Early sequential changes in serum markers of acute pancreatitis induced by endoscopic retrograde cholangiopancreatography.

Abstract

BACKGROUND/AIMS:

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.

PATIENTS AND 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: Marko Lempinen, Ulf-Håkan Stenman, Jorma Halttunen, Pauli Puolakkainen, Reijo Haapiainen, Esko Kemppainen
• Journal: Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] (Pancreatology) Vol. 5 Issue 2-3 Pg. 157-64 ( 2005) ISSN: 1424-3903 [Print] Switzerland
• PMID: 15849486 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Biomarkers
• Carrier Proteins
• Intercellular Signaling Peptides and Proteins
• SPINK1 protein, human
• alpha 1-Antitrypsin
• trypsin-2-alpha1-antitrypsin
• PRSS2 protein, human
• Trypsin Inhibitor, Kazal Pancreatic
• Trypsinogen
• Trypsin

Topics

• Acute Disease
• Adult
• Aged
• Aged, 80 and over
• Biomarkers (blood)
• Carrier Proteins
• Cholangiopancreatography, Endoscopic Retrograde (adverse effects)
• Early Diagnosis
• Female
• Humans
• Intercellular Signaling Peptides and Proteins (blood)
• Male
• Middle Aged
• Pancreatitis (blood, diagnosis, etiology)
• Predictive Value of Tests
• Severity of Illness Index
• Trypsin (blood)
• Trypsin Inhibitor, Kazal Pancreatic
• Trypsinogen (blood)
• alpha 1-Antitrypsin (metabolism)