Disintegration Mechanisms of Functioning and Structural Changes of the Pancreas in Patients with Acute Pancreatitis Considering the Lipid Profile and Hepatocytes Functions

S.І. Ivashchuk

Abstract


Objective. To investigate the systemic relationships of the pancreas and liver functional state, lipid metabolism and systemic inflammatory response considering the etiological factor and gender of patients with acute pancreatitis and exacerbation of chronic pancreatitis.
Materials and Methods. The study involved 86 patients, among them were 35 (40.7 %) women and 51 (59.3 %) men, aged 23 to 77 years. All patients had oedematous form of pancreatitis: primary acute pancreatitis was diagnosed in 45 (52.3 %) patients, exacerbation of chronic pancreatitis — in 41 (47.7 %) patients. The system relationship of the data of the structural and functional state of the pancreas, liver, lipid metabolism and C-reactive protein considering etiological factors and gender of patients with acute pancreatitis and exacerbation of chronic pancreatitis was analysed.
Results and Discussion. The structural changes of the pancreas in patients with acute pancreatitis, depending on the etiological factors were as follows: heterogeneity of the pancreas structure was observed 1.78 times more likely for biliary pancreatitis, while parapancreatic hydrophilicity 1.94 times more often was of alcoholic pancreatitis origin; in patients with acute pancreatitis of alcoholic origin ultrasonographically simple cysts were diagnosed, which are not observed in patients with acute biliary pancreatitis origin.
We have found that the majority of patients had a significant dyslipidaemia: total cholesterol content was higher than normal levels (> 5 mmol/l) in 64.7 % of men and 17.1 % women, low-density lipoprotein cholesterol (> 3 mmol/l) — in 51.0 and 17.1 %, respectively, triglycerides (> 1.7 mmol/l) — in 56.9 and 17.1 %, atherogenic index (> 3.0) — in 49.0 and 34.3 %, with low antiatherogenic lipoprotein cholesterol high-density (< 1.03 for men and < 1.2 for women) — in 33.3 % of men and 17.1 % of women, respectively.
Alanine aminotransferase slight increase was observed in 31 (36.0 %) patients with acute pancreatitis, mainly due to biliary oedematous pancreatitis. The average rate of aspartate aminotransferase of the examined patients was almost twice the reference value, especially in men with alcoholic acute pancreatitis. Changes of the de Ritis ratio confirm the cause of acute pancreatitis: increases in rate (> 2) in male patients with alcoholic pancreatitis, which exceeded those in men with biliary pancreatitis by 2.2 times (p = 0.032).
Gamma-glutamyl transpeptidase in 59 (68.6 %) patients exceeded the norm 1.7–2.7 times, a significant difference between groups of observations in men: gamma-glutamyl transpeptidase content in patients with alcoholic acute pancreatitis 2.9 times was higher than in biliary pancreatitis (p = 0.007). In women with biliary acute pancreatitis gamma-glutamyl transpeptidase level was 1.52 times higher than that of the men of this group (p = 0.027).
Nonspecific indicator of systemic inflammatory response of C-reactive protein was higher than the reference data (10 mg/l) ten times in 72 (83.7 %) patients with acute pancreatitis with significantly higher values in patients with biliary form of acute pancreatitis than in alcoholic 2.25 times (p = 0.027).
Conclusions. 1. The course of acute oedematous pancreatitis and exacerbation of chronic pancreatitis is accompanied by dysregulation of lipid metabolism, increased indices of systemic inflammatory response and likely changes in the content of organ enzymes.
2. Patients with acute alcoholic pancreatitis had the reduced detoxification function of the liver with the domination of cytolytic and cholestatic components on background system and intraacinar activated pancreatic enzymes and protease inhibitory, low activity of pancreatic elastase 1. Acute biliary pancreatitis is accompanied by stronger systemic inflammatory response according to the level of C-reactive protein and alpha-1 antitrypsin, significant dyslipidaemic disorders with similar to alcoholic acute pancreatitis background aggressiveness of pancreatic enzymes.
3. Structural changes during alcoholic acute pancreatitis are characterized by a moderate inflammatory reaction of parenchyma, parapancreatic hydrophilicity and the appearance of small cysts. Biliary acute pancreatitis is associated with a greater incidence of acute inflammatory changes in the structure: lower echogenicity and its heterogeneity.


Keywords


pancreatitis; inflammation; enzymes; lipids; hepatocytes

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DOI: https://doi.org/10.22141/1997-2938.2.25.2014.83088

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