Akut pankreatitte hastalık şiddetinin ve nekrozun ekzokrin-endokrin yetmezlikle ilişkisinin araştırılması
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Date
2008
Authors
Garip, Gökhan
Journal Title
Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
Akut Pankreatit sonrası geç dönemde hastalık şiddetinin, nekrozun, nekroz oranının ve lokalizasyonunun organın endokrin ve ekzokrin fonksiyonlara etkisinin araştırılmasıdır. Mart 2003 - Ekim 2007 tarihleri arasında Akut Pankreatit tanısı ile tedavi edilmiş ve üzerinden 6 ay süre geçmiş olan 109 hasta çalışmaya dahi edildi. Hastalar hastalık şiddetine, nekroz oranına ve lokalizasyonuna göre sınıflandırıldı. Ekzokrin fonksiyon değerlendirmesi için sübjektif klinik değerlendirme ve dışkıda ELISA ile Fekal Pankreatik Elastaz - I (FPE - I) çalışıldı. Endokrin fonksiyon değerlendirmesi için de Oral Glukoz Tolerans Testi (OGTT) yapıldı. Hastalık şiddeti, organda nekroz varlığı, nekrozun oranı ve lokalizasyonu ile ekzokrin ve endokrin disfonksiyon arasındaki ilişki araştırıldı. Hastaların 58' i erkek, 51' i kadın olup yaş ortalaması 56.5 ± 15.7 idi. % 35.8' i Ağır Akut Pankreatit (AAP) olan hastaların % 27.5' inde pankreasta nekroz vardı. Hastaların %13.7' sinde ekzokrin disfonksiyon tespit edildi (AAP' te % 17.9, Hafif Akut Pankreatitte % 11.4). Hastaların % 34.7' sinde endokrin disfonksiyon tespit edildi. FPE - I düzeyi AAP' te, Nekrotizan Akut Pankreatit' te (NAP) ve pankreas baş lokalizasyonunda nekrozu olan hastalarda diğerlerine göre düşüktü (sırası ile ; 330 ± 170, 292 ± 178 ve 189 ± 82 M9 / 9 dışkı) (p < 0.05). Nekrozektomi yapılan hastaların % 40' ında ekzokrin disfonksiyon görüldü. Endokrin disfonksiyon AAP ve NAP' li hastalarda diğerlerine göre daha belirgindi (sırası ile % 56.4 ve % 66.6) (p < 0.001). Nekrozektomi yapılan hastaların ise tamamında endokrin disfonksiyon saptandı. AAP' li, NAP' li, nekrozektomi uygulanmış ve pankreas baş kesiminde nekroz saptanan hastalar uzun dönemde pankreas fonksiyonları açısından takip edilmelidir.
Evaluation of the impact of the acute pancreatitis on pancreatic exocrine and endocrine functions in the long term, according to severity of the illness, necrosis, necrosis ratio and localization. 109 patients, who were diagnosed and treated as Acute Pancreatitis between March 2003 - September 2007 with at least 6 month follow - up included in the study. Patients were classified according to severity of the illness, necrosis ratio and localization. For exocrine function evaluation; subjective clinical evaluation and Faecal Pancreatic Elastase - I (FPE - I) with ELiSA in the stool were studied. For endocrine function evaluation, Oral Glucose Tolerance Test (OGTT) were completed. The correlation of illness severity, organ necrosis, necrosis ratio and localization with exocrine and endocrine dysfunction were searched. There were 58 male, 51 female patient and mean age was 56.5 ± 15.7. Of the patients; 35.8 % were Severe Acute Pancreatitis (SAP) and 27.5 % had pancreatic necrosis. Exocrine dysfunction was identified in 13.7 % of the patients (17.9 % were SAP, 11.4 % were Mild Acute Pancreatitis). 34.7 % of the patients had endocrine dysfunction. Patients with SAP, Necrotizing Acute Pancreatitis (NAP) and pancreatic head necrosis, FPE - I levels were relatively low. (Respectively 330 ± 170, 292 ± 178, 189 ± 82 |jg / g stool) (p < 0.05). 40 % of the patients who had necrosectomy were with exocrine dysfunction. Endocrine dysfunction was more significant in patients with SAP and NAP (Respectively 56.4 % and 66.6 %) (p < 0.001). There was endocrine dysfunction in all of the patients who had necrosectomy. Patients with SAP, NAP, pancreatic head necrosis and necrosectomy should be pursued for pancreatic functions in the long term.
Evaluation of the impact of the acute pancreatitis on pancreatic exocrine and endocrine functions in the long term, according to severity of the illness, necrosis, necrosis ratio and localization. 109 patients, who were diagnosed and treated as Acute Pancreatitis between March 2003 - September 2007 with at least 6 month follow - up included in the study. Patients were classified according to severity of the illness, necrosis ratio and localization. For exocrine function evaluation; subjective clinical evaluation and Faecal Pancreatic Elastase - I (FPE - I) with ELiSA in the stool were studied. For endocrine function evaluation, Oral Glucose Tolerance Test (OGTT) were completed. The correlation of illness severity, organ necrosis, necrosis ratio and localization with exocrine and endocrine dysfunction were searched. There were 58 male, 51 female patient and mean age was 56.5 ± 15.7. Of the patients; 35.8 % were Severe Acute Pancreatitis (SAP) and 27.5 % had pancreatic necrosis. Exocrine dysfunction was identified in 13.7 % of the patients (17.9 % were SAP, 11.4 % were Mild Acute Pancreatitis). 34.7 % of the patients had endocrine dysfunction. Patients with SAP, Necrotizing Acute Pancreatitis (NAP) and pancreatic head necrosis, FPE - I levels were relatively low. (Respectively 330 ± 170, 292 ± 178, 189 ± 82 |jg / g stool) (p < 0.05). 40 % of the patients who had necrosectomy were with exocrine dysfunction. Endocrine dysfunction was more significant in patients with SAP and NAP (Respectively 56.4 % and 66.6 %) (p < 0.001). There was endocrine dysfunction in all of the patients who had necrosectomy. Patients with SAP, NAP, pancreatic head necrosis and necrosectomy should be pursued for pancreatic functions in the long term.
Description
Keywords
Akut pankreatit, Ekzokrin disfonksiyon, endokrin disfonksiyon, Pankreas fonksiyon testleri, Pankreatik nekroz, Acute pancreatitis, Exocrine dysfunction, Endocrine dysfunction, Pancreas function test, Pancreatic necrosis
Citation
Garip, G. (2008). Akut pankreatitte hastalık şiddetinin ve nekrozun ekzokrin-endokrin yetmezlikle ilişkisinin araştırılması. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.