Serum and Urine Trypsinogen Activation Peptide in Assessing Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis
Abstract
Data di Pubblicazione:
2010
Citazione:
Serum and Urine Trypsinogen Activation Peptide in Assessing Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis / A. Barassi, R. Pezzilli, R. Capra, A. Mariani, A. Gabrielli, A.M. Morselli Labate, R. Pacciolla, G. MELZI D'ERIL. - In: CLINICAL CHEMISTRY. - ISSN 0009-9147. - 56:Suppl. 6(2010), pp. A105-A105. (Intervento presentato al 62. convegno Annual Meeting of Clinical Chemistry tenutosi a Anaheim nel 2010).
Abstract:
Background. Trypsinogen activation peptide (TAP) reflects the amount of activation
trypsinogen, not taking into account how much trypsin is active or linked to specific
inhibitors. TAP is released into the peritoneal cavity and circulates after which the
peptide, thanks to its small size, is rapidly metabolized in the kidney and excreted in the
urine. It seems logical that the greater the quantity of trypsinogen activated, the more the
pancreas is damaged. The aim of the study was to evaluate the serum TAP concentration
elevation after ERCP and to establish its role in the early diagnosis of post-procedural
acute pancreatitis. The second aim was to explore whether the administration of gabexate
mesylate could prevent the activation of tripsinogen by blocking trypsin activation.
Methods. Sixty-five patients were enrolled in the study. Patients who were under 18 years
of age, patients with a recent onset of acute pancreatitis, those who were pregnant, and
patients with a known allergy to gabexate mesylate were excluded. In all patients, a 5 mL
blood sample was taken immediately before the endoscopic examination and 1, 2, 3, 4
and 6 hours post-ERCP. A two mL sample of urine was also collected before ERCP and
2, 4 and 6 hours after the completion of the ERCP. Serum and urine TAPs were assayed
using a technique previously described [Pancreas 2004;29:298-305]. The detection limit
was 1.0 ng/mL and healthy subjects had no detectable values of TAP in serum and in
urine. Serum trypsinogen concentrations were determined using commercially available
RIA-kits (Sorin Biomedica). The detection limit was 2.5 ng/mL and the reference values
of our laboratory were 10-57 ng/mL. The use of gabexate mesylate was decided by the
endoscopist. Post-ERCP acute pancreatitis was defined as the appearance of typical
abdominal pain associated with an increase in serum amylase activity greater than 3 times
the upper reference limit. The severity of the pancreatitis was assessed by clinically-based
Atlanta criteria.
Results. In the 65 patients who completed the study, 2-hour post-ERCP serum TAP
concentrations were elevated (P=0.034 vs. pre-ERCP) whereas these concentrations
significantly declined at 4 hours (P=0.006). Urine TAP showed a similar behavior. Mean
serum trypsinogen concentrations were slightly below the upper reference limit before
ERCP and then significantly increased thereafter. Serum and urine TAP levels, as well
as serum trypsinogen concentration, showed no significant differences between patients
who developed acute pancreatitis and those who did not. Within the group of the patients
who received gabexate mesylate, serum TAP concentrations were significantly lower at
1 and 2 hours after ERCP in the patients who developed acute pancreatitis (P=0.033 and P=0.041, respectively).
Conclusions. Serum and urine concentrations of TAP are detectable very early in patients
who undergo ERCP, i.e. within the first 6 hours. As for the other pancreatic enzymes,
serum and urine TAP determination is of limited value in diagnosing post-ERCP acute
pancreatic damage if used alone. Finally, more studies are necessary to precisely establish
the role of TAP determination in patients treated prophylactically with drugs capable of
blocking the activation of trypsin.
Tipologia IRIS:
01 - Articolo su periodico
Elenco autori:
A. Barassi, R. Pezzilli, R. Capra, A. Mariani, A. Gabrielli, A.M. Morselli Labate, R. Pacciolla, G. MELZI D'ERIL
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