Calcitonin precursors:: Early markers of gut barrier dysfunction in patients with acute pancreatitis

被引:45
|
作者
Ammori, BJ
Becker, KL
Kite, P
Snider, RH
Nylén, ES
White, JC
Barclay, GR
Larvin, M
McMahon, MJ
机构
[1] Univ Leeds, Div Surg, Leeds, W Yorkshire, England
[2] Gen Infirm, Dept Microbiol, Leeds LS1 3EX, W Yorkshire, England
[3] George Washington Univ, Washington, DC USA
[4] Vet Affairs Med Ctr, Washington, DC 20422 USA
[5] Royal Infirm, Scottish Natl Blood Transfus Serv, Edinburgh EH1 2QN, Midlothian, Scotland
关键词
acute pancreatitis; calcitonin precursors; gut barrier function; endotoxin; antiendotoxin antibodies; intestinal permeability;
D O I
10.1097/00006676-200310000-00008
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background: Severe acute pancreatitis is associated with an early increase in intestinal permeability and endotoxemia. Endotoxin is a potent stimulator for the production and release of procalcitonin and its components (calcitonin precursors; [CTpr]). The aim of this study is to evaluate the role of plasma CTpr as an early marker for gut barrier dysfunction in patients with acute pancreatitis. Methods: Intestinal permeability to macromolecules (polyethylene glycol 3350), serum endotoxin and antiendotoxin core antibodies, plasma CTpr, and serum C-reactive protein (CRP) were measured on admission in 60 patients with acute pancreatitis. Attacks were classified as mild (n = 48) or severe (n = 12) according to the Atlanta criteria. Results: Compared with mild attacks of acute pancreatitis, severe attacks were significantly associated with an increase in intestinal permeability index (median: 0.02 vs. 0.006, P < 0.001), the frequency of endotoxemia (73% vs. 41%, P = 0.04), and the extent of depletion of serum IgM antiendotoxin antibodies (median: 43 MMU vs. 100 MMU, P = 0.004). Plasma CTpr levels were significantly elevated in patients with severe attacks compared with mild attacks on both the day of admission and on day 3 (median: 64 vs. 22 fmol/mL, P = 0.03; and 90 vs. 29 fmol/mL, P = 0.003 respectively). A positive and significant correlation was observed between the admission serum endotoxin and plasma CTpr levels on admission (r = 0.7, P < 0.0001) and on day 3 (r = 0.96, P < 0.0001), and between plasma CTpr on day 7 and the intestinal permeability index (r = 0.85, P = 0.0001). In contrast, only a weak positive correlation was observed between peak serum levels of CRP and plasma CTpr on admission (r = 0.3, P = 0.017) and on day 7 (r = 0.471, P = 0.049), as well as between CRP and each of the admission serum endotoxin (r = 0.3, P = 0.03) and the intestinal permeability index (r = 0.375, P = 0.007). Conclusions: In patients with acute pancreatitis, plasma concentrations of CTpr appear to reflect more closely the derangement in gut barrier function rather than the extent of systemic inflammation.
引用
收藏
页码:239 / 243
页数:5
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