Determination of ribonuclease activity in serum of patients with pancreatic necrosis. An attempt of extending the enzyme diagnosis of acute pancreatitis.

Though the substantial part of serum ribonuclease (EC 3.1.27.5) is of pancreatic origin, there are no consistent data on changes in activity of serum alkaline ribonuclease in acute pancreatitis. The recent findings suggest that the increase in ribonuclease activity refers only to patients with necrotic outcome of acute pancreatitis. The aim of this study was to reevaluate the suggestion that elevated ribonuclease activity is specifically related to pancreatic necrosis. Our studies included 57 patients with verified acute pancreatitis, and 11 patients evolving haemorrhagic or necrotic lesions of the pancreas. It was found, that the enzyme increasing in some percentage of patients with acute pancreatitis is the Poly-C avid "pancreatic" ribonuclease. This enzyme begins to increase in the 2nd or third day after onset of the disease, always after decrease in serum amylase activity down to levels close to normal range. Ribonuclease activity increased up to days 5 or 6 of the disease, and then decreased along with diminution of disease symptoms upon treatment. Correlation studies showed that increased ribonuclease activity in acute pancreatitis is related to a higher than the 2nd degree of severity of the clinical course of the disease, to pancreatic necrosis, death, diminished glomerular filtration rate, and age. Thus, pancreatic necrosis is not the exclusive factor directing the increased ribonuclease activity in acute pancreatitis, but the increased ribonuclease activity seems to be a late marker of acute pancreatitis of a severe clinical course.