Diagnostic Criteria for Acute Destructive Pancreatitis

Abstract

The relevance of the emergence of innovative technologies, more sophisticated diagnostics methods, opportunities for intensive therapy, antibacterial prophylaxis, surgical methods of treatment involving minimally invasive surgery, does not solve the problem of high overall mortality in severe acute pancreatitis at this time. This indicator for the last ten years remains at a high level (10-30%), and in case of inflammatory forms of severe pancreatitis, reaches 85%. Traditional laboratory criteria for the diagnosis of pancreatic necrosis may involve leukocytosis with the destruction of the leukocyte formula and appearance of myelocytes and metamylocytes in it; improvement of leukocyte index of intoxication; improvement of the nuclear index of the destruction; blood glucose growth; growth of blood urea; growth of neutrophil-lymphocytic coefficient; change in endogenous creatinine clearance; improvement of blood transaminases. The indicator enzymes have the greatest value for the diagnosis of gastrointestinal pancreatitis in the diagnostic plan. The determining of α-amylase activity is a sensitive and valuable criterion for diagnostics of gastrointestinal pancreatitis and control over the effectiveness of treatment. Also, talking about laboratory diagnostics of acute pancreatitis it is worth noting about acute-phase proteins. The increase in the level of acute-phase proteins in inflammation is a compensatory reaction associated with the ability to inhibit cells released during destruction and cause secondary tissue damage by proteolytic enzymes, as well as to suppress autoimmune aggression. Due to this, the inflammatory process in the body is limited and autoaggression is restrained. The purpose of the study was to study the proteins of the acute phase in the blood of patients with acute pancreatitis of varying severity. Materials and methods. The study is based on the results of examination of 88 patients with acute pancreatitis of varying severity who were treated at the V.T. Zaytsev Institute of the General and Urgent Surgery of Academy of Medical Sciences of Ukraine, Kharkiv, as well as 45 donors (control group). Results and discussion. The determination of the activity of serum enzymes in the dynamics of acute destructive pancreatitis was carried out. The parameters were verified before the operation and after the operative treatment in dynamics, as well as before and after the second operation in the dynamics. Markers of tissue destruction can simultaneously serve as indicators of the severity of the inflammatory process in the pancreas and determine the quality of the performed surgical intervention. The diagnostic value of ferritin and lactofferin as markers of an acute destructive process was proved on the basis of a significant increase in their level in blood serum and exudates of patients. It has been shown that ferroproteins are reliable markers of the inflammatory process, among others, including classical acute phase proteins. At the same time, their identification is distinguished by its explicitness in the diagnosis of not only latent destructive states. Conclusion. The detected changes in the concentration of clinical and laboratory parameters of alpha-2-macroglobulin, lactoferrin, C-reactive protein, ferritin in the blood serum correlate with the degree of the inflammatory process and purulent-destructive changes in the pancreas