Abstract
Objective: To measure pancreatic and non-pancreatic phospholipase A2 activity in human acute necrotising pancreatitis.
Design: Prospective study.
Setting: University hospital, Finland.
Subjects: 20 patients with acute necrotising pancreatitis.
Interventions: Serum and urine samples were taken daily for a week and fluid from peritoneal lavage for six days after admission. Samples from the pleural cavity were taken from patients in whom pleural drainage was considered necessary. Pancreatic tissue was recovered from the patients who were operated on for acute pancreatitis or for pancreatic tumour.
Main outcome measures: Serum phospholipase A2, amylase, and lipase activities.
Results: Serum phospholipase A2 activity increased up to eightfold, 25.0 (5.4) IU/L (n = 20, range 9.0-77 IU/L) (reference value <3 IU/L) and remained high during the first week, whereas serum amylase and lipase returned to the reference range during the first four days. The maximal phospholipase A2 activity in urine was 4.5 IU/L, in the fluid from peritoneal lavage 16.9 IU/L, and in the fluid from the pleural cavity 37.0 IU/L. Phospholipase A2 activity in necrotic pancreatic tissue ranged from 0.25 to 5.70 IU/g and in normal pancreatic tissue from 9.85 to 15.0 IU/g. Preincubation at 60°C showed non-pancreatic phospholipase A2 activity predominated in serum, whereas part of the enzyme activity in the fluids from pleural cavity and peritoneal lavage proved to be of pancreatic derivation.
Conclusions: The results suggest a role for both pancreatic and non-pancreatic phospholipase A2 in acute pancreatitis. Preincubation at 60°C proved useful in the differentiation between pancreatic and non-pancreatic phospholipase A2 activity.