Whenever there is obstruction of the principal pancreatic ducts, the pancreatic enzymes enter the circulation by way of lymphatic draine ge of the pancreas. The measurements of serum amylase and hourly urine amylase has long been used clinically for the diagnosis of acute pancreatitis. Recently, however, these methods are observed to have little reliability for the diagnosis of acute-pancreatitis, in view of the other disorders causing hyperamylasemia or deteriorated renal function.
In 1969, Levitt, et al have suggested an ingenious device, whereby the comparison of´ urinary amylase clearance with the urinary creatinine clearance in an amylase/creatinine clearance ratio (CAm/CCr ratio) not only eliminates the necessity for a timed quantitative collection of urine, but also includes, within the index ratio, information concerning the serum amylase, the urinary amylase and thestate of renal function. In 1975, Warshaw and Fuller confirmed that CAm/CCr, ratio in acutepancreatitis rises more than threefold as high as in the other diseases which may possibly, cause hyper amylasemia.
In Korea, however, these data have not yet been obtained, wherefore this study has been carried out in order to evaluate the diagnostic significance of CAm/CCr ratio in acute pancreatitis.
A comparative study is made in this paper by use of Leyitt, et al´s method in 28 normal controls,
29 cases of acute pancreatitis, 14 cases of biliary tract disease with pancreatitis, 9 cases of pancreatic
pseudocyst, 2 cases of chronic relapsing pancreatitis, 13 cases of biliary tract disease without pancreatitis, 7 cases of pancreatic carcinoma, 20 cases of peptic ulcer, 15 cases of stomach cancer, 57 cases of liver disease, and 8 cases of chronic renal failure.
The level of serum and urine amylase was measured by Somogyi units.
The CAm/CCr ratio in each group is as follows:
a) normal control: 1.88±0.40%, biliary tract disease without pancreatitis: 1.89±0.49%, pancreatic carcinoma: 2.40±1.56%, liver disease: 2.00±0.70%, chronic renal failure: 2.22±0.49%.
The results were within the normal range, as is seen above.
b) Acute pancreatitis: 4.55±1.44%(P[t]<0.05), biliary tract disease with pancreatitis: 4.20±1.31% (P[t]<0.05),
pancreatic pseudocyst:3.27±1.75%( P[t]<0.05), chronic relapsing pancreatitis: 4.88±3. 06%. The results reached 2.5 to 3 times the normal
data, as is seen above.
In addition, CAmCCr ratio in different periods of days after the onset of acute pancreatitis rose up to the level of 5.77±1.51% in the period of 8th to 9th days, and then fell down to that of 3.87±0.92% in the period of 10th to 15th days.
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