경증 급성췌장염 환자의 장투과성의 변화
The changes of intestinal permeability in patients with mild acute pancreatitis
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목적 : 장투과성의 증가는 중증의 급성 췌장염 환자에서 잘 알려져 있지만 경증의 급성췌장염 환자에서는 잘 알려져 있지 않다. 장관장벽손상을 측정하는 장투과성 검사는 임상에서 시행하기에는 어려운 점이 있다. 본 연구에서는 경증의 급성 췌장염 환자에서 장투과성의 변화와 췌장염 환자에서 장투과성 변화와 관계있는 임상인자를 알아보았다. 방법 : 건강대조군 14명, 양성질환에 의한 경증의 급성췌장염 환자 41명에서 장투과성검사를 실시하였으며 질환군간 차이와 각종 임상양상과 연관성을 비교하였다. 장투과성 검사는 51Cr-EDTA (51Cr-ethylenediaminetetraacetic acid)을 이용하여 24시간 소변에서의 회수율로 측정하였다. 결과 : 장투과성은 장상대조군보다 급성 췌장염 환자에서 높았으나(p<0.001) 알코올에 의한 췌장염, 담석에 의한 췌장염 및 특발성 췌장염 사이에 장투과성은 차이가 없었다. 급성기 염증반응, 담관 폐색, 간기능 및 신기능과 연관된 항목들과 혈액응고 인자, 혈색소 및 칼슘와 같이 췌장염 환자에서 변화가 관찰되는 항목에서 연관성이 관찰되지 않았다. 또한 췌장염 환자의 예후 평가에 사용되는 지표들과 장투과성 사이의 연관성도 관찰되지 않았다.
Abstract
Background : Many studies in severe acute pancreatitis have demonstrated an increase in intestinal permeability, but not in mild acute pancreatitis. The current methods to measure intestinal permeability need much time and also laborious work. Therefore, we investigate the changes of intestinal permeability in patients with mild acute pancreatis and clinical predictive factor for the intestinal permeability in patients with acute pancreatitis. Methods : The intestinal permeability were measured in 14 normal heathy controls, 41 patients with mild acute pancreatitis (alcoholic 14, biliary 12, idiopathic 15) by measuring 24 hour urine excretion of 51Cr-EDTA (51Cr-ethylenediaminetetraacetic acid) for evaluation of the gut barrier dysfunction. We compared the intestinal permeability with clinical characteristics of patients. Results : The intestinal permeability was significantly increased in patients with mild acute pancreatitis (6.01±4.11%, p<0.001) versus control subjects (1.86±0.52%). There was no significant difference in the intestinal permeability among the patients with alcoholic, biliary and idiopathic pancreatitis. The correlation was not found between intestinal permeability and clinical characteristics in patients with mild acute pancreatitis. Conclusions : The intestinal permeability is increased in patients with mild acute pancreatitis regardless of etiology of pancreatitis. The predictive factor for gut barrier dysfunction is not detected in patients with mild acute pancreatitis.(Korean J Med 71:38-44, 2006)
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