췌장 질환에서 혈청 및 대변 pancreatic elastase-1 측정의 임상적 의의

초록

Backgrounds: The aims of this study were to evaluate the diagnostic value of pancreatic elastase-1 (PE-1) in patients with pancreatic diseases and to compare the significance of PE-1 with that of the pancreatic exocrine function test by pure pancreatic juice (PPJ) collection. Methods: For evaluation of PE-1, seventy-nine patients with pancreatic diseases were examined. For evaluation of exocrine pancreatic function by PPJ, twenty-three patients with chronic pancreatitis (CP) were examined. PPJ was collected by endoscopic cannulation of the main pancreatic duct under intravenous bolus injection of secretin (0.25 CU/kg body weight) and cholecystokinin (CCK, 40 ng/kg body weight). Results: Pancreatic exocrine functions were significantly decreased in patients with CP showing moderate and severe ductal changes on pancreatogram. The mean concentration of fecal PE-1 was significantly decreased in patients with CP and pancreatic cancer, but not in patients with acute pancreatitis. When we analyzed the PE-1 concentration according to the Cambridge classification, the concentration of fecal PE-1 was significantly decreased only in patients with moderate and severe CP. With a cut-off of 200 µg fecal PE-1/g, the sensitivity of PE-1 was 25%, 60%, and 100%, respectively, for mild, moderate, and severe CP, and the specificity was 88.1%. The mean concentration of serum PE-1 was increased both in patients with acute and chronic pancreatitis, but there was no significant difference between the two groups. Conclusion: Fecal PE-1 is useful for the diagnosis of pancreatic exocrine insufficiency in patients with CP, especially in moderate and severe grades of pancreatic exocrine insufficiency. The diagnostic value of fecal PE-1 was also similar to the secretin-CCK test in evaluating pancreatic exocrine insufficiency.

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