Новые подходы к неинвазивной диагностике фиброза поджелудочной железы при хроническом панкреатите

Abstract

Study Objective: to search for novel approaches to non-invasive diagnosis of pancreatic fibrosis in chronic pancreatitis (CP) patients. Study Design: prospective comparative non-randomised study. Materials and Methods. 43 subjects were examined: 22 (51.2%) patients with calcific CP and 21 (48.8%) patients with CP resulting from acute pancreatitis with pancreonecrosis, aged 35 to 82 years old. All patients underwent multislice computer-aided tomography (CT) of abdomen with IV contrast, and had their fibronectin (FN), С-peptide and faecal pancreatic elastase 1 concentrations measured. Study Results. There were no differences in C-peptide between study groups (p = 0,18). Faecal elastase 1 concentration (108.36 ± 144 μg/g) was significantly lower in calcific CP (p = 0.03) vs. patients with post-pancreonecrosis CP (185.67 ± 145.1 μg/g). Blood FN level negatively correlated with CP severity (M-ANNHEIM system) (r = –0.36, p = 0.018). In calcific CP, median contrast ratio (1.01 ± 0.06) was significantly higher (p = 0.033) than in post-pancreonecrosis CP (0.95 ± 0.14). Conclusion. Patients with calcific CP demonstrated more severe exocrine insufficiency. Decreased FN levels in severe CP are likely to be due to long-term increased FN intake because of pacreatic fibrosis. Pancreatic fibrosis augmentation impacts pancreas contrast study and results in higher contrast ratio at CT. Therefore, it allows using this parameter for non-invasive diagnosis of pancreas fibrosis in patients with CP. Keywords: fibrosis, chronic pancreatitis, pancreas, computer-aided tomography.