Clinical evaluation of serum cationic trypsin-like immunoreactivity in patients with different pancreatic diseases

Serum cationic human trypsin-like immunoreactivity (TLI) has been evaluated in 119 patients with different pancreatic diseases and in 85 normal controls. In acute pancreatitis TLI levels varied from a minimal two-fold to a maximal 20-fold increase of the upper normal limit. In chronic pancreatitis TLI levels overlapped with controls, but 33% of these patients presented values below the lower normal limit. The mean concentration in patients with steatorrhea was significantly lower than in those without steatorrhea. No TLI was detectable in 3 total pancreatectomized patients, while in pancreatic cancer and in patients with partial pancreatectomy mean values significantly lower than controls were present. In conclusion, elevated TLI seems to be specifically associated with acute pancreatic damage, while low levels are associated with either chronic pancreatitis or pancreatic cancer. Low levels are not, in fact, an early feature of chronic pancreatitis but are found in an advanced state, sometimes before the appearance of steatorrhea.