만성 췌장염이 의심되는 환자에서 대변 및 혈청 Elastase 1 측정의 임상적 의의

Background/Aims: Indirect pancreatic function tests available currently are unreliable in clinical practice for early chronic pancreatitis because of their low sensitivity in mild and moderate exocrine pancreatic insufficiency. In addition, the measurement of serum amylase and lipase serum levels of levels is not useful in the diagnosis of chronic pancreatitis. Methods: We evaluated the sensitivity and specificity of fecal elastase 1 determination in diagnosing pancreatic insufficiency. Concentrations of fecal and serum elastase 1 were measured with enzyme linked immunosorbent assay (ELISA) in 25 patients with chronic pancreatitis, 29 patients with acute pancreatitis and 29 normal controls. Results: The mean concentration of fecal elastase 1 was 136.8±24.7 μg/g stool in chronic pancreatitis patients, 644.2±52.1 μg/g stool in acute pancreatitis and 649.8±56.7 μg/g stool in control group. When the cut-off value was set at 300 μg/g stool, the sensitivity and specificity of stool elastase 1 determination were 88% and 94.8%, respectively, in patients with chronic pancreatitis. Significant correlations were found between serum amylase level and serum lipase level (r=0.923, p<0.01). Fecal elastase 1 level was not correlated with serum level of amylase or lipase. Conclusions: Fecal elastase 1 determination may be a highly sensitive and specific exocrine pancreatic function test in diagnosing chronic pancreatitis. (Kor J Gastroenterol 1999;34:528 - 536)