Clinical characteristics and prognostic analysis of pancreatic enzyme abnormalities in children / 中华实用儿科临床杂志

Objective:To investigate the etiology, prognosis and clinical characteristics of abnormal serum amylase and lipase in children.Methods:This study was a retrospective study.A total of 7 813 children older than 28 days who had their serum amylase and lipase detected in Hunan Children′s Hospital from August 2017 to August 2020 were included as the study subjects.Children with acute and chronic pancreatitis were excluded.The age, gender, impatient department, imaging exams, discharge outcomes, main diagnosis, diagnostic ICD10 code, and the highest values of serum amylase and lipase during hospitalization were collected through the medical record system.According to the levels of serum amylase and lipase, the children were divided into 3 groups.Patients in group A had normal serum amylase and serum lipase levels.The serum amylase or lipase levels of patients in group B was 1 to 3 times higher than that of group A. The serum amylase or lipase levels in group C was 3 times higher than that of group A. Group B and group C had abnormal pancreatic enzyme levels.According to the prognosis, patients were divided into the survival group and the death group.The relationship of the occurrence of abnormal serum amylase and lipase levels with the age, sex, disease type and prognosis of children was analyzed.Results:The ratio of abnormal trypsin in male and female was 11.5% and 12.9%, respectively.The number of children with abnormal pancreatic enzyme levels in the 28 day -1 year old group, >1-3 years old group, >3-6 years old group, >6 -12 years old group and > 12 year old group were 37 cases (4.6%), 185 cases (15.4%), 199 cases (10.5%), 431 cases (13.9%), and 94 cases (11.7%), respectively.The mortality rate was 1.6% (112/6 867 cases) in group A, 5.2% (32/617 cases) in group B, and 7.6% (25/329 cases) in group C. The mortality risk of group B and C was both higher than that of group A. Compared with group A, the OR (95% CI) of group B and group C was 3.30 (2.21-4.93) and 4.96 (3.17-7.77), respectively.In group C, the top five diseases were parotitis (26.4%), cholangiectasis (11.6%), choledochal cysts (8.5%), gastroenteritis (4.5%) and sepsis (3.3%). Conclusions:Pancreatic enzyme abnormalities in children are associated with adverse prognosis.Pancreatic enzyme abnormalities are more prone to occur in children aged >1-3 with mumps, digestive diseases and congenital digestive system structural deformities.In addition, children with sepsis are also easy to present pancreatic enzyme abnormalities.Clinical attention should be paid to the possibility of secondary pancreatic damage in children with sepsis.

Research advances in pancreatic exocrine insufficiency secondary to pancreatic cancer / 临床肝胆病杂志

At present, there is still a lack of comprehensive diagnosis and treatment criteria for pancreatic exocrine insufficiency around the world. Pancreatic surgeons often ignore or misjudge pancreatic exocrine insufficiency secondary to pancreatic cancer, and as a result, pancreatic exocrine insufficiency is not adequately treated, which greatly affects the quality of life of patients with pancreatic cancer. This article summarizes the latest research advances in the pathogenesis, typical symptoms, and diagnostic methods of pancreatic exocrine insufficiency, as well as pancreatic enzyme replacement therapy in different stages of pancreatic cancer. It is pointed out that pancreatic enzyme replacement therapy can significantly improve the quality of life of patients with different stages of pancreatic cancer.

¿Es una alternativa terapéutica la pancrelipasa (Zenpep®) para pacientes con fibrosis quística?: síntesis rápida de evidencia / Is pancrelipase (Zenpep®) a therapeutic alternative for patients with cystic fibrosis?: rapid evidence synthesis

ANTECEDENTES Y OBJETIVO La fibrosis quística es una enfermedad multisistémica asociada a un componente genético, que se caracteriza por la presencia constante de secreciones en múltiples órganos, siendo las exacerbaciones pulmonares las que conllevan la mayor morbilidad y mortalidad. El Ministerio de Salud, a través del plan de Garantías Explícitas en Salud (GES), comprende dentro de su cobertura para esta condición de salud, las terapias de reemplazo enzimático para insuficiencia pancreática. Sin embargo, existe un único laboratorio que cuenta con registro sanitario en Chile (pancreatina). De esta forma, se le ha solicitado al Ministerio la inclusión de otras alternativas terapéuticas disponibles y, en particular de pancrelipasa (Zenpep®). En este contexto la Secretaría Técnica GES solicita una síntesis de evidencia con el objetivo de informar la toma de decisiones respecto de si es posible contar con una alternativa terapéutica a la pancreatina (Creon®) para pacientes con fibrosis quística. METODOLOGÍA Se formula una estrategia de búsqueda para ser utilizada en las bases de datos Epistemonikos, la Biblioteca Cochrane, y PubMed con el objetivo de identificar revisiones sistemáticas que abordaran la pregunta formulada. Al no encontrarse revisiones que abordaran las comparaciones deseadas, se realizó una búsqueda de estudios primarios en PubMed. Los resultados de la búsqueda se presentan en los hallazgos del presente documento. Se utiliza la metodología de certeza de la evidencia GRADE. Se incluyeron todas las preparaciones de pancrelipasa con cualquier nombre comercial. Se utilizó como comparador único placebo, priorizando éste por sobre la pancreatina. RESULTADOS Se utilizan 8 estudios primarios, de los cuales se obtienen los siguientes resultados: -En comparación a placebo, el uso de pancrelipasa en niños con fibrosis quística, podría au mentar la absorción de grasa y nitrógeno en un 34,5% y 34.6%, respectivamente. -La utilización de pancrelipasa en población adulta con fibrosis quística, podría aumentar la absorción de grasa y nitrógeno en un 38.5% y 34.5%, respectivamente. -La pancrelipasa no cuenta con registro sanitario vigente en Chile por lo que, de momento, habría que esperar la solicitud de registro, para incorporarla como alternativa terapéutica en pa cientes tratados en nuestro país.

Research progress of pancreatic enzyme replacement therapy after gastric resection / 国际外科学杂志

Gastric resection can cause a multifactorial clinical manifestations of dyspepsia,such as flatulence,diarrhea,weight loss,and fat diarrhea.Exocrine pancreatic insufficiency (EPI) is one of the possible mechanisms of fat maldigestion following gastric surgery,the main causes may be related to rapid gastric emptying;asynchrony between gastric emptying and bilio-pancreatic secretion due to new tracts of various reconstructions;bacterial overgrowth after gastrectomy and so on.Oral pancreatic enzyme replacement therapy (PERT) is the mainstay of treatment for EPI,due to lack of available evidence so far,the efficacy and safety of pancreatic enzyme substitution in patients following gastric resection remains unclear and cannot be generally recommended.This review will sum up the revelant studies addressing EPI and PERT after gastric resection in recent years,and summarizes the mechanisms,clinical diagnostic methods and PERT treatment perscription of EPI after gastrectomy to improve the cognition of clinicans.

Advances in the role of autophagy in acute pancreatitis / 中华危重病急救医学

Autophagy is a self-protect cellular mechanism by which the unneeded cellular structure or impaired protein are targeted to degeneration. Acute pancreatitis (AP) is associated with autophagy tightly. This article is aimed to mainly elaborate the phenomenon that AP can be triggered by impaired autophagy and the mechanism of AP exacerbation by damaged autophagy. In AP, the reasons of impaired autophagy is dysfunction of cathepsins and lysosome associated membrane protein, which present as vacuoles accumulation in acinar cells and combination disorder of autophagolysosome, finally to activation of trypsin. By the relocation of high mobility group box 1 (HMGB1) and promotion of mitochondrial permeability transition (MPT), impaired autophagy aggravates AP. Understanding the above mechanism has certain significance to the prevention and treatment of AP.

Advances in the role of autophagy in acute pancreatitis / 中华危重病急救医学

Autophagy is a self-protect cellular mechanism by which the unneeded cellular structure or impaired protein are targeted to degeneration. Acute pancreatitis (AP) is associated with autophagy tightly. This article is aimed to mainly elaborate the phenomenon that AP can be triggered by impaired autophagy and the mechanism of AP exacerbation by damaged autophagy. In AP, the reasons of impaired autophagy is dysfunction of cathepsins and lysosome associated membrane protein, which present as vacuoles accumulation in acinar cells and combination disorder of autophagolysosome, finally to activation of trypsin. By the relocation of high mobility group box 1 (HMGB1) and promotion of mitochondrial permeability transition (MPT), impaired autophagy aggravates AP. Understanding the above mechanism has certain significance to the prevention and treatment of AP.

The replacement therapy of pancreatic enzyme / 肠外与肠内营养

Pancreatic enzyme replacement therapy is given to manage pancreatic exocrine insufficiency (PEI) in cystic fibrosis (CF) and following pancreatectomy, total gastrectomy or chronic pancreatitis. The article reviews on aspects of pancreatic enzyme replacement therapy containing the assement of pancreatic exocrine function, the pathogenesis of exocrine pancreatic insufficiency, pancreatic enzyme preparations and their efficiency, dosing of pancreatic enzymes, enteral nutrition and pancreatic enzyme replacement, the modulation of pancreatic exocrine and adverse reactions to pancreatic enzyme.

Effects of voluntary training on pancreatic enzyme activity and acinar cells in rats / 体力科学

The authors have found that compulsory training using treadmill running increases pancreatic weight, protein content, and enzyme activity in hypertrophied acinar cells in rats. The purpose of the present study was to investigate the effect of voluntary running exerise on the exocrine pancreas in rats. Female F344 rats were divided into control, compulsory training, and voluntary training groups. The compulsory trained rats were exercised for 60 min on a treadmill (final speed, 35 m/min), 5 days a week, for 8 weeks. The voluntary trained rats were exercised on a voluntary basis on a wheel ergometer with a load of 30% of their body weight every day. Mean running distance for the voluntary training group was 5.2±1.0 km/day. Final body weight for the compulsory and voluntary training groups was significantly lower than for the control group. Soleus muscle weight and citrate synthase activity of the plantaris muscle for the compulsory and voluntary training groups were significantly higher than for the control group. Pancreatic wet weight, protein content, and amylase and lipase activities for the compulsory and voluntary training groups were significantly higher than for the control group. Pancreatic wet weight, protein content, and amylase and lipase activities for the compulsory and voluntary training groups were significantly higher than for the control group. Total DNA content of whole pancreas in the voluntary training group was significantly higher than for the control and compulsory training groups. Electron micrographs revealed that acinar cells obviously hypertrophied and zymogen granules increased in the compulsory and voluntary training groups rats compared with the compulsory group. These results suggest that voluntary training increases pancreatic weight and protein content in hypertrophied and/or hyperplasic acinar cells, which in turn increases synthesis and the storage of exocrine pancreatic enzymes.

The effect of endurance training on the pancreatic enzyme activity in aged rats / 体力科学

The purpose of the present study was to investigate the effect of endurance running training on pancreatic enzyme activity in aged rats. Young (Y ; age, 12 weeks) and old (O ; age, 100 weeks) female Fischer 344 rats were divided into control (YC ; n = 6, OC ; n = 4) and trained (YT ; n = 6, OT ; n=7) groups respectively. Rats in the YC and OC groups were kept sedentary. Rats in the YT and OT groups ran up a 15% gradient treadmill for 60 min a day (final speed, YT : 32 m ⋅min<SUP>-1</SUP>, OT 22 m⋅min<SUP>-1</SUP>), 5 days a week. After 10 weeks, the pancreas was excised and weighed. Protein content, amylase and lipase activities in pancreatic tissue were measured. Pancreatic wet weight, protein content, and enzymes (amylase and lipase) activity in the OC group were significantly lower than in the YC group. However, these parameters in the OT group were significantly higher than in the OC group. These results suggest that endurance training may restore the age-related decrease of pancreatic enzyme synthesis and storage.

Renal Excretion of Pancreatic Enzyme in Dogs / 대한비뇨기과학회지

It is generally accepted that in acute pancreatitis, the enzymes normally excreted by the pancreas are released from the disrupted parenchyma into the extraductal space and taken up by way of the lymphatics and capillaries. The enzymes in the blood stream may appear in high concentration in the serum. Therefore, serum amylase and lipase determinations has long been a mainstay in the diagnosis of acute pancreatitis and other pancreatic diseases. However, many investigators have claimed that the urinary output of amylase may be elevated more consistently in acute pancreatitis than in the serum concentration of either amylase or lipase, and urinary amylase measurement is a more sensitive reflection of the presence of pancreatitis and of its clinical course than is the measurement of serum amylase or lipase. Clinically, one of the ominous signs which may develop during the early course of acute pancreatitis is severe hypotension. But, no agreement has been reached among investigators as to the cause of the hypotension, although several investigators have implicated a blood volume deficiency resulting form inflammatory process, and hypercalcemia. Perhaps, the majority have attributed the hypotension to systemic effect of some of the pancreatic enzymes, especially trypsin. Nevertheless, the correction of these factors sometimes fail to restore a normal blood pressure clinically. The purpose of the present investigation was to observe the relationships between serum concentration and urinary output of pancreatic enzymes, and to determine the degree of hypotension resulting from the systemic administration of pancreatic enzymes. These experimental procedures, consisted of heteroinfusion of human pancreatic juice and homoinfusion of canine pancreatic emulsion intravenously, and pancreatic ductal ligation in dogs. Blood and urine samples for the enzyme analysis were collected serially thorough the femoral vein and ureteral catheter before and after the procedure. Blood pressure was measured consistently by the kymograph before and after infusion of pancreatic juice. Activities of amylase and lipase were determined by methods of Nelson and, Cherry and Crandall, respectively. The results obtained are summarized as follows; 1. Following intravenous infusions of pancreatic juice exogenously. serum and urine concentrations of amylase and lipase increased rapidly, but these enzymes decreased rapidly in urinary excretion and gradually in serum concentration. Urinary recovery of amylase was approximately 10% of the total infused amount of pancreatic juice at the end of 4 hours. 2. Following ligation of the pancreatic duct, the amylase and lipase levels of serum rose gradually and reached the maximum at 24-48 hours after ligation and then gradually fell. The output of these enzymes in the urine were relatively constant while serum enzymes were increased. 3. When the human pancreatic juice was infused, hypotension was pronounced, and it was deeper and more prolonged in hypotensive effect with infusion of highly concentrated juice in the enzyme activities. With human pancreatic juice, a more sustained hypotension occurred than was observed after infusion of canine pancreatic emulsion. As a result of this investigation, it is felt that the hypotension in acute pancreatitis is probably the result of pancreatic enzymes itself. 4. In postinfusion period, the urine volume was markedly decreased following hypotension, and the urine volume was increased following blood pressure to normal level. This suggests that urine volume may diminish resulting from transient acute renal failure due to hypotensive effect by pancreatic enzymes.