Şebnem GÖK, Gül Sevim SAYDAM, Cengiz AYDIN, Nuray YAZIHAN, Oğuz ÜSKÜDAR, Dilek OĞUZ

Kronik pankreatit tanısında fekal elastazın klinik önemi

Kronik pankreatit tanısında fekal elastazın klinik önemi Kronik pankreatitte pankreas ekzokrin fonksiyonlarının değerlendirilmesi hastalığın tanı ve tedavisinde önemlidir. Günümüzde araştırmacılar kronik pankreatit tanısı için invaziv olmayan, tanısal doğruluğu yüksek, rutin çalışmaya uygun yeni testler araştırmaya yönelmiştir. Fekal pank-reatik elastaz-1 (FE-1) pankreatik ekzokrin fonksiyonla-rın değerlendirilmesinde kullanılabilecek noninvaziv bir yöntem olarak orta ve ciddi pankreatik ekzokrin fonksi-yonlarının tanısına imkan vermektedir. Bu çalışmada amacımız, gastroenteroloji kliniğinde ultrasonografi, bilgi-sayarlı tomografi, endoskopik retrograd kolonjiyo pankreotografi ile kronik pankreatit tanısı almış hastalar-da non-invaziv pankreas ekzokrin fonksiyonunun göster-gesi olarak FE-1 düzeyinin klinik önemini belirlemek, mikro ELISA yöntemi ile belirlenen FE-1 değerleri için en uygun cut-off değerini tespit etmek, yöntemin sensitivite ve spesifitesini belirlemek, tedavi amaçlı enzim preperatı kullanan kronik pankreatitli hastalarda FE-1 testinin tanısal doğruluğunu göstermek, kronik pankreatitli hastalarda FE-1 düzeyleri ile serum lipaz düzeyleri arasındaki korelasyonu araştırmaktır. Çalışmamızı kronik pankreatit tanısı alan 26 hasta ile 17 sağlıklı kişi oluşturdu. Kronik pankreatit tanısı almış hastalarda sağlıklı kontrol grubuna göre fekal elastaz-1 düzeyleri düşük bulundu (p

Anahtar Kelimeler:

Enzim bağlı immünosorbent tayini, Pankreatit, Kronik hastalık, Pankreas, egzokrin, Tomografi, x-ışınlı bilgisayarlı, Pankreatik elastaz, Tanı, Kolanjiyopankreatografi, endoskopik retrograd

Importance of the fecal elastase in chronic pancreatitis diagnosis

Evaluation of exocrine functions of pancreas during chronic pancreatitis is important for diagnosis and treatment of disease. Nowadays; researchers tend to look for new tests which are noninvasive, avaiable for routine usage and have high diagnostic value. Fecal pancreatic elastase 1 (FE-1) has been advocated as a noninvasive marker of pancreatic exocrine function and allows detection of moderate and severe exocrine insufficiency. After these findings; a new ELISA test with elastase specific antibodies is found available to measure human specific elastase-1 concentration in stool. In this study we aimed to find out clinical importance of fecal elastase-1 (FE-1) level as a noninvasive indicator of pancreatic exocrine function in patients with chronic pancreatitis who were diagnosed according to findings in ultrasonography, computed tomography, endoscopic retrograde cholangiopancreatography in gastroenterology clinic. The sensitivity, specificity and cut off value of micro ELISA FE-1 assay method were evaluated. Diagnostic accuracy of FE-1 assay in chronic pancreatitis patients who use enzyme preparates and its correlation with serum lipase were determined. Twenty six patients with chronic pancreatitis diagnosis and seventeen healty subjects involved in our study. FE-1 level was determined with micro ELISA method. FE-1 levels of chronic pancreatitis group were lower than healthy control group (p<0.001). We found a cut off value of 240 μg/g for FE-1 measurements. Sensivity and specifity of method was 92,3% and 70% respectively. Significant difference was not found between chronic pancreatitis patients with and without enzyme treatment (p=0.091). FE-1 and lipase levels of chronic pancreatitis patients were not correlated (p=0.836). As a result; fecal elastase-1 might be used as a supportive test because of its lower diagnostic value during chronic pancreatitis. Further studies with higher number of patients are needed to evaluate exact diagnostic accuracy of FE-1 measurement. But FE-1 levels are not effected from enzyme preparate usage and this is an important avantage from other diagnostic tests.

Keywords:

Enzyme-Linked Immunosorbent Assay, Pancreatitis, Chronic Disease, Pancreas, Exocrine, Tomography, X-Ray Computed, Pancreatic Elastase, Diagnosis, Cholangiopancreatography, Endoscopic Retrograde,

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