SUBCLINICAL EXOCRINE PANCREATIC DERANGEMENT IN HUMAN DIABETIC-PATIENTS EVALUATED FROM PURE PANCREATIC-JUICE

To elucidate the mechanism responsible for histological derangement of pancreas in diabetic patients, pure pancreatic juice (PPJ) aspirated directly from pancreatic duct was analyzed before and after strict gly cemic control on poorly controlled diabetic patients without clinical exocrine pancreatic dysfunction. PPJ obtained from 18 diabetics showed a significantly decreased amylase activity compared with ten healthy subjects (109 +/- 4 versus 168 +/- 9 U/mg protein, p < 0.005) in spite of negligible changes in lipase activity, protein concentration, bica rbonate concentration, and its volume. PPJ showed higher concentration s of prostanoids in diabetic patients than in healthy subjects (TXB(2) , 259 +/- 48 versus 118 +/- 30 pg/mL, p < 0.05; 6-keto-PGF1 alpha, 52. 6 +/- 11.5 versus 38.5 +/- 7.5 pg/mL, p > 0.05). Ratio of 6-keto-PGF1 alpha/TXB(2) of PPJ in diabetic patients was significantly lower than in healthy subjects (0.195 +/- 0.016 versus 0.422 +/- 0.041, p < 0.005 ). After strict glycemic control for 1-3 months on nine of 18 diabetic patients, amylase activity of PPJ was significantly higher than that before the control (112 +/- 4 versus 128 +/- 7 U/mg protein, p < 0.01) , but still significantly lower than that of healthy subjects (p < 0.0 05). Lipase activity showed no significant difference between before a nd after the control. TXB(2) and 6-keto-PGF1 alpha concentrations were decreased. Ratio of 6-keto-PFG1 alpha/TXB(2) after the control (0.320 +/- 0.038) significantly (p < 0.005) increased from 0.168 +/- 0.019 a nd reached a comparable level to that of healthy subjects. These data indicated that pure pancreatic juice in poorly controlled diabetics sh owed a significantly lower amylase activity and a decreased ratio of 6 -keto-PGF1 alpha/TXB(2), implying local derangement in exocrine pancre as by hyperglycemia. Strict glycemic control was proven to normalize t he imbalance in prostanoids but not completely improve a decreased amy lase activity.