Serum pankreatik elastaz-1, acil servislerde akut pankreatit tanısı için güvenilir bir yöntem olabilir mi?

Öz

Giriş ve amaç: Acil servise karın ağrısı ile başvuran hastaların bir kısmında, rutin radyolojik ve laboratuvar testleri ile akut pankreatit teşhis edilememektedir. Bu çalışmada, akut pankreatit tanısında serum elastazın duyarlılığı araştırılmıştır. Gereç ve yöntem: Acil servise karın ağrısı ile başvuran, tanı almadan önce karın ağrısı kendiliğinden iyileşen, aynı zamanda radyolojik ve laboratuvar bulguları normal olan 80 hastanın serum elastaz düzeyine bakılmıştır. Bulgular: Laboratuvar sonuçları ve USG bulguları normal olan 2 olguda, elastaz düzeyi yüksek bulunmuştur. Bu olgular daha sonra pankreatit bulguları göstermiş ve hastaneye yatırılmıştır. Sonuç: Serum pankreatik elastaz, acil serviste akut pankreatit tanısında diğer laboratuvar testlerinden daha özgül ve duyarlı olabilir.

Anahtar Kelimeler

• Karın ağrısı, akut pankreatit, serum pankreatik elastaz

Can serum pancreatic elastase-1 be safe method for acute pancreatitis in emergency department?

Öz

Background/aim: Some patients admitted to the Emergency Department (ED) for abdominal pain secondary to acute pancreatitis cannot be diagnosed with routine radiologic and laboratory tests. We investigated the sensitivity of serum elastase in diagnosing acute pancreatitis. Materials and methods: We investigated serum elastase levels in 80 patients that were admitted to the ED with abdominal pain that resolved spontaneously before a diagnosis could be made and who also had normal radiological and laboratory findings. Results: Two cases had elevated elastase levels with normal USG and laboratory results. These cases later showed signs of pancreatitis and were hospitalized. Conclusion: Serum pancreatic elastase can be more sensitive and specific than the other laboratory tests for acute pancreatitis in the ED.

Anahtar Kelimeler

• Abdominal pain, acute pancreatitis, serum pancreatic elastase

Kaynakça

1. Kylanpaa-Back M.L, Kemppainen E, Puolakkainen P ve ark. Reli- able screening for acute pancreatitis with rapid urine trypsinogen – 2 test strip. Br J Surg 2000; 87: 49-52.
2. Clavien P.A, Burgan S, Mooassa A.R. Serum enzymes and the other laboratory tests in acute pancreatitis.Br J Surg 1989; 76: 1234-43.
3. Vissers R.J, Abu-Laban R.B, McHugh D.F. Amylase and lipase in the emergency department evaluation of acute pancreatitis. J Em Med 1999; 17 : 1027-37.
4. Lott J.A. The value of clinical laboratory studies in acute pancreati- tis. Arch Pathol Lab Med 1991; 115: 325-6.
5. Apple F.S, Preese L.M. Dose increased lipase activity in serum imply damage to the pancreas? Clin Chem 1992; 38: 602-3.
6. Wong E.C.C, Butch A.W, Rosenblum J.L, et al. The clinical che- mistry laboratory and acute pancreatitis. Clin Chem 1993; 39: 234- 43.
7. Lott J, Speicher J, Nemesanszky E. Is serum amylase an absolute test in the diagnosis of acute pancreatitis? Arch Pathol Lab Med 1985; 109: 314-5.
8. Skude G. On human amylase isoenzymes. Scand J Gastroenterol 1977; 12: 1-37.

9. Clink D, Weaver D, Bowman D, et al. Clinical application of organ specific isoamylases. Am Surg 1982; 48: 422-5.
10. Ammann R.W, Berk JE, Fridhandler LS, et al. Hyperamylasemia with carcinoma of the lung. Ann Intern Med 1973; 78: 521-5.
11. Skude G, Mardh P.A, Westrom L. Amylase of the genital tract I. Iso- amylases of genital tract tissue homogenates and peritoneal fluid . Am J Obstet Gynecol 1976; 126: 652-6.
12. Sudo K, Kanno T. Properties of the amylase produced in carcinoma of the lung. Clin Chem Acta 1976; 73: 1-12.
13. Westrom L, Skude G, Mardh P.A. Amylases of the genital tract II.Peritoneal fluid isoamylase in acute salpingitis. Am J Obstet Gynecol 1976; 126: 657-60.
14. Belafiore F, Vecchio L.L, Napoli E. Serum enzymes in diabetes mel- litus.Clin Chem 1973; 19: 447-52.
15. Berk J.E, Shimamura J, Fridhandler L. Tumor – associated hype- ramylasemia. Am J Gastroenterol 1977; 68: 572-7.
16. Fung W.P, Murray R.N, Masarei J.R.L, ve ark. P3 amylase isoenzy- me with cholelithiasis . Am J Gastroenterol 1981; 76: 52-5.
17. Young M. Acute diseases of the pancreas and biliary tract . Emerg Med Clin North Am 1989; 7: 555-73.
18. Pace B.W, Bank S, Wise L, et al. Amylase isoenzymes in the acute abdomen: an adjunt in those patients with elevated total amylase. Am J Gastroenterol 1985; 80: 898-901.
19. Pieper –Bigelow C , Strocchi A, Levitt M. Where does serum amy- lase come from and where does it go? Gastroenterol Clin North Am 1990; 19: 793-810.
20. Steinburg W, Tenner S. Acute pancreatitis. N Engl J Med 1994; 330: 1198-210.
21. Lankisch P, Schirren C, Kunze E. Undetected acute fatal pancreati- tis: why is the disease so frequently overlooked? Am J Gastroente- rol 1991; 86: 322-6.
22. Clavien PA, Robert J, Meyer P, et al. Acute pancreatitis and normo- amylasemia. Ann Surg 1989; 210: 614-20.
23. Spechler S, Dalton JW, Robbins AH, et al. Prevalance of normal se- rum amylase levels in patients with acute alcoholic pancreatitis. Dig Dis Sci 1983; 28: 865-9.
24. Clavien PA, Robert J, Meyer P, et al. Acute pancreatitis and normo- amylasemia. Ann Surg 1989; 210: 614-20.
25. Powers E, Guertler A.. Abdominal pain in the ED: stability and change over 20 years. Am J Emerg Med 1995; 13: 301-303.
26. Tietz N, Shuey D. Lipase in serum – the elusive enzyme: an overvi- ew. Clin Chem 1993; 39: 746-56.
27. Steinburg W.S, Goldstein S.S, Davis N, et al. Diagnostic assays in acute pancreatitis. A study of sensitivity and specificity. Ann Intern Med 1985; 102: 576-80.
28. Tietz N, Huang W, Rauh D, et al. Laboratory tests in the differenti- al diagnosis of hyperamylasemia. Clin Chem 1986; 32: 301-7.
29. Lott J.A , Patel S.T, Sawhney A.K, et al. Assays of serum lipase: analytical and clinical considerations. Clin Chem 1986; 32: 1290- 302.
30. Kollars J, Ellis C, Levitt M. Comparison of serum amylase , panc- reatic isoamylase, and lipase in patients with hyperamylasemia. Dig Dis Sci 1984; 29: 289-93.
31. Hedstrom J, Sainio V, Kemppainen E, et al. Serum complex of trypsin 2 and alpha 1 antitrypsin as diagnostic and prognostic mar- ker of acute pancreatitis: clinical study in consecutive patients . BMJ 1996; 313: 333-7.
32. Hedstrom J, Korvuo A, Kenkimaki P, et al. Urinary trypsinogen-2 test strip for acute pancreatitis. Lancet 1995; 347: 729-31.
33. Hedstrom J, Haglund C, Haapiainen R, et al. Serum trypsinogen-2 and trypsin-2-alpha(1)-antitrypsin complex in malignant and be- nign digestive tract diseases. Preferential elevation in patients with cholangiocarcinomas. Int J Cancer 1996; 66: 326-31.
34. Kivisaari L, Somer K, Standertskjöld – Nordenstam C.G et al. Early detection of acute fulminant pancreatitis by contrast enhanced com- puted tomography. Scand J Gastroenterol 1983; 18: 39-41.
35. London N.J, Neoptolemos J.P, Lavelle J, et al. Contrast – enhanced abdominal computed tomography scanning and prediction of seve- rity of acute pancreatitis: a prospective study. Br J Surg 1989; 76: 268-72.
36. Kay A, Imrie C, O’Neill J, Duncan J. Is an early ultrasound scan of value in acute pancreatitis ? Br J Surg 1982; 69: 369-72.
37. Balthazar E. CT diagnosis and staging of acute pancreatitis. Radiol Clin North Am 1989; 27: 19-37.
38. Agarwal N, Pitchumoni C.S, Sivaprasad A.V. Evaluating tests for acute pancreatitis . Am J Gastroenterol 1990; 85: 356-66.
39. Malfertheiner P, Buchler M, Stanescu, A ve ark. Serum elastase 1 in inflamatory pancreatic and gastrointestinal diseases and in renal insufficiency. A comparison with other pancreatic enzymes. Int J Pancreatol 1987; 2: 159-70.
40. Katsanos KH, Tzambouras N, Baltayiannis G, ve ark. The true va- lue of serum elastase-1 in endoscopic retrograde cholangiopancre- atography (ERCP) Eur J Intern Med. 2002 Aug; 13(5): 329-35
41. Wereszczynska-Siemiatkowska U, Jedynak M, Mroczko B, ve ark. Diagnostic value of pancreatic elastase-1 in human acute pancreati- tis. Arch ImmunolTher Exp (Warsz). 2003; 51(3): 195-200.
42. Buchler M, Malfertheiner P, Uhl W, ve ark. Diagnostic and prog- nostic value of serum elastase 1 in acute pancreatitis . Klin Woc- henschr 1986; 64: 1186-91.
43. Scholmerich J, Heinisch A, Leser H.G. Diagnostic approach to acu- te pancreatitis: diagnosis, assesment of etiology and prognosis. He- pato-Gastroenterology 1993; 40: 531-7.
44. Seno T, Harada H, Ochi K, ve ark. Serum levels of six pancreatic enzymes as related to the degree of renal dysfunction. Am J Gastro- enterol 1995; 90(11): 2002-5.
45. Elastase 1 serum test ELISA . Information and product monograph. ScheBo Tech , Bahnhofstresse 6, D-35435 Wettenberg, Germany.
46. Hoffman J.R, Jaber A.J, Schriger D.L. Serum amylase determinati- on in the emergency department evaluation of abdominal pain. J Clin Gastroenterol 1991; 13(4): 401-6.