The Clinical Significance Of Elevated Serum CA199 And Ferritin In Acute Pancreatitis

Acute pancreatitis is an inflammatory reaction of the pancreas's own digestion,edema,hemorrhage or even necrosis when pancreatic enzymes are activated in the pancreas because of many reasons.The clinical condition appears serious and prognosis is poor in severe acute pancreatitis.This study investigated how the changing serum CA199 and ferritin act on acute pancreatitis etiological diagnosis and severity assessment and how it values.The research content is divided into two parts:Chapter I The Clinical Significance of Elevated Serum CA199 in Acute pancreatitisBackground:Carbohydrate antigen 19-9(CA199)has been identified as a tumor marker for pancreatic cancer(PC).In recent years,a large number of studies have found that CA199 increaseed in benign lesions of the digestive system.However,literature associated with the relationship between CA199 and acute pancreatitis(AP)is limited.This study aimed to focus on serum CA199 level measurements in AP patients and the associated clinical significance.Methods:From January 2006 to December 2015,1,609 consecutive patients with AP were admitted to our department and included in the study.The relationships among the etiology of AP,the disease severity,the incidence of pancreatic cancer during hospitalization and CA199 levels were analyzed.Results:Serum CA199 levels were measured for 693 of 1,609 AP patients.Of those patients,186(26.8%)had elevated CA199 levels(>37 U/ml).Patients with high CA199 levels were older(Mean age 62.7 years vs 54.8 years old,P<0.001)and had predominantly biliary causes(53.8%vs 32.9%,P<0.001)in comparison with patients with normal CA199 levels.There were no definite specific correlations between CA199 levels and disease severity in AP.In addition,serum levels of CA199 positively correlated with serum alanine aminotransferase,aspartate transaminase,glutamyl transpeptidase,alkaline phosphatase and creatinine levels.After stratification,the incidence of pancreatic cancer increased proportionally to CA199 levels in AP patients.Conclusion:Serum CA199 levels was elevated in patients with AP,especially in patients with biliary pancreatitis.AP patients with significantly increased CA199 levels may have a higher risk for the presence of pancreatic cancer.We recommended routinely monitoring CA199 levels during hospitalization for AP patients.Chapter II The Clinical Significance of Elevated Ferritin in Acute pancreatitisBackground:Serum ferritin(SF)can reflect the extent of oxidative stress and inflammation in vivo as an acute-phase response protein for systemic inflammatory responses.This study was designed to assess the effect of elevated SF levels on the severity of acute pancreatitis.Methods:From January 2013 to December 2016,140 consecutive patients with AP were retrospectively reviewed to analyze the relationships among the etiologies of pancreatitis,the severity of the disease and SF levels.The receiver operating characteristic(ROC)curve was used to assess whether elevated SF levels could predict the onset of persistent organ failure in AP.Results:SF levels were measured for 140 of 761 AP patients.Of those patients,61(43.6%)had high SF levels(>275 ng/ml),and 79(56.4%)had normal SF levels.SF levels were not associated with the etiology of AP disease.Among patients with high SF levels,there was a significant increase in the proportion of patients with severe AP(SAP)and a higher proportion of systemic inflammatory response scores(SIRS)in comparison to patients with normal SF levels.The area under the ROC curve for SF in predicting persistent organ failure was 0.815(95%confidence interval(CI)0.663-0.967),a sensitivity with 71.4%and specificity with 91%,respectively.Conclusion:SF concentrations were positively correlated with the severity of AP,and quantitative assessment of SF can predict persistent organ failure in patients with AP.Serum ferritin may be a potential biochemical indicator of AP severity.