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[[File:Markers of acute pancreatitis.jpg|thumb|Markers of acute pancreatitis]]
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[[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 serum as a free-form and as a complex with an α1-proteinase inhibitor, and elastase-2 (Mr 25,000; cathodic fraction). The enzyme is secreted into the pancreatic juice, which is then secreted into the [[duodenum]] and the protein sequence selected for [[Immunochemical test of blood in stool|immunochemical detection]] is not degraded during intestinal passage. In inflammatory processes, there is also 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 in 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 pancreatitis|chronic recurrent pancreatitis]], and the increase persists longer and correlates better with clinical status than [[α-amylase]] levels. [[Radioimmunoassay|RIA]] methods with 125 I-labeled elastase or newer [[ELISA]] techniques utilizing a [[monoclonal antibody]] specific 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 innovation 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 into the pancreatic juice, which is then secreted into the [[duodenum]] and the protein sequence selected for [[Immunochemical test of blood in stool|immunochemical detection]] is not degraded during intestinal passage. The detection of elastase in stool therefore is of high diagnostic value. Unlike the chromogenic method of determining fecal [[Chymotrypsin in faeces|chymotrypsin]], the determination of fecal [[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]] specific to human pancreatic elastase. The stool sample is homogenized in the extraction buffer solution, and after a dilution of 1: 500, a standard [[ELISA]] procedure on a microtiter plate with POD-streptavidin detection is performed. 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 [[Intestine (signpost)|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%, while the sensitivity reaches 100% for severe [[Pancreas|pancreatic]] insufficiency and 87% for mild and light forms. This test is commonly used in pediatrics to diagnose [[Cystic Fibrosis|cystic fibrosis]] with a specificity and sensitivity of almost 100%. False reduction in the value may be due to dilution during diarrhea (due to higher water content).<noinclude>


== References ==
=== Literature ===


== Stanovení elastázy-1 (EL-1) ve stolici ==
* 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.
[[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.
* 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.


<noinclude>
* 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.


== Odkazy ==
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</noinclude>
</noinclude>
 
[[Category: Gastroenterology]]
[[Kategorie:Gastroenterologie]]
[[Category: Biochemistry]]
[[Kategorie:Vnitřní lékařství]]
[[Category: Internal Medicine]]
[[Kategorie:Biochemie]]

Latest revision as of 21:36, 17 February 2022

Markers of acute pancreatitis


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 serum as a free-form and as a complex with an α1-proteinase inhibitor, and elastase-2 (Mr 25,000; cathodic fraction). The enzyme is secreted into the pancreatic juice, which is then secreted into the duodenum and the protein sequence selected for immunochemical detection is not degraded during intestinal passage. In inflammatory processes, there is also retrograde release into the bloodstream, and quantification of serum levels of human pancreatic elastase is a suitable marker of acute pancreatitis, such as in 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 utilizing a monoclonal antibody specific 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 innovation in the determination of serum elastase-1 is based on a latex immunoassay.

Determination of elastase-1 (EL-1) in stool[edit | edit source]

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

Human pancreatic elastase-1 is synthesized by pancreatic acinar cells. The enzyme is secreted into the pancreatic juice, which is then secreted into the duodenum and the protein sequence selected for immunochemical detection is not degraded during intestinal passage. The detection of elastase in stool therefore is of high diagnostic value. Unlike the chromogenic method of determining fecal chymotrypsin, the determination of fecal 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 specific to human pancreatic elastase. The stool sample is homogenized in the extraction buffer solution, and after a dilution of 1: 500, a standard ELISA procedure on a microtiter plate with POD-streptavidin detection is performed. 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%, while the sensitivity reaches 100% for severe pancreatic insufficiency and 87% for mild and light forms. This test is commonly used in pediatrics to diagnose cystic fibrosis with a specificity and sensitivity of almost 100%. False reduction in the value may be due to dilution during diarrhea (due to higher water content).

References[edit | edit source]

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