Терапевтический архив (Feb 2015)
Capabilities of ultrasonic histography in the evaluation of the degree of pancreatic fibrosis in chronic pancreatitis
Abstract
Aim. To analyze the clinical and pathogenetic significance of ultrasonic histography in pancreatic fibrosis in patients with chronic pancreatitis (CP). Subjects and methods. One hundred and eighty-six patients with CP were examined. Complete blood count, urinalysis, biochemical blood and urine tests, duodenal intubation test, coproscopy, enzyme immunoassay, and radioimmune assay were performed. The levels of blood transforming growth factor Β1 (TGFΒ1) and fecal elastase-1 were measured. Ultrasonography and ultrasonic histography of the pancreas and liver, Doppler sound study of the abdominal aorta, celiac trunk, and superior mesenteric artery were carried out. Results. There were correlations suggesting the decreased exocrine function of the pancreas as its fibrosis progressed, which was indirectly reflected in the increased L index of an ultrasonic histogram. The positive correlation between L index and TGFΒ1 also showed increased L index in more obvious pancreatic fibrosis. A CP exacerbation was shown to be accompanied by decreased Kgst and N, which was confirmed by pronounced hyperenzymenia (the blood enzyme release phenomenon) with the decrease of those indicators. Pancreatic fibrosis was reflected in the magnitude of clinical manifestations of CP, particularly in the rise of the number of dyspeptic complaints showing diminished pancreatic exocrine secretion. This was also supported by the fact that as the L index increased, the debit hour of lipase and the activity of fecal elastase-1 decreased. There were correlations pointing to more significant fibrosis of the pancreas and its insufficiency with worsened blood flow in it. Moreover, ultrasonic histographic findings accounted for a positive correlation between pancreatic and hepatic fibrosis. Conclusion. Examination of ultrasonic histographic correlations of the pancreas has led to the conclusion that this technique may be used to indirectly estimate the degree of pancreatic fibrosis and a СP exacerbation.
