SU1506355A1 - Method of diagnosis of aggravation of chronic recurring pancreatitis - Google Patents

Abstract

This invention relates to the field of medicine, in particular, to gastroenterology. The purpose of the invention is to improve the accuracy of determining the exacerbation of chronic recurrent pancreatitis. The exacerbation of chronic pancreatitis was established using the study of elastase activity in the secret of the pancreas, obtained through a catheter inserted into the main pancreatic duct. An elastase activity above 62 Mmol / h / L confirms the exacerbation of the disease.

Description

The invention relates to medicine, in particular to a gastroenterologist.,

The purpose of the invention is to improve the accuracy of determining the exacerbation of chronic recurrent pancreatitis (CRP).

The method is carried out as follows.

In pure pancreatic juice, obtained through a catheter inserted into the main pancreatic duct, the activity of zlastase is studied using the substrate succinyl-alanyl-para-nitroanilide.

The method is based on the staining of iron ions with hydroxamic acid in the reaction of an alkaline hydroxylamine with ether from an elastase reaction of the sucrolyl-apanyl-para-nitro-anilide hydrolysis.

Detection procedure: I ml of succinyl-alanyl " -paranitroanilide is added to 2 ml of alkaline hydroxylamine. After 1 minute J, 1 mp of 4N HCl and 1 MP of 0.37 K were added. FeClj in 0.1 N HCl. The mixture is shaken and the absorbance is quickly determined at 540 nm against a control containing all elements except succinyl-alanyl-para-nitrianoylide. To transfer to the SI system (Mmol / h / l), the data obtained is multiplied by 60.

Pure pancreatic juice in the process of research receive 1-3 ml, since this volume is sufficient to determine the elastolytic activity in it. A minimum period sufficient to obtain 1-3 ml of juice is placed in 5 to 10 minutes, after which the study is terminated.

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As a result of clinical studies, in 25 out of 31 patients (81%) of CPP in the acute stage, the level of elastase activity in pure pancreatic juice vpia 62 mmol / h / l was detected, which confirmed the present recurrence of this disease, the serum physical activity in the blood serum in the same patients only this method was improved in 11 of 31 cases (36%).

The control group consisted of six people without pathology on the part of the pancreas. Their elastase activity in the NPV ranged from 3 to 49 Mmol / h / l.

To determine the elastopolytic activity, a minimum volume of juice of 1 ml is required. This volume is obtained within minutes.

Example 1. Elastase activity in pure pancreatic juice, indicating the absence of exacerbation of CPD, was observed in a patient Sh. T., 72 years old, who reported with complaints of paroxysmal pain in the right hypochondrium. On examination, the patient is in satisfactory condition. Abdomen: cue, palpation more painful in the right hypochondrium. In laboratory research, leukocytosis is found. By dakg-m of retrograde pancreatography, an ultrasound examination of the pathogenesis c: the side of the pancreas has not been revealed. The activity of amylase in the blood (80 Mmol / h / l), trypsy a (ZO. Jule / h / l), elastase (16 Mmol / h l) n normal limits. From the side of the hepatobillary system, the data were indicated by retrograde cholangas of the photograph, ultrasound study, and increased numbers in the blood of total and direct bilirubin and ACT, ALT, S

According to the endoscope canap, a flon probe with a length of 1–50 cm and a diameter of 1.8 mm was introduced into a large duodenal nipple to a depth of 15–25 mm. Stimulations of the gland did not produce. Within 5 minutes, 1 ml of pure pancreatic juice was obtained, the elastolytic activity of which is 49 Mmol / h / l.

PRI mme R 2. Increased elastase activity in pure pancreatic juice at its normal level in the blood during the exacerbation of CPD was observed in patient CH.A., 66 years old, who turned to the clinic with a complaint

MI for aching paroxysmal pain in the right hypochondrium, epigastric pain, nausea, belching. At admission, marked leukocytosis and accelerated ESR. Blood amylase activity of C120 Mmol / h / l), trypsin (48 Mmol / h / l) and elastase (l9 Mmol / h / l) are within normal limits. An ultrasound examination revealed signs of exacerbation of CPD. When performing retrograde pancreatography, signs characteristic of CRP were found.

A teflon probe 150 cm long and 1.8 mm in diameter was introduced into the large duodenal nipple to a depth of 15-25 mm through the endoscope channel. Stimulation of the gland was not performed. Within 10 minutes, 2 ml of juice was obtained, the activity of which was equal to 78 Mmol / h / l

Example 3. Increased elastase activity in pure pancreatic juice during an exacerbation was observed in patient A., 55 years old, fasting, - who drank with complaints of paroxysmal pain in the right hypochondrium, epigastric pain, nausea. On examination, the patient is in satisfactory condition. The language is overlaid. The abdomen is soft, with painful palpation in the zigastrium. The liver and spleen were not palpable. Laboratory tests revealed leukocytosis and accelerated ESR. Uroamylase activity in the urine increased to 1064 units, trypsin in the blood serum to 260 Mmol / h / l, elastase to 70 Mmol / h / l. Due to the presence of gases in the intestine, the size of the pancreas could not be determined. With retrograde pancreatography, signs characteristic of HRP have been identified.

A teflon probe 150 cm long and 1.8 mm in diameter was introduced into the large duodenal nipple to a depth of 15-25 mm through the endoscope channel. Stimulation zhel.; PS did not. Within 7 minutes, 1.2 ml of pure pancreatic juice was obtained, elastolytic, the activity of which is equal to 920 Mmol / h / l

Examples 2 and 3 show that in both cases the activity of elastase in pure pancreatic juice indicates an exacerbation of CPD, while in example 2 the activity of elastase in the blood serum is within the normal range, but ultrasound data indicate an exacerbation of CPD, in example 3 the level of elastase is the blood significantly exceeded the norm, however, it was not possible to reveal the exacerbation of HSP using ultrasound.

According to research data, in comparison with the known, the proposed method makes the diagnosis of acute exacerbation of CPD by 45%.

Thus, the proposed method makes it possible to establish an exacerbation of CPD and can be widely used before retrograde pancreatography.

Claims (1)

Invention Formula A method for diagnosing the exacerbation of chronic recurrent pancreatitis by examining the activity of elastase in a biological fluid, characterized in that, in order to improve the accuracy of the method, a catheter is inserted into the main pancreatic duct, 1-3 MP of a plow are examined within 5-10 minutes, the activity of elastase is examined and at an active level of 62 mmol / h / l, exacerbation of chronic recurrent pancreatitis is determined.