[The role of selected enzymes and acute phase proteins in necrotizing pancreatitis].
OBJECTIVE
Despite potent clinical manifestation of acute necrotizing pancreatitis symptoms, its severity estimation and prognosis based on laboratory tests proves to be difficult. In general, the key role in disease diagnostics is attributed to enzymes secreted by this organ. However, this opinion doesn't find confirmation in all cases.


METHODS
A-amylase, C-reactive protein, and lipoprotein (a) serum concentration changes were evaluated in 60 patients treated in our department because of necrotizing pancreatitis. Observation period was 30 days and the severity of disease was taken into account. All patients were divided onto 2 groups. Group 1 contained 42 individuals who survived the 30 day observation period. Group 2 consisted of 18 patients with poor prognoses, who died. All patients were operated on between 15th and 30th day of treatment. Overall condition was monitored by means of Ranson and APACHE II scores.


RESULTS
The decrease in alpha-amylase activity was noted in both groups; however the differences between groups lost its significance from the 5th day on. Initially, the pancreatic lipase activity was increased in both groups, but the differences showed no significance. In subsequent days of study those differences became statistically significant. On the contrary, differences between subsequent measurements appeared as late as in the fourth time point. C-reactive protein serum concentrations were significantly higher in poorly prognosing patients. In group 1 patients these concentrations underwent a gradual normalization. In Group 2 lipoprotein (a) serum concentration increased reaching 100 mg/dL at the end of observation.


CONCLUSIONS
The study shows lack of feasibility of alpha-amylase serum concentration assessment as a method of pancreatic necrosis extent determination in patients with necrotizing pancreatitis. High level of lipase proves the existence of inflammatory reaction, but unspecific one regarding acute pancreatitis. Although CRP levels change non-specifically during acute pancreatitis, they are extremely high at the early stage of pancreas necrosis. Serum level of Lp (a) increases in necrotizing pancreatitis along with overall patient standing deterioration. Low levels of mentioned parameters do not exclude the diagnosis of most severe form of acute pancreatitis.
Modzelewski
Bogdan
B
Klinika Chirurgii Ogólnej i Gastroenterologicznej Uniwersytetu Medycznego, Lodzi. Bogdanm@ventura.pl
Hołyński
Jarosław
J
D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism*; D005260:Female; D006801:Humans; D017270:Lipoprotein(a) / Q000097:blood*; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000097:blood* / Q000201:enzymology / Q000601:surgery; D011237:Predictive Value of Tests; D011379:Prognosis; D012720:Severity of Illness Index; D013997:Time Factors; D000516:alpha-Amylases / Q000097:blood*
D017270:Lipoprotein(a); D002097:C-Reactive Protein; D000516:alpha-Amylases