Pancreatic elastase: Difference between revisions
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'''O správnosti tohoto článku se vede polemika – blíže v diskusi'''
[[File:Markers of acute pancreatitis.jpg|thumb|Markers of acute pancreatitis]]
'''There is a controversy about the correctness of this article - in more detail in the discussion'''




[[Soubor:Markery akutni pankreatitis.jpg|thumb|Markery akutní pankreatitidy]]
'''Elastase-1''' (EC 3.4.21.11) is secreted as proelastase and activated by [[trypsin]]. We distinguish between elastase-1 (Mr 30,000; anodic fraction), which occurs in free-form serum and in complex with an α1-proteinase inhibitor, and elastase-2 (Mr 25,000; cathodic fraction). The enzyme is secreted by the pancreatic juice into the [[duodenum]] and the protein sequence selected for [[immunochemical detection]] is not degraded during intestinal passage. In inflammatory processes, there is also a retrograde release into the [[bloodstream]], and quantification of serum levels of human pancreatic elastase is a suitable marker of [[Acute pancreatitis (diagnostic tests)|acute pancreatitis]], such as post-ERCP, and [[Pancreatic Cancer|pancreatic cancer]]. Elastase-1 (determined by ELISA) has the highest specificity and sensitivity of all pancreatic enzymes for pancreatic cancer. Elastase-1 levels are elevated in both acute and [[chronic recurrent pancreatitis]], and the increase persists longer and correlates better with clinical status than [[α-amylase]] levels. [[RIA]] methods with 125 I-labeled elastase or newer [[ELISA]] techniques with a [[monoclonal antibody]] to elastase-1 are used to determine elastase-1. Elastase-1 (determined by ELISA) has the highest specificity and sensitivity of all pancreatic enzymes for pancreatic cancer. The reference range (for the [[RIA]] methodology) is 1.3-4.3 µg / l. The latest study in the determination of serum elastase 1 is based on a latex immunoassay.
'''Elastáza-1''' (EC 3.4.21.11) je secernována jako proelastáza a aktivována [[Trypsin|trypsinem]]. Rozlišujeme elastázu-1 (Mr 30000; anodická frakce), která se vyskytuje v séru ve volné formě a v komplexu s a<sub>1</sub>-proteinázovým inhibitorem, a elastázu-2 (Mr 25000; katodická frakce). Enzym je secernován pankreatickou šťávou do [[Duodenum|duodena]] a během střevní pasáže není degradována proteinová sekvence zvolená pro [[Imunochemie|immunochemickou detekci]]. Při zánětlivých procesech dochází také k retrográdnímu uvolnění do [[Krevní řečiště|krevního oběhu]] a kvantifikace sérové hladiny lidské pankreatické elastázy je vhodným markerem [[Pankreatitida akutní|akutní pankreatitidy]], např. post-ERCP, a [[Karcinom pankreatu|karcinomu pankreatu]]. Elastáza-1 (stanovená ELISA technikou) má ze všech pankreatických enzymů pro karcinom pankreatu nejvyšší specificitu i sensitivitu. Hladina elastázy-1 je zvýšena u akutní i [[Pankreatitida chronická|chronické recidivující pankreatitidy]], přičemž zvýšení přetrvává déle a lépe koreluje s klinickým stavem než hladina [[Amyláza|&alpha;-amylázy]]. Ke stanovení elastázy-1 se používá [[RIA]] metody se <sup>125</sup>I-značenou elastázou nebo novějších [[ELISA]] technik s [[Monoklonální protilátka|monoklonální protilátkou]] k elastáze-1. Elastáza-1 (stanovená ELISA technikou) má ze všech pankreatických enzymů pro karcinom pankreatu nejvyšší specificitu i sensitivitu. Referenční rozmezí (pro [[RIA]] metodiku) je 1.3–4.3 µg/l. Nejnovější studie stanovení sérové elastázy 1 je založena na latexové immunoassay.
== Determination of elastase-1 (EL-1) in stool ==
[[File:Elastasis in the stool.jpg|thumb|Determination of elastase-1 (EL-1) in stool]]
Human pancreatic elastase 1 is synthesized by [[Pancreas|pancreatic]] acinar cells. The enzyme is secreted by the pancreatic juice into the [[duodenum]] and the protein sequence selected for [[immunochemical detection]] is not degraded during intestinal passage. The determination of elastase therefore shows a higher dg. Unlike the chromogenic method of determining faecal [[Chymotrypsin in faeces|chymotrypsin]], the determination of faecal [[lipase]] is not important. Human pancreatic elastase 1 activity in stool samples reflects the degree of exocrine pancreatic function. Recent applications recommend the determination of pancreatic elastase-1 in duodenal juice in a stimulated functional test. Stool elastase-1 determination is of clinical importance in the differential diagnosis of [[malabsorption syndrome]], as a screening test for pancreatic disease and for long-term follow-up of patients with [[chronic pancreatitis]]. The laboratory method is based on [[ELISA]] with a [[Monoclonal antibody|monoclonal]] (or polyclonal) [[Monoclonal antibody|antibody]] to human pancreatic elastase. The stool sample is homogenized in the extraction buffer solution and, after a dilution of 1: 500, further processed by a standard [[ELISA]] procedure on a microtiter plate with POD-streptavidin detection. The kit contains 5 calibration standards in the range of 0.3-10.0 ng / ml.
[[File:Elastasis in the stool II.jpg|thumb|Determination of elastase in stool]]
The reference values ​​are 200–500 µg / g stool, the cut-off range is 100–200 µg / g, severe pancreatic insufficiency is determined at values ​​<100 µg / g stool. Immunochemical determination of elastase-1 is not affected by [[Colon|colonic]] passage, replacement therapy, or other factors that affect the enzymatic determination of [[Chymotrypsin in faeces|chymotrypsin in the stool]]. The specificity of the method is 93%, the sensitivity reaches 100% for severe [[Pancreas|pancreatic]] insufficiency, 87% for medium and light forms. This test is commonly used in pediatrics to detect [[Cystic Fibrosis|cystic fibrosis]] with a specificity and sensitivity of almost 100%. False reduction may be due to dilution (water content) during diarrhea.<noinclude>


== Odkazy ==
=== Použitá literatura ===
* KAPETANOS, D, et al. The value of serum amylase and elastase measurements in the prediction of post-ERCP acute pancreatitis. ''Hepatogastroenterology. ''2007, vol. 54, no. 74, s. 556-60, ISSN 0172-6390. PMID: 17523321.
* WU, D, et al. Evaluating the role of serum elastase 1 in the diagnosis of pancreatic cancer. ''Chin J Dig Dis. ''2006, vol. 7, no. 2, s. 117-20, ISSN 1443-9611 (Print), 1443-9573 (Electronic). PMID: 16643340.
* WILSON, RB, et al. Serum elastase in the diagnosis of acute pancreatitis: a prospective study. ''ANZ J Surg. ''2005, vol. 75, no. 3, s. 152-6, ISSN 1445-1433 (Print), 1445-2197 (Electronic). PMID: 15777396.
* KEIM, V, et al. Evaluation of Pankrin, a new serum test for diagnosis of acute pancreatitis. ''Clin Chim Acta. ''2003, vol. 332, no. 1-2, s. 45-50, ISSN 0009-8981 (Print), 1873-3492 (Electronic). PMID: 12763279.
* KATSANOS, KH, et al. The true value of serum elastase-1 in endoscopic retrograde cholangiopancreatography (ERCP). ''Eur J Intern Med. ''2002, vol. 13, no. 5, s. 329-335, ISSN 0953-6205 (Print), 1879-0828 (Electronic). PMID: 12144913.
* OHDE, K, et al. Determination of elastase 1 in plasma or serum by latex turbidometric immunoassay with automatic analyzer. ''Rinsho Byori. ''2002, vol. 50, no. 4, s. 376-80, ISSN 0047-1860. PMID: 12014017.
* MILLSON, CE, et al. A prospective study of serum pancreatic elastase-1 in the diagnosis and assessment of acute pancreatitis. ''Scand J Gastroenterol. ''1998, vol. 33, no. 6, s. 664-8, ISSN 0036-5521 (Print), 1502-7708 (Electronic). PMID: 9669641.
* IKEI, S, et al. Blood concentrations of polymorphonuclear leucocyte elastase and interleukin-6 are indicators for the occurrence of multiple organ failures at the early stage of acute pancreatitis. ''J Gastroenterol Hepatol. ''1998, vol. 13, no. 12, s. 1274-83, ISSN 0815-9319 (Print), 1440-1746 (Electronic). PMID: 9918438.


== Stanovení elastázy-1 (EL-1) ve stolici ==
* KEIM, V, et al. Polyclonal pancreatic elastase assay is superior to monoclonal assay for diagnosis of acute pancreatitis. ''Clin Chem. ''1997, vol. 43, no. 12, s. 2339-44, ISSN 0009-9147 (Print), 1530-8561 (Electronic). PMID: 9439452.
[[Soubor:Elastaza ve stolici.jpg|thumb|Stanovení elastázy-1 (EL-1) ve stolici]]
Lidská pankreatická elastáza 1 je syntetizována acinárními buňkami [[Pankreas|pankreatu]]. Enzym je secernován pankreatickou šťávou do [[Duodenum|duodena]] a během střevní pasáže není degradována proteinová sekvence zvolená pro [[Imunochemie|immunochemickou detekci]]. Stanovení elastázy vykazuje proto vyšší dg. přínos, na rozdíl od chromogenní metody stanovení [[Chymotripsin|chymotrypsinu]] ve stolici, význam nemá ani stanovení [[Lipáza|lipázy]] ve stolici. Aktivita lidské pankreatické elastázy 1 ve vzorcích stolice odráží míru exokrinní pankreatické funkce. Nejnovější aplikace doporučují stanovení pankreatické elastázy-1 v duodenální šťávě při stimulovaném funkčním testu. Klinický význam má stanovení elastázy-1 ve stolici v diferenciální diagnostice [[Malabsorpční syndrom|malabsorpčního syndromu]], jako screeningový test onemocnění pankreatu a pro dlouhodobé sledování nemocných s [[Pankreatitida chronická|chronickou pankreatitídou]].
[[Soubor:Elastaza ve stolici II.jpg|thumb|Stanovení elastázy ve stolici]]
Laboratorní metoda je založena na imunologickém průkazu [[ELISA]] metodou s [[Monoklonální protilátka|monoklonální]] (nebo polyklonální) [[Protilátka|protilátkou]] k lidské, pankreatické elastáze. Vzorek stolice je v laboratoři homogenizován v extrakčním nárazníkovém roztoku a po ředění 1:500 dále zpracován běžným [[ELISA]] postupem na mikrotitrační destičce s detekcí pomocí POD-streptavidin. Souprava obsahuje 5 kalibračních standardů v rozmezí 0.3–10.0 ng/ml.  


Referenční hodnoty jsou 200–500 µg/g stolice, hraniční pásmo je 100–200 µg/g, závažná pankreatická insuficience je stanovena při hodnotách < 100µg/g stolice. Imunochemické stanovení elastázy-1 není ovlivněno pasáží [[Tlusté střevo|tlustým střevem]], substituční terapií ani jinými faktory, které ovlivňují enzymové stanovení [[Chymotrypsin ve stolici|chymotrypsinu ve stolici]]. Specificita metody je 93%, senzitivita dosahuje pro těžkou [[Pankreas|pankreatickou]] insuficienci hodnoty 100%, pro střední a lehké formy 87%. Tento test je běžně používán v pediatrii k průkazu [[Cystická fibróza|cystické fibrózy]] se specificitou i senzitivitou téměř 100%. Falešná snížená hodnota může být způsobena zředěním (obsahem vody) při průjmu.
* IWASE, K, et al. Serial changes in plasma levels of pancreatic elastase 1 after pancreatic surgeries. ''Res Exp Med (Berl). ''1995, vol. 195, no. 2, s. 93-100, ISSN 0300-9130. PMID: 7659839.


<noinclude>
* SATAKE, K, et al. CA19-9 as a screening and diagnostic tool in symptomatic patients: the Japanese experience. ''Pancreas. ''1994, vol. 9, no. 6, s. 703-6, ISSN 0885-3177 (Print), 1536-4828 (Electronic). PMID: 7846012.


== Odkazy ==
* HOMMA, T, et al. The study of the mass screening of persons without symptoms and of the screening of outpatients with gastrointestinal complaints or icterus for pancreatic cancer in Japan, using CA19-9 and elastase-1 or ultrasonography. ''Int J Pancreatol. ''1991, vol. 9, s. 119-24, ISSN 0169-4197. PMID: 1744437.
=== Použitá literatura ===
 
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* LINDER, R, et al. Pancreatic elastase 1 after pancreatic transplantation. ''Pancreas. ''1991, vol. 6, no. 1, s. 31-6, ISSN 0885-3177 (Print), 1536-4828 (Electronic). PMID: 1704632.
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* TRAN, TC, et al. Pancreatic fibrosis correlates with exocrine pancreatic insufficiency after pancreatoduodenectomy. ''Dig Surg. ''2008, vol. 25, no. 4, s. 311-8, ISSN 0253-4886 (Print). 1421-9883 (Electronic). PMID: 18818498.
| článek = The value of serum amylase and elastase measurements in the prediction of post-ERCP acute pancreatitis
 
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* ERICKSON, JA, et al. Evaluation of a fecal pancreatic elastase-1 enzyme-linked immunosorbent assay: Assessment versus an established assay and implication in classifying pancreatic function. ''Clin Chim Acta. ''2008, vol. 397, no. 1-2, s. 87-97, ISSN 0009-8981 (Print), 1873-3492 (Electronic). PMID: 18706899.
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* LIEB, JG, et al. Pancreatic function testing: here to stay for the 21st century. ''World J Gastroenterol. ''2008, vol. 14, no. 20, s. 3149-58, ISSN 1007-9327. PMID: 18506918.
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* HAHN, JU, et al. Low fecal elastase 1 levels do not indicate exocrine pancreatic insufficiency in type-1 diabetes mellitus. ''Pancreas. ''2008, vol. 36, no. 3, s. 274-8, ISSN 0885-3177 (Print) 1536-4828 (Electronic). PMID: 18362841.
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* PEZZILLI, R, et al. Fecal calprotectin and elastase 1 determinations in patients with pancreatic diseases: a possible link between pancreatic insufficiency and intestinal inflammation. ''J Gastroenterol. ''2007, vol. 42, no. 9, s. 754-60, ISSN 0944-1174 (Print), 1435-5922 (Electronic). PMID: 17876545.
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* BOROWITZ, D, et al. Comparison of monoclonal and polyclonal ELISAs for fecal elastase in patients with cystic fibrosis and pancreatic insufficiency. ''J Pediatr Gastroenterol Nutr. ''2007, vol. 44(2):219-23, no. 2, s. 219-23, ISSN 0277-2116 (Print), 1536-4801 (Electronic). PMID: 17255835.
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* NARUSE, S, et al. Fecal pancreatic elastase: a reproducible marker for severe exocrine pancreatic insufficiency. ''J Gastroenterol. ''2006, vol. 41, no. 9, s. 901-8, ISSN 0944-1174 (Print), 1435-5922 (Electronic). PMID: 17048055.
| článek = Evaluating the role of serum elastase 1 in the diagnosis of pancreatic cancer
 
| časopis = Chin J Dig Dis
* KRECHLER, T, et al. Faecal elastase I--its use in diagnosis of chronic pancreatitis. ''Cas Lek Cesk. ''2006, vol. 145, no. 6, s. 480-3, ISSN 0008-7335. PMID: 16836002.
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* SENKAL, M, et al. Pancreatic elastase-1 in the stool for the determination of exocrine pancreas function of postoperative patients with early enteral nutrition -- a pilot study. ''Dtsch Med Wochenschr. ''2006, vol. 131, no. 1-2, s. 13-6, ISSN 0012-0472 (Print), 1439-4413 (Electronic). PMID: 16374736.
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* ELPHICK, DA, et al. Comparing the urinary pancreolauryl ratio and faecal elastase-1 as indicators of pancreatic insufficiency in clinical practice. ''Pancreatology. ''2005, vol. 5, no. 2-3, s. 196-200, ISSN 1424-3903 (Print), 1424-3911 (Electronic). PMID: 15849489.
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* MOLINARI, I, et al. Fecal chymotrypsin and elastase-1 determination on one single stool collected at random: diagnostic value for exocrine pancreatic status. ''Clin Biochem. ''2004, vol. 37, no. 9, s. 758-63, ISSN 0009-9120 (Print), 1873-2933 (Electronic). PMID: 15329313.
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* {{Citace
* MIENDJE, Y, et al. Polyclonal versus monoclonal ELISA for the determination of fecal elastase 1: diagnostic value in cystic fibrosis and chronic pancreatic insufficiency. ''Clin Lab. ''2004, vol. 50, no. 7-8, s. 419-24, ISSN 1433-6510. PMID: 15330510.
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* STEVENS, T, et al. Analysis of pancreatic elastase-1 concentrations in duodenal aspirates from healthy subjects and patients with chronic pancreatitis. ''Dig Dis Sci. ''2004, vol. 49, no. 9, s. 1405-11, ISSN 0163-2116 (Print), 1573-2568 (Electronic). PMID: 15481311.
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* LANKISCH, PG. Now that fecal elastase is available in the United States, should clinicians start using it?. ''Curr Gastroenterol Rep. ''2004, vol. 6, no. 2, s. 126-31, ISSN 1522-8037 (Print), 1534-312X (Electronic). PMID: 15191690.
| článek = Serum elastase in the diagnosis of acute pancreatitis: a prospective study
 
| časopis = ANZ J Surg
* BRYDON, WG, et al. Limitations of faecal elastase-1 and chymotrypsin as tests of exocrine pancreatic disease in adults. ''Ann Clin Biochem. ''2004, vol. 41, s. 78-81, ISSN 0004-5632 (Print), 1758-1001 (Electronic). PMID: 14713391.
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* HARDT, PD, et al. The commercially available ELISA for pancreatic elastase 1 based on polyclonal antibodies does measure an as yet unknown antigen different from purified elastase 1. Binding studies and clinical use in patients with exocrine pancreatic insufficiency. ''Z Gastroenterol. ''2003, vol. 41, no. 9, s. 903-6, ISSN 0044-2771 (Print), 1439-7803 (Electronic). PMID: 13130326.
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* WALKOWIAK, J, et al. Comparison of faecal lipase test and faecal elastase-1 test in the assessment of exocrine pancreatic function in cystic fibrosis. ''Med Wieku Rozwoj. ''2003, vol. 7, no. 2, s. 149-55, ISSN 1428-345X. PMID: 12878785.
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* SONWALKAR, SA, et al. A prospective, comparative study of the para-aminobenzoic acid test and faecal elastase 1 in the assessment of exocrine pancreatic function. ''Aliment Pharmacol Ther. ''2003, vol. 17, no. 3, s. 467-71, ISSN 0269-2813 (Print) 1365-2036 (Electronic). PMID: 12562462.
}}
 
* {{Citace
* TAKEDA, M, et al. Fecal elastase-1 test: clinical evaluation of a new noninvasive pancreatic function test. ''Rinsho Byori. ''2002, vol. 50, no. 9, s. 893-8, ISSN 0047-1860. PMID: 12386968.
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* WALKOWIAK, J, et al. Fecal elastase-1 is superior to fecal chymotrypsin in the assessment of pancreatic involvement in cystic fibrosis. ''Pediatrics. ''2002, vol. 110, no. 1, s. e7-e7, ISSN 0031-4005 (Print), 1098-4275 (Electronic). PMID: 12093988.
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* BEHARRY, S, et al. How useful is fecal pancreatic elastase 1 as a marker of exocrine pancreatic disease?. ''J Pediatr. ''2002, vol. 141, no. 1, s. 84-90, ISSN 0022-3476 (Print), 1097-6833 (Electronic). PMID: 12091856.
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| časopis = Clin Chim Acta
* DOMINICI, R, et al. Fecal elastase-1 as a test for pancreatic function: a review. ''Clin Chem Lab Med. ''2002, vol. 40, no. 4, s. 325-32, ISSN 1434-6621. PMID: 12059069.
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* LÜTH, S, et al. Fecal elastase-1 determination: 'gold standard' of indirect pancreatic function tests?. ''Scand J Gastroenterol. ''2001, vol. 36, no. 10, s. 1092-9, ISSN 0036-5521(Print), 1502-7708 (Electronic). PMID: 11589385.
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* ICKS, A, et al. Low fecal elastase-1 in type I diabetes mellitus. ''Z Gastroenterol. ''2001, vol. 39, no. 10, s. 823-30, ISSN 0044-2771 (Print), 1439-7803 (Electronic). PMID: 11605150.
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* CARROCCIO, A, et al. Diagnostic accuracy of fecal elastase 1 assay in patients with pancreatic maldigestion or intestinal malabsorption: a collaborative study of the Italian Society of Pediatric Gastroenterology and Hepatology. ''Dig Dis Sci. ''2001, vol. 46, no. 6, s. 1335-42, ISSN 0163-2116 (Print), 1573-2568 (Electronic). PMID: 11414313.
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* {{Citace
* NISSLER, K, et al. Pancreatic elastase 1 in feces of preterm and term infants. ''J Pediatr Gastroenterol Nutr. ''2001, vol. 33, no. 1, s. 28-31, ISSN 0277-2116 (Print), 1536-4801 (Electronic). PMID: 11479404.
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* LEUS, J, et al. Detection and follow up of exocrine pancreatic insufficiency in cystic fibrosis: a review. ''Eur J Pediatr. ''2000, vol. 159, no. 8, s. 563-8, ISSN 0340-6199 (Print), 1432-1076 (Electronic). PMID: 10968231.
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* PHILLIPS, IJ, et al. Faecal elastase 1: a marker of exocrine pancreatic insufficiency in cystic fibrosis. ''Ann Clin Biochem. ''1999, vol. 36, no. 6, s. 739-42, ISSN 0004-5632 (Print), 1758-1001 (Electronic). PMID: 10586310.
| článek = The true value of serum elastase-1 in endoscopic retrograde cholangiopancreatography (ERCP)
 
| časopis = Eur J Intern Med
* GULLO, L, et al. Fecal elastase 1 determination in chronic pancreatitis. ''Dig Dis Sci. ''1999, vol. 44, no. 1, s. 210-3, ISSN 0163-2116 (Print), 1573-2568 (Electronic). PMID: 9952246.
| rok = 2002
 
| svazek = 13
** KAPETANOS, D, et al. The value of serum amylase and elastase measurements in the prediction of post-ERCP acute pancreatitis. ''Hepatogastroenterology. ''2007, vol. 54, no. 74, s. 556-60, ISSN 0172-6390. PMID: 17523321.
| číslo = 5
** WU, D, et al. Evaluating the role of serum elastase 1 in the diagnosis of pancreatic cancer. ''Chin J Dig Dis. ''2006, vol. 7, no. 2, s. 117-20, ISSN 1443-9611 (Print), 1443-9573 (Electronic). PMID: 16643340.
| strany = 329-335
** WILSON, RB, et al. Serum elastase in the diagnosis of acute pancreatitis: a prospective study. ''ANZ J Surg. ''2005, vol. 75, no. 3, s. 152-6, ISSN 1445-1433 (Print), 1445-2197 (Electronic). PMID: 15777396.
| issn = 0953-6205 (Print), 1879-0828 (Electronic)
** KEIM, V, et al. Evaluation of Pankrin, a new serum test for diagnosis of acute pancreatitis. ''Clin Chim Acta. ''2003, vol. 332, no. 1-2, s. 45-50, ISSN 0009-8981 (Print), 1873-3492 (Electronic). PMID: 12763279.
| pmid = 12144913
** KATSANOS, KH, et al. The true value of serum elastase-1 in endoscopic retrograde cholangiopancreatography (ERCP). ''Eur J Intern Med. ''2002, vol. 13, no. 5, s. 329-335, ISSN 0953-6205 (Print), 1879-0828 (Electronic). PMID: 12144913.
}}
** OHDE, K, et al. Determination of elastase 1 in plasma or serum by latex turbidometric immunoassay with automatic analyzer. ''Rinsho Byori. ''2002, vol. 50, no. 4, s. 376-80, ISSN 0047-1860. PMID: 12014017.
* {{Citace
** MILLSON, CE, et al. A prospective study of serum pancreatic elastase-1 in the diagnosis and assessment of acute pancreatitis. ''Scand J Gastroenterol. ''1998, vol. 33, no. 6, s. 664-8, ISSN 0036-5521 (Print), 1502-7708 (Electronic). PMID: 9669641.
| typ = článek
** IKEI, S, et al. Blood concentrations of polymorphonuclear leucocyte elastase and interleukin-6 are indicators for the occurrence of multiple organ failures at the early stage of acute pancreatitis. ''J Gastroenterol Hepatol. ''1998, vol. 13, no. 12, s. 1274-83, ISSN 0815-9319 (Print), 1440-1746 (Electronic). PMID: 9918438.
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| pmid = 11589385
}}
* {{Citace
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| jméno1 = A
| kolektiv = ano
| článek = Low fecal elastase-1 in type I diabetes mellitus
| časopis = Z Gastroenterol
| rok = 2001
| svazek = 39
| číslo = 10
| strany = 823-30
| issn = 0044-2771 (Print), 1439-7803 (Electronic)
| pmid = 11605150
}}
* {{Citace
| typ = článek
| příjmení1 = Carroccio
| jméno1 = A
| kolektiv = ano
| článek = Diagnostic accuracy of fecal elastase 1 assay in patients with pancreatic maldigestion or intestinal malabsorption: a collaborative study of the Italian Society of Pediatric Gastroenterology and Hepatology
| časopis = Dig Dis Sci
| rok = 2001
| svazek = 46
| číslo = 6
| strany = 1335-42
| issn = 0163-2116 (Print), 1573-2568 (Electronic)
| pmid = 11414313
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* {{Citace
| typ = článek
| příjmení1 = Nissler
| jméno1 = K
| kolektiv = ano
| článek = Pancreatic elastase 1 in feces of preterm and term infants
| časopis = J Pediatr Gastroenterol Nutr
| rok = 2001
| svazek = 33
| číslo = 1
| strany = 28-31
| issn = 0277-2116 (Print), 1536-4801 (Electronic)
| pmid = 11479404
}}
* {{Citace
| typ = článek
| příjmení1 = Leus
| jméno1 = J
| kolektiv = ano
| článek = Detection and follow up of exocrine pancreatic insufficiency in cystic fibrosis: a review
| časopis = Eur J Pediatr
| rok = 2000
| svazek = 159
| číslo = 8
| strany = 563-8
| issn = 0340-6199 (Print), 1432-1076 (Electronic)
| pmid = 10968231
}}
* {{Citace
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| jméno1 = IJ
| kolektiv = ano
| článek = Faecal elastase 1: a marker of exocrine pancreatic insufficiency in cystic fibrosis
| časopis = Ann Clin Biochem
| rok = 1999
| svazek = 36
| číslo = 6
| strany = 739-42
| issn = 0004-5632 (Print), 1758-1001 (Electronic)
| pmid = 10586310
}}
* {{Citace
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| jméno1 = L
| kolektiv = ano
| článek = Fecal elastase 1 determination in chronic pancreatitis
| časopis = Dig Dis Sci
| rok = 1999
| svazek = 44
| číslo = 1
| strany = 210-3
| issn = 0163-2116 (Print), 1573-2568 (Electronic)
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Markers of acute pancreatitis

There is a controversy about the correctness of this article - in more detail in the discussion


Elastase-1 (EC 3.4.21.11) is secreted as proelastase and activated by trypsin. We distinguish between elastase-1 (Mr 30,000; anodic fraction), which occurs in free-form serum and in complex with an α1-proteinase inhibitor, and elastase-2 (Mr 25,000; cathodic fraction). The enzyme is secreted by the pancreatic juice into the duodenum and the protein sequence selected for immunochemical detection is not degraded during intestinal passage. In inflammatory processes, there is also a retrograde release into the bloodstream, and quantification of serum levels of human pancreatic elastase is a suitable marker of acute pancreatitis, such as post-ERCP, and pancreatic cancer. Elastase-1 (determined by ELISA) has the highest specificity and sensitivity of all pancreatic enzymes for pancreatic cancer. Elastase-1 levels are elevated in both acute and chronic recurrent pancreatitis, and the increase persists longer and correlates better with clinical status than α-amylase levels. RIA methods with 125 I-labeled elastase or newer ELISA techniques with a monoclonal antibody to elastase-1 are used to determine elastase-1. Elastase-1 (determined by ELISA) has the highest specificity and sensitivity of all pancreatic enzymes for pancreatic cancer. The reference range (for the RIA methodology) is 1.3-4.3 µg / l. The latest study in the determination of serum elastase 1 is based on a latex immunoassay.

Determination of elastase-1 (EL-1) in stool

Determination of elastase-1 (EL-1) in stool

Human pancreatic elastase 1 is synthesized by pancreatic acinar cells. The enzyme is secreted by the pancreatic juice into the duodenum and the protein sequence selected for immunochemical detection is not degraded during intestinal passage. The determination of elastase therefore shows a higher dg. Unlike the chromogenic method of determining faecal chymotrypsin, the determination of faecal lipase is not important. Human pancreatic elastase 1 activity in stool samples reflects the degree of exocrine pancreatic function. Recent applications recommend the determination of pancreatic elastase-1 in duodenal juice in a stimulated functional test. Stool elastase-1 determination is of clinical importance in the differential diagnosis of malabsorption syndrome, as a screening test for pancreatic disease and for long-term follow-up of patients with chronic pancreatitis. The laboratory method is based on ELISA with a monoclonal (or polyclonal) antibody to human pancreatic elastase. The stool sample is homogenized in the extraction buffer solution and, after a dilution of 1: 500, further processed by a standard ELISA procedure on a microtiter plate with POD-streptavidin detection. The kit contains 5 calibration standards in the range of 0.3-10.0 ng / ml.

Determination of elastase in stool

The reference values ​​are 200–500 µg / g stool, the cut-off range is 100–200 µg / g, severe pancreatic insufficiency is determined at values ​​<100 µg / g stool. Immunochemical determination of elastase-1 is not affected by colonic passage, replacement therapy, or other factors that affect the enzymatic determination of chymotrypsin in the stool. The specificity of the method is 93%, the sensitivity reaches 100% for severe pancreatic insufficiency, 87% for medium and light forms. This test is commonly used in pediatrics to detect cystic fibrosis with a specificity and sensitivity of almost 100%. False reduction may be due to dilution (water content) during diarrhea.

Odkazy

Použitá literatura

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    • KAPETANOS, D, et al. The value of serum amylase and elastase measurements in the prediction of post-ERCP acute pancreatitis. Hepatogastroenterology. 2007, vol. 54, no. 74, s. 556-60, ISSN 0172-6390. PMID: 17523321.
    • WU, D, et al. Evaluating the role of serum elastase 1 in the diagnosis of pancreatic cancer. Chin J Dig Dis. 2006, vol. 7, no. 2, s. 117-20, ISSN 1443-9611 (Print), 1443-9573 (Electronic). PMID: 16643340.
    • WILSON, RB, et al. Serum elastase in the diagnosis of acute pancreatitis: a prospective study. ANZ J Surg. 2005, vol. 75, no. 3, s. 152-6, ISSN 1445-1433 (Print), 1445-2197 (Electronic). PMID: 15777396.
    • KEIM, V, et al. Evaluation of Pankrin, a new serum test for diagnosis of acute pancreatitis. Clin Chim Acta. 2003, vol. 332, no. 1-2, s. 45-50, ISSN 0009-8981 (Print), 1873-3492 (Electronic). PMID: 12763279.
    • KATSANOS, KH, et al. The true value of serum elastase-1 in endoscopic retrograde cholangiopancreatography (ERCP). Eur J Intern Med. 2002, vol. 13, no. 5, s. 329-335, ISSN 0953-6205 (Print), 1879-0828 (Electronic). PMID: 12144913.
    • OHDE, K, et al. Determination of elastase 1 in plasma or serum by latex turbidometric immunoassay with automatic analyzer. Rinsho Byori. 2002, vol. 50, no. 4, s. 376-80, ISSN 0047-1860. PMID: 12014017.
    • MILLSON, CE, et al. A prospective study of serum pancreatic elastase-1 in the diagnosis and assessment of acute pancreatitis. Scand J Gastroenterol. 1998, vol. 33, no. 6, s. 664-8, ISSN 0036-5521 (Print), 1502-7708 (Electronic). PMID: 9669641.
    • IKEI, S, et al. Blood concentrations of polymorphonuclear leucocyte elastase and interleukin-6 are indicators for the occurrence of multiple organ failures at the early stage of acute pancreatitis. J Gastroenterol Hepatol. 1998, vol. 13, no. 12, s. 1274-83, ISSN 0815-9319 (Print), 1440-1746 (Electronic). PMID: 9918438.
    • KEIM, V, et al. Polyclonal pancreatic elastase assay is superior to monoclonal assay for diagnosis of acute pancreatitis. Clin Chem. 1997, vol. 43, no. 12, s. 2339-44, ISSN 0009-9147 (Print), 1530-8561 (Electronic). PMID: 9439452.
    • IWASE, K, et al. Serial changes in plasma levels of pancreatic elastase 1 after pancreatic surgeries. Res Exp Med (Berl). 1995, vol. 195, no. 2, s. 93-100, ISSN 0300-9130. PMID: 7659839.
    • SATAKE, K, et al. CA19-9 as a screening and diagnostic tool in symptomatic patients: the Japanese experience. Pancreas. 1994, vol. 9, no. 6, s. 703-6, ISSN 0885-3177 (Print), 1536-4828 (Electronic). PMID: 7846012.
    • HOMMA, T, et al. The study of the mass screening of persons without symptoms and of the screening of outpatients with gastrointestinal complaints or icterus for pancreatic cancer in Japan, using CA19-9 and elastase-1 or ultrasonography. Int J Pancreatol. 1991, vol. 9, s. 119-24, ISSN 0169-4197. PMID: 1744437.
    • LINDER, R, et al. Pancreatic elastase 1 after pancreatic transplantation. Pancreas. 1991, vol. 6, no. 1, s. 31-6, ISSN 0885-3177 (Print), 1536-4828 (Electronic). PMID: 1704632.
    • PEZZILLI, R, et al. Serum pancreatic enzymes in the diagnosis of carcinoma of the pancreas. G Ital Oncol. 1989, vol. 9, no. 1, s. 7-13, ISSN 0392-128X. PMID: 2468605.
    • TRAN, TC, et al. Pancreatic fibrosis correlates with exocrine pancreatic insufficiency after pancreatoduodenectomy. Dig Surg. 2008, vol. 25, no. 4, s. 311-8, ISSN 0253-4886 (Print). 1421-9883 (Electronic). PMID: 18818498.
    • ERICKSON, JA, et al. Evaluation of a fecal pancreatic elastase-1 enzyme-linked immunosorbent assay: Assessment versus an established assay and implication in classifying pancreatic function. Clin Chim Acta. 2008, vol. 397, no. 1-2, s. 87-97, ISSN 0009-8981 (Print), 1873-3492 (Electronic). PMID: 18706899.
    • LIEB, JG, et al. Pancreatic function testing: here to stay for the 21st century. World J Gastroenterol. 2008, vol. 14, no. 20, s. 3149-58, ISSN 1007-9327. PMID: 18506918.
    • HAHN, JU, et al. Low fecal elastase 1 levels do not indicate exocrine pancreatic insufficiency in type-1 diabetes mellitus. Pancreas. 2008, vol. 36, no. 3, s. 274-8, ISSN 0885-3177 (Print) 1536-4828 (Electronic). PMID: 18362841.
    • PEZZILLI, R, et al. Fecal calprotectin and elastase 1 determinations in patients with pancreatic diseases: a possible link between pancreatic insufficiency and intestinal inflammation. J Gastroenterol. 2007, vol. 42, no. 9, s. 754-60, ISSN 0944-1174 (Print), 1435-5922 (Electronic). PMID: 17876545.
    • GILLAMS, A, et al. Correlation of MRCP quantification (MRCPQ) with conventional non-invasive pancreatic exocrine function tests. Abdom Imaging. 2008, vol. 33, no. 4, s. 469-73, ISSN 0942-8925 (Print), 1432-0509 (Electronic). PMID: 17653788.
    • BOROWITZ, D, et al. Comparison of monoclonal and polyclonal ELISAs for fecal elastase in patients with cystic fibrosis and pancreatic insufficiency. J Pediatr Gastroenterol Nutr. 2007, vol. 44(2):219-23, no. 2, s. 219-23, ISSN 0277-2116 (Print), 1536-4801 (Electronic). PMID: 17255835.
    • NARUSE, S, et al. Fecal pancreatic elastase: a reproducible marker for severe exocrine pancreatic insufficiency. J Gastroenterol. 2006, vol. 41, no. 9, s. 901-8, ISSN 0944-1174 (Print), 1435-5922 (Electronic). PMID: 17048055.
    • KRECHLER, T, et al. Faecal elastase I--its use in diagnosis of chronic pancreatitis. Cas Lek Cesk. 2006, vol. 145, no. 6, s. 480-3, ISSN 0008-7335. PMID: 16836002.
    • SENKAL, M, et al. Pancreatic elastase-1 in the stool for the determination of exocrine pancreas function of postoperative patients with early enteral nutrition -- a pilot study. Dtsch Med Wochenschr. 2006, vol. 131, no. 1-2, s. 13-6, ISSN 0012-0472 (Print), 1439-4413 (Electronic). PMID: 16374736.
    • ELPHICK, DA, et al. Comparing the urinary pancreolauryl ratio and faecal elastase-1 as indicators of pancreatic insufficiency in clinical practice. Pancreatology. 2005, vol. 5, no. 2-3, s. 196-200, ISSN 1424-3903 (Print), 1424-3911 (Electronic). PMID: 15849489.
    • MOLINARI, I, et al. Fecal chymotrypsin and elastase-1 determination on one single stool collected at random: diagnostic value for exocrine pancreatic status. Clin Biochem. 2004, vol. 37, no. 9, s. 758-63, ISSN 0009-9120 (Print), 1873-2933 (Electronic). PMID: 15329313.
    • MIENDJE, Y, et al. Polyclonal versus monoclonal ELISA for the determination of fecal elastase 1: diagnostic value in cystic fibrosis and chronic pancreatic insufficiency. Clin Lab. 2004, vol. 50, no. 7-8, s. 419-24, ISSN 1433-6510. PMID: 15330510.
    • STEVENS, T, et al. Analysis of pancreatic elastase-1 concentrations in duodenal aspirates from healthy subjects and patients with chronic pancreatitis. Dig Dis Sci. 2004, vol. 49, no. 9, s. 1405-11, ISSN 0163-2116 (Print), 1573-2568 (Electronic). PMID: 15481311.
    • LANKISCH, PG. Now that fecal elastase is available in the United States, should clinicians start using it?. Curr Gastroenterol Rep. 2004, vol. 6, no. 2, s. 126-31, ISSN 1522-8037 (Print), 1534-312X (Electronic). PMID: 15191690.
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Kategorie:Gastroenterologie Kategorie:Vnitřní lékařství Kategorie:Biochemie

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