Time course profile of serum trypsinogen-2 and trypsin-2-alpha(1)-antitrypsin in patients with acute pancreatitis

Background: Trypsinogen-2 and the trypsin-2-alpha (1)-antitrypsin complex a re recently introduced new laboratory markers for acute pancreatitis. They show high sensitivity and specificity for acute pancreatitis on admission, but little is known on their time course profiles. Methods: The serum conce ntrations of trypsinogen-2 and trypsin-2-alpha (1)-antitrypsin were monitor ed in 92 patients with verified acute pancreatitis. The follow-up period wa s 42 days in patients with severe acute pancreatitis (N = 73) and 9 days in mild disease (N = 19). Results: On admission the mean serum concentration of trypsinogen-a was 2880 mug/l in severe and 920 mug/l in mild acute pancr eatitis. These values were 32- and 10-fold the upper reference limit, respe ctively. Trypsin-2-alpha (1)-antitrypsin concentrations were 1250 mug/l (10 0-fold the upper reference limit) and 635 mug/l (52-fold), respectively. Th e differences were statistically significant (P = 0.026-0.001). The concent rations of trypsinogen-2 and trypsin-2-alpha (1)-antitrypsin decreased grad ually during the follow-up period, but they remained elevated for the entir e study period in patients with severe and mild disease. Conclusions: The t ime course profile of trypsinogen-2 and trypsin-2-alpha (1)-antitrypsin is favorable for diagnosing acute pancreatitis. The elevation starts within ho urs after the onset of the disease and it is very steep. Both markers remai n elevated longer than amylase and the magnitude of the elevation correlate s with the severity of the disease. This is further evidence to support the use of trypsinogen-2 and trypsin-2-alpha (1)-antitrypsin for the evaluatio n of patients suspected of having acute pancreatitis.