Protease Inhibitors in Acute Human Pancreatitis

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Abstract
A clinical and biochemical analysis of 27 attacks of acute pancreatitis was made throughout the course of the disease. In severe attacks alpha2-macroglobulin (alpha2-M) decreased during the first days, reaching values in blood below 40% of the normal value. In addition, this remaining alpha2-M had a decreased trvpsin-binding capacity, indicating circulating alpha2-M protease complexes. The inter-alpha-trypsin inhibitor concentration was also decreased, whereas alpha1-proteinase inhibitor, antichymotrypsin, and pancreatic secretory trypsin inhibitor increased. All changes were most pronounced in the peritoneal fluid and were also closely correlated to the severity of the disease, assessed by both Ranson's and McMahon's classification systems. All patients with clinical complications had profound biochemical changes. In accordance with earlier findings, activation of both the complement and kinin systems seems possible in both blood and peritoneal fluid at the low alpha2-M concentrations found in severe attacks.

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