Novosti
Khirurgii
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indexed in Scopus



Year 2014 Vol. 22 No 4

GENERAL AND SPECIAL SURGERY

DOI: http://dx.doi.org/10.18484/2305-0047.2014.4.428   |  

D.M. OVSIANIK

THE DIAGNOSIS OF INFECTED PANCREATIC NECROSIS BASED ON AN ASSESSMENT OF INDICATORS OF ENDOTHELIAL DYSFUNCTION

EE Vitebsk State Medical University,
The Republic of Belarus

Objectives. To study the indicators of endothelial dysfunction in acute pancreatitis and assess their potential for differential diagnosis of infected and sterile pancreatic necrosis.
Methods. A prospective investigation of indicators of endothelial dysfunction - the number of circulating endothelial cells and concentration of stable degradation products of nitric oxide in the blood of patients (n=92) with various forms of acute pancreatitis has been carried out. The results of a study of healthy volunteers (n=15) were used as a control. For diagnostic test evaluation of sensitivity/specificity for forecast verification and diagnosis of infected pancreatic necrosis the Receiver Operating Characteristic (ROC) analysis has been applied.
Results. In case of the edematous form of acute pancreatitis a statistically significant increase of circulating endothelial cells number and the level of nitrate/nitrite in the blood by 1.5-folds compared to healthy persons (=0,0051; =0,0206) have been observed. An expressive clinical manifestation of endothelial dysfunction has been occurred in pancreatic necrosis, as for its sterile course the tendency to regress have been appeared. In the infected pancreatic necrosis the negative dynamics demonstrating this disease usually was found in increase of the number of circulating endothelial cells in the blood. Within the first week of hospitalization the level of nitrate/nitrite >36 uM/L (sensitivity 81,8%, specificity 60,3%, AUC=0,7; =0,0323) may be used in prediction of infected pancreatic necrosis. The presence of 39 and more circulating endothelial cells in 100 ul. plasma (sensitivity 84 %, specificity 86%, AUC = 0,834; p <0,001) happen to be one of diagnostic signs of infection of pancreatic necrosis in the second phase of disease.
Conclusions. The received results testify to expediency of the research of endothelial dysfunction by determination of the number of circulating endothelial cells in the blood of patients with acute pancreatitis as a method should be applied for early detection of infection of pancreatic necrosis.

Keywords: acute pancreatitis, infected pancreatic necrosis, endothelial dysfunction, diagnostics
p. 428 435 of the original issue
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Address for correspondence:
210023, Respublika Belarus, g. Vitebsk, pr. Frunze, d. 27, UO Vitebskiy gosudarstvennyiy meditsinskiy universitet, kafedra fakultetskoy khirurgii,
e-mail: ovsyanik.dmitriy@yandex.ru,
Ovsianik Dmitriy Mechislavovich
Information about the authors:
Ovsianik D.M. A post-graduate student of the faculty surgery chair of EE Vitebsk State Medical University.
Contacts | ©Vitebsk State Medical University, 2007