| Abstract | Cilj istraživanja: Akutni pankreatitis (AP) je akutni upalni proces gušterače
koji dovodi do poremećaja njezine egzokrine i endokrine funkcije te poremećaja
funkcije okolnog tkiva i organskih sustava. Za postupak liječenja oboljelih važno je
rano predviđanje težine tijeka bolesti kojemu doprinosi određivanje specifičnih
laboratorijskih pokazatelja. Cilj rada bio je utvrditi prognostički značaj citokina kao
biokemijskih biljega i uobičajenih bodovnih sustava s obzirom na razvoj sistemskih
komplikacija tijekom bolesti.
Ispitanici i metode: Istraživanjem je obuhvaćeno 150 bolesnika oba spola (71
muškarac i 79 žena) s dijagnozom AP zaprimljenih na liječenje u Zavod za
gastroenterologiju Klinike za internu medicinu KBC Rijeka. Vrijednosti koncentracije
biokemijskih pokazatelja izmjerene su imunoenzimometrijskom metodom (citokini i
elastaza) i imunoturbidimetrijskom metodom (CRP).
Rezultati: Izmjerena je koncentracije proupalnih (IL-6, IL-8, sTNF-r, IL-15,
IL-17, IL-18) i protuupalnih citokina (IL-10) u serumu bolesnika oboljelih od akutnog
pankreatitisa te koncentracije elastaze kao specifičnog enzima gušterače i CRP-a kao
dominantnog proteina akutne faze upale prvog i trećeg dana po prijamu bolesnika u
bolnicu. Na temelju biokemijskih i kliničkih pokazatelja izračunate su i vrijednosti
bodovnih sustava (Ranson, APACHE II, APACHE III, SAPS i Balthasar) kao
čimbenika predviđanja tijeka bolesti. Na osnovu rezultata utvrđen je značaj citokina,
elastaze i CRP-a, te prognostičkih bodovnih sustava kao čimbenika za prognozu
bolesti s obzirom na razvoj sistemskih komplikacija.
Vrijednosti interleukina: IL-6, IL-8, IL-10 i sTNFr su bile značajno više u
bolesnika koji su razvili sistemske komplikacije u akutnom pankreatitisu od onih
bolesnika koji nisu imali sistemske komplikacije. IL-6, IL-8, IL-10 i sTNFr su se
pokazali osjetljivim parametrima za prognozu težine bolesti. Vrijednosti interleukina
IL-15 i IL-17 nisu bile povišene u bolesnika s akutnim pankreatitisom. Vrijednost
interleukina-18 je bila povišena u bolesnika s akutnim pankreatitisom, ali se IL-18
nije pokazao vrijednim čimbenikom za prognozu tijeka AP. Koncentracije elastaze i
CRP-a izmjerene treći dan od početka bolesti pokazale su se vrijednim čimbenikom
za procjenu tijeka AP. Prognostički bodovni sustavi Balthasar, Ranson i APACHE II
su dobri pokazatelji u procjeni tijeka akutnog pankreatitisa, dok za SAPS i APACHE
III nije dokazan značaj u predviđanju komplikacija u tijeku bolesti.
Zaključak: Bodovni sustavi imaju nesumnjivo važnu ulogu u procjeni stanja
bolesnika, ali ih je potrebno nadopunjavati da bi se bolje, sigurnije i brže procijenila
težina akutnog pankreatitisa. Kombinacijom bodovnih sustava s vrijednostima
interleukina, osobito IL-6, IL-8, IL-10 i sTNFr te uz koncentracije elastaze i CRP-a
treći dan bolesti, procjena težine akutnog pankreatitisa je vjerodostojnija. |
| Abstract (english) | Objectives: Acute pancreatitis is a inflammatory process of the pancreas which
leads to endocrine and exocrine disturbances of pancreas. Although the disease
process may be limited to pancreatic tissue, it also can involve peripancreatic tissue or
more distant organ sites. For the treatment of the acute pancreatitis is very important
to be able to predict outcome in the early stage of the disease. The aim of the study is
to establish the prognostic value of cytokines as biochemistry markers and prognostic
score systems in prediction of complications in acute pancreatitis with special regard
to their clinical usefulness and test performance for stratifying severity and
monitoring disease progression.
Patients and Methods: The study was carried out in a group of 150 patients with
acute pancreatitis, both sex (71 male and 79 female) admitted to Division of
Gastroenterology, Department of Internal Medicine, Clinical Hospital Centre Rijeka.
Concentration of cytokines and elastase were determined by enzyme-linked
immunosorbent assay and C-reactive protein by immunoturbidimetry. Blood tests for
the pro-inflammatory cytokines (IL-6, IL-8, sTNFr, IL-15, IL-17, IL-18) and antiinflammatory
cytokine (IL-10), elastase as specific enzyme of pancreas and Creactive
protein as dominant protein of acute phase of the illness, in patients with
acute pancreatitis were performed. Blood tests for elastase and C-reactive protein
were performed on 1st and and 3rd hospital days. We calculated prognostic score
systems Ranson, APACHE II, APACHE III, SAPS and Balthasar as predictors of
outcome of illness.
Results: The serum concentration of IL-6, IL-8, IL-10 and sTNFr were
significantly higher in patients with acute pancreatitis with complications of illness than those patients without complications. IL6, IL-8, IL-10 and sTNFr are sensitive
and useful parametars for early prediction of the severity of acute pancreatitis. Serum
concentration of IL-15 and IL-17 were not elevated in patients with acute pancreatitis,
while serum concentration of IL-18 were elevated in patients with acute pancreatitis
but without significant value in prediction of the severity of illness. The serum
concentration of elastase and C-reactive protein measured on the third day of
admission in hospital are useful for prediction of the severity of acute pancreatitis.
Prognostic score systems Balthasar, Ranson and APACHE II are useful to assess
severity of illness, while SAPS and APACHE III are not useful.
Conclusion: Prognostic scoring systems has, without doubt, very important
role in assessment of severity of acute pancreatitis, but they need further evaluation to
achieve better, safer and earlier assessment of severity of illness. Combination with
IL-6, IL-8, IL-10 and sTNFr, and with serum concentration of elastase and C-reactive
protein third day of admission in hospital, evaluation of severity of acute pancreatitis
will become more reliable. |
