ЭКЗОКРИННАЯ ПАНКРЕАТИЧЕСКАЯ НЕДОСТАТОЧНОСТЬ ПРИ САХАРНОМ ДИАБЕТЕ 1-ГО ТИПА У ДЕТЕЙ: НОВАЯ ПРОБЛЕМА ПЕДИАТРИЧЕСКОЙ ГАСТРОЭНТЕРОЛОГИИ

В статье представлены данные о наличии у части детей, страдающих сахарным диабетом 1-го типа, экзокринной панкреатической недостаточности. Показано, что применение заместительной ферментотерапии панкреатическими энзимами способствует ликвидации синдрома нарушенного переваривания пищи (мальдигестии) у данной группы детей. В статье также оценено значение определения фекальной эластазы 1 в качестве диагностического стандарта экзокринной панкреатической недостаточности у детей с сахарным диабетом 1-го типа.

1. Kharlashina Ye. A., Kononenko I. V., Smirnova O. M., Mayo rov A.Yu. Diabetes as a consequence of biliary recurrent pancreatitis. Diabetes. 2011; 2: 121–125.

2. Shiryayeva L. V., Zelinskaya D. I. Endocrinological pathology and its consequences in children’s health. Children’s hospital. 2011; 3: 50–55.

3. Andren-Sanberg A., Hardt P. Second Giessen international workshop on interactions of exocrine and endocrine pancreatic diseases (workshop report). JOP. 2008; 9 (4): 541–575.

4. Keller J., Layer P. Human pancreatic exocrine response to nutrients in health and disease. Gut. 2005; 54 (Suppl. VI): 1–28.

5. Lam W. F., Lindeboom M. E., Lamers C. B., Masclee A. Hyperglycemia reduces pancreaticobiliary secretion in response to modified sham feeding in humans. Digestion. 1999; 60 (2): 141–146.

6. Nair S., Yadav D., Pitchumoni C. S. Association of diabetic ketoacidosis and acute pancreatitis: observations in 100 consecutive episodes of DKA. Am. J. Gastroenterol. 2000; 95 (10): 2795–2800.

7. Johansson B. B., Torsvik J., Bjorkhang L. et al. Diabetes and pancreatic exocrine dysfunction due to mutations in the carboxylesterlipase gene — maturity onset diabetes of the young (CEL–MODY): a protein misfolding disease. J. Biol. Chem. 2011; 286 (40): 34593–34605.

8. Laass M., Henker J., Thamm K. et al. Exocrine pancreatic insufficiency and its consequences on physical development and metabolism in children and adolescents with type 1 diabetes mellitus. Eur. J. Pediatr. 2004; 163: 681–682.

9. Belmer S. V., Gasilina T. V. Disorders of pancreatic gland exocrine function in children: diagnostics and ways of correction. Questions of practical Pediatrics. 2009; 4 (4): 60–66.

10. Bijoor A., Geetha S., Venkatesh T. Faecal fat content in healthy adults by the acid steatocrit method. Ind. J. Clin. Biochem. 2004; 19 (2): 20–22.

11. Hardt P. D., Hauenschild A., Jaeger C. et al. High prevalence of steatorrhea in 101 diabetic patients likely to suffer from exocrine pancreatic insufficiency according to low fecal elastase 1 concentrations: a prospective multicenter study. Dig. Dis. Sci. 2003; 48 (9): 1688–1692.

12. Kazak S. S. Causes, diagnostics and therapy with enzymes of secondary endocrine insufficiency in children and adolescents. Clinical experimental pathology. 2008; 7 (3): 1–20.

13. Czako L., Hegyi P., Rakonczay Z. et al. Interactions between the endocrine and exocrine pancreas and their clinical relevance. Pancreatology. 2009; 9 (4): 351–359.

14. Panicot L., Mas E., Thivolet C., Lombardo D. Circulating antibodies against an exocrine pancreatic enzyme in type 1 diabetes. Diabetes. 1999; 48: 2316–2323.

15. Sierra C., Blasco J., Lopez-Siguero J. et al. Pancreatic fecal elastase in children with type 1 diabetes. J. Pediatr. Gastroenterol. Nutr. 2004; 39 (Suppl. 1): 370.

16. Luth S., Teyssen S., Forssmann K. et al. Fecal elastase 1 determination: 'gold standard' of indirect pancreatic function tests? Scand. J. Gastroenterol. 2001; 36 (10): 1092–1099.

17. Soldan W., Henker J., Sprossig C. Sensitivity and specificity of quantitative determination of pancreatic elastase 1 in feces of children. J. Pediatr. Gastroenterol. Nutr. 1997; 24 (1): 53–55.

18. Dominguez-Munos J., Hieronymus C., Sauerbruch T., Malfertheiner P. Fecal elastase test: evaluation of a new noninvasive pancreatic function test. Am. J. Gastroenterol. 1995; 90 (10): 1834–1837.

19. Cavalot F., Bonomo K., Perna P. et al. Pancreatic elastase 1 in stools, a marker of exocrine pancreas function, correlates with both residual -cell secretion and metabolic control in type 1 diabetic patients. Diabetes care. 2004; 27 (8): 2052–2054.

20. Icks A., Haastert B., Giani G., Rathmann W. Low fecal elastase-1 in type 1 diabetes mellitus. Z. Gastroenterol. 2001; 39 (10): 823–830.

21. Borysiuk M., Dosenko V., Byts I. V. Elastolytic system of the pancreas in modelling diabetes mellitus. Fiziol. Zh. 2002; 48 (5): 17–21.

22. Parkhomenko L. K., Yeshchenko A. V. Pancreatic insufficiency in children. Modern Pediatrics. 2010; 1 (29): 126–129.

23. Ewald N., Bretzel R., Fantus I. et al. Pancreatin therapy in patients with insulin-treated diabetes mellitus and exocrine pancreatic insufficiency according to low fecal elastase 1 concentrations. Results of a prospective multicentre trial. Diabetes Metab. Res. Rev. 2007; 23 (5): 386–391.

24. Lowe M. E. Pancreatitis. In: Pancreatic gastrointestinal and liver disease. R. Wyllie, J. Hyams, M. Kay (eds.). Elsevier Saunders, USA. 2011. P. 905–914.