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Clinical Chemistry 47: 231-236, 2001;
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(Clinical Chemistry. 2001;47:231-236.)
© 2001 American Association for Clinical Chemistry, Inc.

Articles

The Ratio of Trypsin-2-{alpha}1-Antitrypsin to Trypsinogen-1 Discriminates Biliary and Alcohol-induced Acute Pancreatitis

Jan M. Andersén1, Johan Hedström1, Esko Kemppainen2, Patrik Finne1, Pauli Puolakkainen2 and Ulf-Hkan Stenman1,a

1 Department of Clinical Chemistry and
2 Second Department of Surgery, Helsinki University Central Hospital, Haartmaninkatu 4, FIN 00290 Helsinki, Finland.
a Address correspondence to this author at: Department of Clinical Chemistry, Helsinki University Central Hospital, FIN-00290 Helsinki, Finland. Fax 358-9-47174804; e-mail ulf-hakan.stenman{at}huch.fi.

Background: Rapid determination of the etiology of acute pancreatitis (AP) enables institution of appropriate treatment. We evaluated the ability of trypsinogen-1, trypsinogen-2, trypsin-1-{alpha}1-antitrypsin (AAT), and trypsin-2-AAT in serum to identify the etiology of AP.

Methods: The study consisted of 67 consecutive patients with AP admitted to Helsinki University Central Hospital. Forty-two had alcohol-induced AP, 16 had biliary AP, and 9 had unexplained etiology. Serum samples were drawn within 12 h after admission. Trypsinogen-1, trypsinogen-2, trypsin-1-AAT, and trypsin-2-AAT were determined by time-resolved immunofluorometric assays. Logistic regression was used to estimate the ability of the serum analytes to discriminate between alcohol-induced and biliary AP. The validity of the tests was evaluated by ROC curve analysis.

Results: Patients with alcohol-induced AP had higher median values of trypsin-1-AAT (P = 0.065), trypsinogen-2 (P = 0.034), and trypsin-2-AAT (P <0.001) than those with biliary AP, who had higher values of amylase (P = 0.002), lipase (P = 0.012), and alanine aminotransferase (P = 0.036). The ratios of trypsin-2-AAT to trypsinogen-1, lipase, or amylase efficiently discriminated between biliary and alcohol-induced AP (areas under ROC curves, 0.92–0.96).

Conclusions: Trypsinogen-2 and trypsin-2-AAT are markedly increased in AP of all etiologies, whereas trypsinogen-1 is increased preferentially in biliary AP. The trypsin-2-AAT/trypsinogen-1 ratio is a promising new marker for discrimination between biliary and alcohol-induced AP.




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 Clin. Chem.Home page
B. Lumbreras-Lacarra, J. M. Ramos-Rincon, and I. Hernandez-Aguado
Methodology in Diagnostic Laboratory Test Research in Clinical Chemistry and Clinical Chemistry and Laboratory Medicine
Clin. Chem., March 1, 2004; 50(3): 530 - 536.
[Abstract] [Full Text] [PDF]


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