非侵入性检测指标。这项前瞻性研究纳入了10名健康男性对照者和23名因胰腺功能管检测而转诊的患者。该研究旨在：(a) 将进食状态下（以2.5千卡/分钟的速度十二指肠灌注混合液体餐150分钟）弹性蛋白酶-1的十二指肠输出量和粪便浓度与淀粉酶、脂肪酶、胰蛋白酶和糜蛋白酶的十二指肠输出量进行关联；(b) 比较粪便弹性蛋白酶-1和粪便糜蛋白酶的诊断准确性；(c) 描述健康受试者和慢性胰腺炎患者餐后胰腺分泌的周期性模式。根据他们对十二指肠餐灌注的酶反应和成像程序，12名患者被分类为胰腺功能正常，11名患者被分类为慢性胰腺炎。慢性胰腺炎患者弹性蛋白酶-1的十二指肠酶输出量显著降低（p < 0.0001），并且与其他四种酶的输出量相关性良好（r > 0.71，p < 0.00001）。慢性胰腺炎患者粪便中弹性蛋白酶-1的浓度也明显降低（p < 0.0001）。粪便糜蛋白酶与十二指肠酶输出量的相关性较弱（r = 0.33至r = 0.587），而粪便弹性蛋白酶-1与所有五种酶的十二指肠输出量相关性更精确（r = 0.637至r = 0.830，p < 0.00001）。粪便弹性蛋白酶-1检测慢性胰腺炎的敏感性和特异性分别为0.64和0.95，粪便糜蛋白酶的敏感性和特异性分别为0.27和0.95。在餐后状态下，酶分泌峰值出现的频率约为1个峰值/150分钟。慢性胰腺炎患者分泌峰值的幅度而非频率明显降低（p < 0.01）。我们得出结论，在慢性胰腺炎的诊断中，粪便弹性蛋白酶-1的敏感性明显超过粪便糜蛋白酶，但不能可靠地检测出所有轻至中度疾病的病例。即使在慢性胰腺炎患者中分泌输出量极少，餐后胰腺分泌模式也是周期性的。
