The Clinical Significance Of Serum Trypsinogen-2、IL-10and PAF In Post ERCP Pancreastitic Patients

Objectives: Endoscopic retrograde cholangiopancreatography（ERCP) isone of the the important means of diagnosis and treatment for liver, braverypancreatic diseases. There are many advantages for ERCP, which includeexact diagnosis, good curative effect, small trauma, less side effects, low costand so on. But ERCP belongs to a invasive operation, some complicationsoccur after ERCP, such as Pain, bleeding, infection, hyperamylasemia, postERCP pancreatitis (PEP), etc. The hyperamylasemia and PEP are the mostcommon complications. After ERCP, the patient whose blood amylaseincreased more than three times, with upper abdominal pain, or in accordancewith pancreatitis imaging in CT can be diagnosed as PEP, while the patientwith higher amylase and without accompanied by abdominal pain andpancreatitis imaging in CT can be diagnosed as hyperamylasemia. The PEPwas significantly associated with patients’ age, sex, nipple incision, pancreaticduct contrast injection, sphincterotomy and other factors. The incidence ofPEP is about5%, while the incidence of high-risk patients is even up to30%~50%. So understanding the mechanism of the PEP, searching for moreeffective methods of early detection, and reducing the happening of the PEPbecome a research hotspot in recent years. We plan to quantitatively measurethe level of trypsinogen-2, IL-10and platelet activating factor in serum in thecontrol group, the post ERCP hyperamylasemia group and PEP group, in orderto understand their relationship with PEP and provide the basis for preventingand reducing the occurrence of the PEP.Trypsinogen-2, the precursor of trypsin, whose relative molecular mass is25000, secreted by the pancreas exocrine cells into the pancreatic juice.Trypsinogen mainly have two kinds of subtypes: trypsinogen-1andtrypsinogen-2. Both trypsinogen-1and trypsinogen-2are rising in Pancreatitis, and trypsinogen-2is rising more apparently. So trypsinogen-2can be used asmarkers in early diagnosis of acute pancreatitis.IL-10, an important endogenous anti-inflammatory cytokines, producedby the Th2cells, T cells and activation of B cells, is a single glycoprotein.IL-10inhibits the expression of TNF-alpha, beta TNF-1, IL-6and IL-8and soon in mononuclear macrophage and also reduces SAP serious degree in theanimal models. IL-10is one of the important negative feedback factors tomaintain balance of cytokine network. The proinflammatory cytokines IL-6,IL-8and anti-inflammatory cytokine IL-10increased in SAP.PAF, a powerful lipid inflammatory mediator, is considered to be keyinflammatory mediators in occurrence and development of acute pancreatitis.It plays an important role in the occurrence and the development of AP. WhenAP occers, PAF is produced and released from mast cells and platelets, whichcause many kinds of cytokines released such as PGE-2, IL-1and IL-6, IL-8and so on. Then pancreatic tissue serious damaged. PAF is not only involvedin the production of a variety of cytokines in AP, but also interact in bothcause and effect with the inflammatory factors. Which rapid exacerbate theinflammatory response. With the deterioration acute pancreatitis, PAF levelsincrease significantly early and fall in the late, but were higher than the controlgroup. It plays an important role in the process from the MAP to the SAP. Itcan be an index for judging the prognosis of AP.The effect of trypsinogen-2, IL-10and PAF on occurrence anddevelopment of acute pancreatitis is already reported in literature. Because thestudy of the impact of trypsinogen-2, IL-10and PAF in PEP and its severity isless, we decide to begin our research to provide the basis for early detection ofPEP.Methods: According to the amylase after ERCP, the presence ofpancreatitis symptoms such as abdominal pain, nausea, complications and CTimaging,56patients with ERCP are divided into three groups: the controlgroup, the hyperamylasemia group, and the PEP group.Then we test serumTrypsinogen-2, IL-10and PAF levels before and after ERCP (4h and24h after treatment). Three factors are all tested with double antibody sandwichABC-ELISA detection.Results:1In the PEP group, serum trypsinogen-2, IL-10, PAF level in4h and24hafter ERCP compared with the levels before ERCP were significantlyincreased （4h: F=34.223, P<0.05; F=19.530, P<0.05; F=37.889, P<0.05;24h: F=51.627, P<0.05; F=21.904, P<0.05; F=46.555, P<0.05） SerumTrypsinogen-2and PAF level in24h after ERCP are significantly decreasedcompared with the levels in4h after ERCP (F=7.022, P<0.05; F=6.247,P<0.05). The level of IL-10in24h after ERCP is no statistical significancecompared with the level in4h after ERCP（F=1.764, P>0.05）2The relevance of amylase and trypsin-2, IL-10, PAF: The spearmancorrelation index between amylase and trypsinogen-2, IL-10, PAF are0.586,0.673,0.654.(P<0.05) Amylase and trypsin-2, Il-10, PAF are positivelycorrelated.3The sensitivity and specificity of amylase, trypsin-2, Il-10and PAF in4h after ERCP in the diagnosis of PEP: Atter ERCP4h, the sensitivity,specific degree for the levels of amylase (>3times normal), trypsinogen-2（>100ng/ml）, IL-10（>60pg/ml）and PAF（>28mU/ml）in the diagnosisof PEP are:80.0%,97.6%;86.7%,82.9%;86.7%,80.5%;86.7%,85.4%. Thesensitivity, specific degree of trypsinogen-2, IL-10and PAF in4h after ERCPin the diagnosis of PEP join with amylase are:100.0%,97.6%;93.3%,97.6%;93.3%,97.6%.Conclusions:1The Studies have shown that the levels of serum trypsinogen-2, IL-10,PAF in PEP group4h after ERCP are significantly higher than the normalcontrol group. All of them can be used for early diagnosis of the PEP. Thelevel of serum trypsinogen-2, IL-10, PAF may be associated with the severityof PEP. They can be uesd to assess the seriousness of the PEP.2Amylase is positively correlated with trypsin-2, IL-10, and PAF.Trypsinogen-2, Il-10and PAF can effectively improve the sensitivity and specificity of the PEP join with amylase.