Year 2015 Vol. 23 No 3

GENERAL & SPECIAL SURGERY

B.F. SHEVCHENKO, A.M. BABIY, O.M. TATARCHUK, V.A. MACARCHUK, O.P. PETISHKO

NON-INVASIVE ASSESSMENT OF FIBROUS TRANSFORMATION AND INFLAMMATORY ACTIVITY OF THE PANCREAS AT CHRONIC PANCREATITIS

SE "Institute of Gastroenterology of the National Academy of Sciences",
Dnipropetrovsk,
Ukraine

Objectives. To work out the program of non-invasive assessment of inflammation activity and fibrous transformation degree of the pancreas at chronic pancreatitis.
Methods. The comparison analysis of biochemical, immunological and sonoelastometric results with those of morphological assessment of the pancreatic biopsies obtained during surgical interventions due to the complications of chronic pancreatitis had been carried out in 86 patients. Age of patients varied from 26 up to 76, there were 69 (80,2%) males and 17 (19,8%) females.
Results. The followings operative interventions had been performed in 86 patients: in 27 (31,3%) symptomatic operations as the first stage of surgical treatment (external drainage of pseudocysts, gastroenteric bypass and others), in 16 (18,7%) drainage operations (cystogastro-, cystojejuno-, cystopancreatico-, pancreatico-jejunostomy), in 43 (50,0%) resection-drainages (Begers and Freys procedures so as hybrid modifications) and resections (distal resections of the pancreas).
According to ROC analysis of the non-invasive assessment of inflammation activity, the high sensitivity and specificity were typical for PMN-elastase (83,3% and 92,9%) and the ratio of TNF-α / IL-10 (91,7% and 84,6%), the evaluation of the fibrotic transformation degree of the pancreas the ratio between protein-bonded hydroxyproline (HP/b) and free hydroxyproline (HPf) HPp/b / HPf (93,3% and 88,9%) and TNF-α/TGF-β1 (87,8% and 81,8%), the estimation of the severity of the fibrotic transformation according to the sonoelastometric images of anatomical parts of the pancreas a head (83,3% and 88,9%) and a body (81,8% and 76,9%), the valuation of inflammation activity in the head of pancreas at the early (73,3% and 80,0%) and later (87,5% and 100,0%) degrees of pancreatic fibrosis at cronic pancreatitis.
Conclusion. Thus, indices of PMN-elastase, the ratio of TNF-α/IL-10, Pp/b/Pf, TNF-α/TGF-β1, sonoelastometry of pancreatic head and body in assessing of fibrotic transformation degree and pancreatic inflammation activity allowed establishing validity of each research methods and using them as diagnostic non-invasive markers of the morphological state of the pancreas at chronic pancreatitis.

Keywords: pancreas, chronic pancreatitis, fibrous transformation, inflammation, non-invasive markers
p. 275-285 of the original issue
References
  1. Beger HG, MatsunoS, Cameron JL. Diseases of the Pancreas. Springer-Verlag Berlin Heidelberg; 2008:905.
  2. Shevchuk M, Shevchuk MG, Khrunik AD, Fedorkv MB. Khrurgchne lkuvannia khronchnogo pankreatitu [Surgical treatment of chronic pancreatitis]. Ukran Zhurn Khrurg. 2011;(3)12:211-14.
  3. Sukhodolia A, Petrushenko VV, Pdmurniak OO, Grishchuk OV, Sukhodolia SA, Chubar V. Etapn khrurgchn vtruchannia pri uskladnenomu khronchnomu pankreatit [Landmark surgery in complicated chronic pancreatitis]. Kharkv Khrurg Shkola. 2013;(2)59:85-88.
  4. Shchastnyi AT. Posleoperatsionnye oslozhneniia proksimal'nykh rezektsii podzheludochnoi zhelezy u patsientov s khronicheskim pankreatitom [Postoperative complications proximal resection of the pancreas in patients with chronic pancreatitis]. Novosti Khirurgii. 2011;(3)19:30-43.
  5. Shevchenko BF, Babii AM, Makarchuk VA, Oshmianskaia NIu, Petishko OP. Morfofunktsional'noe sostoianie podzheludochnoi zhelezy na etapakh ee fibroznoi transformatsii pri khronicheskom pankreatite [Morphofunctional state of the pancreas at stages of its fibrous transformation in chronic pancreatitis]. Vsn Problem Bolog Meditsini. 2014;(4)1:305-12. Mode of access: http://nbuv.gov.ua/j-pdf/Vpbm_2014_4(1)__64.pdf
  6. Paklina OV, Karmazanovskii GG, Setdikova GR. Patomorfologicheskaia i luchevaia diagnostika khirurgicheskikh zabolevanii podzheludochnoi zhelezy [Pathological and radiation diagnosis of surgical diseases of the pancreas]. Moscow, RF: Vidar-M, 2014. 188 p.
  7. Dinnik OB, Zhaivoronok MM, Kobiliak NM, Kharchenko MS. Ul'trazvukova elastografia: teoria praktika stvorennia navchal'nogo trenazhera [Ultrasonic elastography: theory and practice creating training simulator]. Promeneva Dagnostika, Promeneva Terapia. 2014;(3):42-53.
  8. Morgenroth K, Kozuschek W. Pancreatitis. Walter de Gruyter. Berlin-New York, 1991. 88 p.
  9. Klimenko MV. Osobennosti tsitokinovoi reaktivnosti pri ostrom i khronicheskom pankreatit [Features cytokine reactivity in acute and chronic pancreatitis]. Ukr Zhurn Khrurg. 2013;(21)2:111-14.
  10. Srenko OIu. Pankreatichn zrchast kltini iak morfologchna osnova rozvitku fbrozu pdshlunkovo zalozi [Pancreatic stellate cells as the basis of morphological development of fibrosis of the pancreas]. Morfologia. 2010;(4)1:5-12.
  11. Iarovaia GA. Svoistva i kliniko-diagnosticheskoe znachenie opredeleniia elastazy iz pankreaticheskoi zhelezy i polimorfnoiadernykh leikotsitov [Properties and clinical diagnostic value of determination of pancreatic elastase and polymorphonuclear leukocytes]. Lab Meditsina. 2006;(8):43-49.
  12. Uhl W, Büchler M, Malfertheiner P, Martini M, Beger HG. PMN-elastase in comparison with CRP, antiproteases, and LDH as indicators of necrosis in human acute pancreatitis. Pancreas. 1991 May;6(3):253-59.
  13. EditorsIn: Grippo PJ, Munshi HG, editors. Imaging the pancreatic ECM. AuthorsVenkatasubramanian PN. Source Pancreatic Cancer and Tumor Microenvironment. Trivandrum (India): Transworld Research Network; 2012. Chapter 2.
  14. El-Shabrawi MH, Zein El Abedin MY, Omar N, Kamal NM, Elmakarem SA, Khattab S, El-Sayed HM, El-Hennawy A, Ali AS. Predictive accuracy of serum hyaluronic acid as a non-invasive marker of fibrosis in a cohort of multi-transfused Egyptian children with β-thalassaemia major. Arab J of Gastroenterol. 2012;(13):4548.
  15. Saba, Khan S, Parvez S, Chaudhari B, Ahmad F, Anjum S, Raisuddin S.Ellagic acid attenuates bleomycin and cyclophosphamide-induced pulmonary toxicity in Wistar rats. Food Chem Toxicol. 2013 Aug;58:210-19. doi: 10.1016/j.fct.2013.03.046.
  16. Sandrin L, Fourquet B, Hasquenoph JM, Yon S, Fournier C, Mal F, Christidis C, Ziol M, Poulet B, Kazemi F, Beaugrand M, Palau R.Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol. 2003 Dec;29(12):1705-13.
  17. Săftoiu A, Vilmann P, Gorunescu F, Janssen J, Hocke M, Larsen M, Iglesias-Garcia J, Arcidiacono P, Will U, Giovannini M, Dietrich C, Havre R, Gheorghe C, McKay C, Gheonea DI, Ciurea T. European EUS Elastography Multicentric Study Group. Accuracy of endoscopic ultrasound elastography used for differential diagnosis of focal pancreatic masses: a multicenter study. Endoscopy. 2011 Jul;43(7):596-603. doi: 10.1055/s-0030-1256314.
Address for correspondence:
49074, Ukraina, g.Dnepropetrovsk,
prospekt im. Gazetyi "Pravda", d. 96,
GU "Institut gastroenterologii NAMN Ukrainyi",
otdelenie khirurgii organov pischevareniya,
tel. office: 38 0562 27 05 59,
e-mail: aleksandr_babiy@ukr.net,
Babiy Aleksandr Mihaylovich
Information about the authors:
Shevchenko B.F. MD, professor, a chief researcher of the department of surgery of the digestive organs of SE "Institute of Gastroenterology of NAMS of Ukraine".
Babiy .. PhD, a senior researcher of the department of surgery of the digestive organs of SE "Institute of Gastroenterology of NAMS of Ukraine".
Ttarchuk .. PhD, a senior researcher of the laboratory of microbiology and immunology of SE" Institute of Gastroenterology of NAMS of Ukraine".
Macarchuk V.A. A researcher of the biochemistry laboratory of SE "Institute of Gastroenterology of NAMS of Ukraine".
Petishko O.P. A researcher of the department of the scientific-organizational, methodical work and informative technologies of SE "Institute of Gastroenterology of NAMS of Ukraine".
Contacts | ©Vitebsk State Medical University, 2007-2023