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Protease activation, pancreatic leakage, and inflammation in acute pancreatitis: differences between mild and severe cases and changes over the first three days.

AbstractBACKGROUND/AIMS:
The pathophysiology of acute pancreatitis (AP) may be studied using markers of protease activation (active carboxypeptidase B (aCAP), the activation peptide of carboxypeptidase B (CAPAP)), leakage of pancreatic enzymes (trypsinogen-2, procarboxypeptidase B (proCAP), amylase), and inflammation (monocyte chemoattractant protein-1 (MCP-1), CRP).
METHODS:
This prospective study included 140 cases of AP. Mild (n = 124) and severe (n = 16) cases were compared with respect to serum levels of trypsinogen-2, proCAP, amylase, aCAP, CAPAP (serum/urine), MCP-1 (serum/urine) and CRP on days 1, 2 and 3 from onset of symptoms. All patients with information on all 3 days were included in a time-course analysis (n = 44-55, except amylase: n = 27).
RESULTS:
High levels in severe versus mild cases were seen for trypsinogen-2, CAPAP in serum and urine, and MCP-1 in serum on days 1-3. No differences were seen for proCAP, amylase and aCAP. MCP-1 in urine was significantly elevated on day 1-2, and CRP on day 2-3. CAPAP and MCP-1 levels peaked early and stayed elevated for 48 h in serum.
CONCLUSION:
Protease activation and inflammation are early events in AP, with high levels of these markers within 24 h. Protease activation declines after 48 h, whereas inflammation is present for a longer time.
AuthorsS Regnér, J Manjer, S Appelros, C Hjalmarsson, J Sadic, A Borgström
JournalPancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] (Pancreatology) Vol. 8 Issue 6 Pg. 600-7 ( 2008) ISSN: 1424-3911 [Electronic] Switzerland
PMID18849642 (Publication Type: Journal Article)
CopyrightCopyright 2008 S. Karger AG, Basel and IAP.
Chemical References
  • CCL2 protein, human
  • Chemokine CCL2
  • PRSS2 protein, human
  • Trypsinogen
  • C-Reactive Protein
  • Amylases
  • Peptide Hydrolases
  • Carboxypeptidase B
  • Trypsin
Topics
  • Adult
  • Aged
  • Aged, 80 and over
  • Amylases (blood)
  • C-Reactive Protein (metabolism)
  • Carboxypeptidase B (blood)
  • Chemokine CCL2 (blood, urine)
  • Enzyme Activation
  • Female
  • Humans
  • Inflammation
  • Male
  • Middle Aged
  • Pancreatitis (classification, enzymology, physiopathology)
  • Peptide Hydrolases (blood)
  • Trypsin (blood)
  • Trypsinogen (blood)

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