Labordiagnostik von Pankreaserkrankungen des Hundes – Möglichkeiten und Grenzen^[*]

Zusammenfassung

Da die Diagnostik von Pankreaserkrankungen des Hundes eine besondere Herausforderung darstellt, wird der aktuelle Stand labordiagnostischer Möglichkeiten in der Pankreasdiagnostik aufgeführt und diskutiert. Studien zur Diagnostik der akuten Pankreatitis wiesen nach, dass die Sensitivität und Spezifität der Blutserumparameter Amylase-und Lipaseaktivität relativ gering sind. Von noch geringerem diagnostischen und prognostischen Wert zeigten sich canine trypsin-like immunoreactivity (cTLI), kanines α₂-Makroglobulin, kaniner α₁-Proteaseinhibitor-Trypsin-Komplex im Blutserum sowie trypsinogen activation peptid (TAP) im Blutplasma oder Urin. Vielversprechend erscheint die Ermittlung von kaniner pankreatischer Lipase-Immunoreaktivität (cPLI), kaniner pankreatischer Elastase (cE1) und kaninem C-reaktivem Protein (cCRP) im Blutserum sowie der UCTR (urine creatinine-TAP-ratio) im Urin. Allerdings ist von Nachteil, dass für diese Parameter nur zeit-und kostenintensive Labormethoden verfügbar sind. Somit stehen sie im Gegensatz zu den Blutserumaktivitäten von Amylase und Lipase noch nicht für die Notfalldiagnostik zur Verfügung.

Der Nachweis einer klinisch manifesten exokrinen Pankreasinsuffizienz (EPI) beruht auf den für eine EPI typischen Symptomen in Verbindung mit pathologisch verminderten Konzentrationen an cTLI im Blutserum oder cE1 im Kot.

Hinweise auf eine subklinische EPI infolge einer partiellen Pankreasatrophie geben wiederholt auftretende subnormale oder pathologische cTLI-Werte im Blutserum von klinisch unauffälligen Hunden oder Patienten mit unspezifischen gastrointestinalen Störungen. Von geringem oder eingeschränktem diagnostischem Wert in der EPI-Diagnostik sind folgende Methoden: unverdaute Nahrungsbestandteile, proteolytische Aktivität und Chymotrypsinaktivität im Kot, Fettbelastungstest, Pancrolauryltest und Ceruletidoder

TLI-Stimulationstest. Labordiagnostische Verfahren zum Nachweis einer chronischen Pankreatitis oder eines Pankreaskarzinoms existieren zurzeit nicht. Die Diagnostik dieser Erkrankungen beruht daher auf der Nutzung bildgebender Verfahren (Sonographie, Computertomographie) oder der Laparoskopie bzw. Laparotomie mit Pankreasbiopsie.

Summary

Since the diagnosis of pancreatic diseases is still challenging in dogs the article revues and discusses the current status of laboratory possibilities to reveal these diseases. Studies about the diagnosis of acute pancreatitis showed that the sensitivity and specificity of serum amylase and lipase activity are relatively low. Even lower diagnostic and prognostic values were revealed for the diagnostic and prognostic value of serum canine trypsin-like immunoreactivity (cTLI), canine α₂-macroglobulin, canine α₁-protease inhibitor-trypsin-complex as well as plasma or urine trypsinogen activation peptid (TAP). Promising parameters are serum canine pancreatic lipase immunoreactivity (cPLI), canine pancreatic elastase (cE1), canine C-reactive protein (cCRP) and the UCTR (urine creatinine-TAP-ratio). However, the disadvantage of these parameters is the need of laboratory methods that are time and cost intensive. Therefore they are not available as a diagnostic tool for emergency cases in contrast to serum amylase and lipase activity.

The diagnosis of clinical exocrine pancreatic insufficiency (EPI) bases on clinical signs typical for EPI in connection with pathologically low serum cTLI or faecal cE1 values. An indication for a subclinical EPI caused by partial pancreatic acinar atrophy are repeated subnormal or pathologic cTLI values in clinically normal dogs or patients with unspecific gastrointestinal problems. Of low or limited diagnostic value for the diagnosis of EPI are the following methods: undigested food components, proteolytic activity and chymotrypsin activity in faeces, lipid assimilation test, pancreolauryl test as well as the ceruletide or TLI stimulation test.

Currently there are no laboratory tests available for the diagnosis of chronic pancreatitis or pancreatic carcinoma. The diagnosis of these diseases bases on the use of imaging techniques (ultrasound, computed tomography) or laparoscopy/laparotomy with pancreatic biopsy.

Schlüsselwörter

Pankreaserkrankungen - Hund - Labordiagnostik

Key words

Pancreatic diseases - Dog - Laboratory diagnosis

^* Herrn Prof. Dr. Ernst-Günther Grünbaum und Herrn Prof. Dr. Ernst Schimke aus Anlass ihrer Verabschiedung in den Ruhestand gewidmet.

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