Optimization of diagnostic approaches of destructive pancreatitis

Abstract

Objective. To improve the diagnostics of destructive pancreatitis based on the concentrations of fibrinogen degradation products and lysozyme in blood serum and peritoneal exudate.

Materials and methods. One hundred and two patients with acute pancreatitis were examined and the diagnostic significance of fibrinogen and lysozyme degradation products was assessed. The age of the patients ranged from 19 to 63 years. The patients were treated in surgical hospitals of the city of Astrakhan. Of them, 74 patients diagnosed an edematous form of acute pancreatitis, received conservative treatment, and 28 patients with destructive forms of pancreatitis were operated on. The reference values of the studied markers were evaluated in 39 healthy individuals (donors).

Results. In the blood serum of patients with destructive pancreatitis, the concentration of fibrinogen degradation products was 2.0 [0.68;13.2] mg/l, that is significantly higher than in the group of patients with edematous acute pancreatitis, as well as in the control group. After the surgery, in the peritoneal exudate of 28 operated patients with destructive pancreatitis, the concentrations of fibrinogen degradation products increased by 0.93 times compared to the group with edematous acute pancreatitis and by 3.1 times significantly higher than in the control group. There were no statistically significant differences in the concentrations of fibrinogen degradation products in the peritoneal exudate and in the blood serum of patients with destructive pancreatitis. The concentration of lysozyme in the blood serum of patients with destructive pancreatitis was 20 [5.0;46.5] mg/l, that is significantly higher than in the control group and in the edematous form of acute pancreatitis. After the surgery, the concentration of lysozyme in the peritoneal exudate was 2.5 times significantly higher in patients with destructive pancreatitis than in the control group. The average lysozyme concentration in the peritoneal exudate of patients with destructive pancreatitis exceeded the serum concentrations by 2.1 times in comparative equivalent.

Conclusions. Assessment of the levels of fibrinogen degradation products, lysozyme in the blood and exudate allows to diagnose the destruction of the pancreas, as well as to determine the correct treatment tactics.

Keywords

diagnostics / destructive pancreatitis / fibrinogen degradation products / lysozyme

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