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Izhodišča in namen raziskave Akutni pankreatitis (AP) je akutno vnetje tkiva trebušne slinavke. Prizadene tako bližnje kot oddaljene organe, lahko poteka kot blago vnetje ali kot hudo, z zapleti, ko je potrebno intenzivno zdravljenje. Namen raziskave je bil opredeliti etiologijo obolenja s slikovnimi metodami, vključno z endosonografijo, napovedati potek bolezni z vnetnimi pokazatelji, določitvijo interlevkinov (IL) IL-6, IL-8, IL-10 ter uporabo napovednih točkovnih sistemov. Bolniki in metode V raziskavo smo vključili bolnike, ki smo jih zdravili zaradi akutnega vnetja trebušne slinavke v obdobju od maja 2012 do januarja 2015 in so izpolnjevali vključitvene kriterije: značilno klinično sliko, trikratni porast aktivnosti serumske amilaze/lipaze in/ali potrditev s slikovnimi preiskavami. Raziskavo je odobrila Komisija Republike Slovenije za medicinsko etiko (št. 36/11/09). Bolnikom smo v prvih 24-tih urah po sprejemu in nato čez 48 ur odvzeli dodatne krvne vzorce za določitev interlevkinov ter razširjene laboratorijske preiskave. Zdravljenje je potekalo v skladu s smernicami in priporočili slovenskega gastroenterološkega združenja ter mednarodnih zdravniških združenj (ESGE, AGA). Opravljena je bila statistična analiza in inteligentna analiza podatkov s tvorjenjem napovednega modela. Rezultati V končno analizo smo uvrstili 117 bolnikov, prevladovali so moški, v 59 % (69/117), žensk pa je bilo 41 % (48/117). Povprečna starost bolnikov je bila 62,5 let, v razponu 22-91 let, SD 15,4 let. Žolčni kamni so bili najpogostejši vzrok za akutni pankreatitis, v 56 % alkohol v 33 % in v 14 % ostali vzroki. Po Ransonovem točkovanju in BISAP lestvici je večina bolnikov (81 %) sodila v skupino z blagim potekom vnetja, pri ostalih (19 %) pa je bil potek težji. Le trije bolniki, 2,5 % (3/117) so umrli zaradi večorganske odpovedi. Razvoj psevdociste smo potrdili pri 11 % bolnikov. Pred ERCP smo vsem bolnikom endosonografsko potrdili holedoholitiazo. V analizi smo ugotavljali največjo napovedno vrednost IL-6 ob sprejemu AUC 0.782, pri mejni vrednosti IL-6=70.05 je občutljivost 0.80 in specifičnost 0.701, ob kontroli je AUC 0.835, pri mejni vrednosti IL-6=35.1 je občutljivost 0.867 in specifičnost 0.75. Ob primerjavi količnika IL-6/IL-10 ob sprejemu, in količnika IL-6/IL-10 ob kontroli, ima višjo napovedno vrednost količnik ob kontroli, AUC=0.789. Pri mejni vrednosti količnika 7.2, je občutljivost 0.667 in specifičnost 0.663. Zaključek Kljub sodobnim postopkom zdravljenja, imajo bolniki s hudo potekajočim AP, še vedno pomembno število zapletov. Žolčni kamni in alkohol sta najpogostejši vzroka AP v skupini naših bolnikov. V naši raziskavi smo potrdili vrednost določanja IL-6, IL-8 in IL-10 ob sprejemu in kontroli za napoved poteka bolezni, endosonografija pa je učinkovita slikovna metoda za pojasnitev etiologije. Z napovednimi modeli lažje napovemo potek AP, še posebej ob podpori s sodobnimi laboratorijskimi metodami in endoskopsko-radiološkimi slikovnimi preiskavami. Background and study aims Acute pancreatitis (AP) is acute inflammatory proces of the gland, which can involve peripancreatic tissue, but also remote organ systems and take mild or severe course. The objective of the study was the definition of etiology, prediction of disease course with inflammatory markers and interleukins (IL) IL-6, IL-8, IL-10, radiologic imaging procedures and endosonography and forming a predictive scoring system. Patient and methods In the study were included patients who were treated due to acute pancreatitis in the period between may 2012 and january 2015 and who fulfilled inclusion criteria: typical clinical picture for AP, three fold increased enzyme activity of serum amylase/lipase and confirmation with imaging procedures. Research was approved by National Medical Ethics Committee of Republic of Slovenia (Nr.36/11/09). We took blood samples at admission and after 48 hours for determination of interleukins and inflammatory markers and other biochemical tests. Patients were treated according to the guidelines of Slovenian Gastroentrological Association, ESGE and AGA. Statistical analysis and intelligent analysis of the data forming the predictive model was performed. Results In the final analysis were included 117 patients, the majority were men, 59 % (69/117), in 41 % women (48/117). Average age was 62,5 years, range 22 - 91, SD 15,41. Gallstones were the most frequent cause in 56 %, followed by alcohol in 33 %, and other causes in 14 % . According to Ranson criteria and BISAP score, the majority of patients, 81 % had mild form of the disease, 19 % of patients had severe form, with complications. Three patients 2,5 % (3/117) died due to multiorgan failure. In 11 % of patients, a complications with psevdocyst developed during treatment. In the statistical analysis, the highest predictive value had IL-6 at admission, AUC = 0.782, at value of IL-6 = 70.05, the sensitivity was 0.80 and specificity 0.701, at the control AUC = 0.835, at value of IL-6 = 35.1, sensitivity was 0.867 and specificity 0.75. We compared the ratio IL-6/IL-10 at admission, and ratio between IL-6 /IL-10 at control, than the best predictive value had ratio at the control, AUC=0.789. At the ratio value =7.2, sensitivity is 0.667 and specificity 0.663. Conclusions Despite modern treatment protocols, patients with severe AP, still have a significant number of complications. Gallstones and alcohol are the most common causes of AP in our patients. The results of our study confirmed, that determination of IL-6 , IL-8 and IL-10 at admission and control, are useful tools to predict the course of the disease. Endosonography is an effective imaging method to clarify the aetiology of the disease. Predictive models are useful to predict the course of AP, particularly with the support of modern laboratory methods and endoscopic - radiological imaging studies. |
