胰胆管连接异常患儿血清淀粉酶同功酶变化

Study on the changes of serum amylase isoenzyme levels in children with pancreaticobiliary maljunction

为观察胰胆管连接异常(PBM)患儿血清淀粉酶同功酶谱变化并探讨其临床意义,采集30例先天性胆管扩张症(CBD)患儿(囊形24例,梭形6例,均伴PBM)手术前、后血清及胆汁;另取30例正常儿童和12例急性胰腺炎成人血清作为对照,应用不连续缓冲系统薄膜电泳法进行酶谱分析。结果显示,正常对照组血清胰型淀粉酶同功酶仅存在P1和P2波峰;PBM患儿术前血清和胆汁的胰型淀粉酶同功酶除有P1和P2外,均出现P3、P4、P5等异常波峰,血清和胆汁各波峰的出现率具相似性;急性胰腺炎组除有P1、P2和P3外,P4较少见,无P5波峰;PBM患儿血清酶学的异常在胰胆分流术后基本消失。提示PBM患儿血清淀粉酶同功酶谱存在异常,具一定特异性。该异常证实PBM畸形存在胆-血返流,对PBM,尤其是胆管扩张不明显者有一定的诊断价值。

Pancreaticobiliary maljunction(PBM) is a congenital malformation of the pancreaticobiliary convergence usually discovered by presence of cholangiectasis .But, about 20%-30% patients with PBM don't have cholangiectasis or only have mild cholangiectasis. So, it's very difficult for these patients to make diagnosis and receive the treatment timely. In this study, changes of serum amylase isoenzyme was monitored in 30 cases with congenital biliary dilatation(CBD)(24 cystic dilatation, 6 fusiform dilatation) including 10 boys and 20 girls with mean age of 5.3 years(from 1 month to 14 years) between Jan. 1998 and Jan. 2001. The diagnosis of PBM was confirmed with cholangiography during the operation in all these children, with the serum from normal children as the control group(30 cases), with the serum collected before operation in the PBM patients as the pre-operation group(30 cases), the serum collected 14 days after operation as the post-operation group(30 cases), and the serum collected in 60 days after operation as the follow-up group(20 cases), at the same period of time, the serum from the adults with acute pancreatitis was assigned as the pancreatitis group(12 cases), and the bile samples collected from the bile duct of children with CBM during operation were used as the bile group(30 cases). Iodine-amylase colorimetric method was used to determine the total activity of amylase. Asynechia buffer system film electrophoresis was used to measure the amylase isoenzyme with Chi-square and T test to compare the results. The results showed as following: (l)The activity of serum amylase was increased in pre-operation group (P<0.05), but the average value was still in the normal range(180 U/ L) with only 20% of the patients(6/ 30 cases) above the normal value. (2)P1-P5 wave peak could be observed on the isozymogram of pancreatic type amylase in pre-operation group, with the 86.7% and 56.7% presentation rate of P4 and P5 wave peak, while 100% and 66. 7% of the P4 and P5 wave peak could be reached in the fusiform dilatation patients with significant difference in comparing with the results from the control group, post-operation group, follow-up group and pancreatitis group(F<0. 01, F<0.05) . (3) The amylase isozymogram of patients with PBM was similar to those of the bile group. (4)Mainly the P1-P3 wave peaks were presented in the pancreatitis group with only 1 case presented with P4 wave peak indicating that there was abnormal serum amylase isozymogram with certern specificity in PBM patients. Such abnormality indicated there existed bile-blood reflux in PBM patients and might have diagnostic value in patients with mild cholangiectasis.