RATIOS OF DIFFERENT SERUM PANCREATIC-ENZYMES IN THE DIAGNOSIS AND STAGING OF CHRONIC-PANCREATITIS

The aim of this study was to define an optimum serum enzyme ratio for the diagnosis of chronic pancreatitis (CP) and for the evaluation of t he stage of the disease. With this goal in mind, a simultaneous and in terrelated analysis of different serum pancreatic enzymes was performe d in 296 consecutive patients with clinically suspected CP. A total of 167 patients were finally diagnosed with CP and 129 with other digest ive diseases (used as controls). Serum values of pancreatic amylase, l ipase, immunoreactive trypsin, and their ratios were determined in eve ry patient before final diagnosis was established. Stepwise logistic r egression analysis was performed. As expected, abnormally low values o f individual serum pancreatic enzymes in the diagnosis of CP were high ly specific (92-98%) but very insensitive (20-32%). Their diagnostic u sefulness was neither improved by calculation of their ratios nor by t he use of multivariate logistic regression analysis. A low pancreatic amylase/lipase ratio correlated with advanced CP (p < 0.01), and had a high degree of accuracy (80.5%) in the evaluation of the stage of the disease (assessed by endoscopic retrograde pancreatography). In concl usion, while serum pancreatic enzymes have limited usefulness in the d iagnosis of CP, the pancreatic amylase/lipase ratio could be a simple method for staging the disease.