title: Early sequential changes in serum markers of acute pancreatitis induced by endoscopic retrograde cholangiopancreatography.
abstract: OBJECTIVE
  Trypsinogen activation is thought to play a crucial role in the pathogenesis of acute pancreatitis (AP). Our aim was to characterize the very early sequential changes of trypsinogen-1, trypsinogen-2, the trypsin-2-alpha1-antitrypsin complex (T2-AAT), and pancreatic secretory trypsin inhibitor (PSTI) in serum from patients with pancreatitis induced by endoscopic retrograde cholangiopancreatography (ERCP), a model for studying the early phase of the disease in humans.
  
  
  METHODS
  The study population consisted of 659 consecutive patients with 897 ERCP procedures. Blood samples were obtained before and at different time points after the procedure. The serum concentrations of trypsinogen-1 and trypsinogen-2, PSTI and T2-AAT were determined by time-resolved immunofluorometric assays.
  
  
  RESULTS
  ERCP-induced pancreatitis developed after 50 of the 897 ERCP procedures (5.6%). Sixty-one randomly selected ERCP patients without post-ERCP pancreatitis served as controls. Trypsinogen-1 and trypsinogen-2 showed an equally steep increase during the two first hours after ERCP in patients developing AP, but trypsinogen-1 decreased more rapidly than trypsinogen-2, which remained elevated during the 5-day study period. Serum PSTI also increased rapidly whereas T2-AAT increased more slowly peaking at 24 h. In patients developing post-ERCP pancreatitis the median concentration of trypsinogen-1 was markedly higher than in the controls already before the ERCP procedure. In the control group the concentrations of trypsinogen-1, trypsinogen-2, PSTI and T2-AAT did not change significantly.
  
  
  CONCLUSIONS
  The rapid increase of trypsinogen-1 and trypsinogen-2 and PSTI in the early phase of AP suggests that release of pancreatic enzymes is the initial event while the delayed increase of T2-AAT may reflect that the capacity of the intrapancreatic PSTI-based inhibitory mechanism has been exhausted.
authors.affiliation: Second Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Marko
authors.initials: M
authors.lastname: Lempinen
authors.forename: Ulf-Håkan
authors.initials: UH
authors.lastname: Stenman
authors.forename: Jorma
authors.initials: J
authors.lastname: Halttunen
authors.forename: Pauli
authors.initials: P
authors.lastname: Puolakkainen
authors.forename: Reijo
authors.initials: R
authors.lastname: Haapiainen
authors.forename: Esko
authors.initials: E
authors.lastname: Kemppainen
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002352:Carrier Proteins; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D036341:Intercellular Signaling Peptides and Proteins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000097:blood / Q000175:diagnosis / Q000209:etiology; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D014357:Trypsin / Q000097:blood; D014359:Trypsin Inhibitor, Kazal Pancreatic; D014362:Trypsinogen / Q000097:blood*; D000515:alpha 1-Antitrypsin / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D002352:Carrier Proteins; D036341:Intercellular Signaling Peptides and Proteins; C486642:SPINK1 protein, human; D000515:alpha 1-Antitrypsin; C425339:trypsin-2-alpha1-antitrypsin; C064831:PRSS2 protein, human; D014359:Trypsin Inhibitor, Kazal Pancreatic; D014362:Trypsinogen; D014357:Trypsin