糖尿病酮症酸中毒中的非特异性高淀粉酶血症和高脂肪酶血症：发病率及其与生化异常的相关性
Nonspecific hyperamylasemia and hyperlipasemia in diabetic ketoacidosis: incidence and correlation with biochemical abnormalities.
作者信息
Yadav D, Nair S, Norkus E P, Pitchumoni C S
机构信息
Department of Biomedical Research, Our Lady of Mercy Medical Center, New York Medical College, Bronx 10466, USA.
出版信息
Am J Gastroenterol. 2000 Nov;95(11):3123-8. doi: 10.1111/j.1572-0241.2000.03279.x.
OBJECTIVES
Amylase and lipase estimations are the standard tests to diagnose acute pancreatitis (AP). Elevation of amylase and lipase < or = 3 times normal may be nonspecific, but elevation of either one > 3 times normal is reported to be diagnostic of AP. The aim of this study was to evaluate the incidence and magnitude of nonspecific elevations of amylase and lipase in diabetic ketoacidosis (DKA) and to correlate their elevation with known metabolic derangements of DKA.
METHODS
A total of 150 consecutive episodes of DKA in 135 patients were evaluated for serum amylase, lipase, and biochemical markers of DKA on admission and 24 h later. Patients were divided according to the following: 1) Clearly nonspecific amylase elevation (CNSA): Amylase elevation < 3 times normal plus normal or < 3 times lipase; 2) Clearly nonspecific lipase elevation (CNSL): Lipase elevation < 3 times normal plus normal or < 3 times amylase; and 3) Probably nonspecific amylase or lipase elevation (PNSA or PNSL): > 3 times elevation of amylase or lipase or both with normal abdominal CT.
RESULTS
Elevated amylase and lipase levels ranged from 111 to 1257 IU/L (normal 30-110 IU/L) and 25-529 IU/dl (normal < 24 IU/dl) (CT-proven AP = 16, excluded). Nonspecific amylase elevation (CNSA + PNSA) = 25 (16.6%) cases, CNSA in 10 (6.6% of all DKA or 27% of amylase elevations), and PNSA in 15 (10% of all DKA or 41% of amylase elevations). Nonspecific lipase elevation (CNSL + PNSL) = 36 (24%), CNSL in 23 (15.3% of all DKA or 47% of all lipase elevations), and PNSL in 13 (8.7% of all DKA or 26.5% of all lipase elevations). Multiple regression analyses showed significant correlation of pH and serum osmolality with amylase elevation. Lipase elevation showed positive correlation with serum osmolality alone.
CONCLUSIONS
In DKA nonspecific elevations of amylase and lipase occur in 16-25% of cases. Amylase elevation is correlated with pH and serum osmolality, but lipase elevation is correlated with serum osmolality alone. Diagnosis of AP based soley on elevated amylase or lipase, even > 3 times normal, is not justifiable.
目的
淀粉酶和脂肪酶测定是诊断急性胰腺炎（AP）的标准检查。淀粉酶和脂肪酶升高至正常上限的≤3倍可能不具有特异性，但据报道，两者中任何一项升高超过正常上限的3倍即可诊断为AP。本研究的目的是评估糖尿病酮症酸中毒（DKA）患者中淀粉酶和脂肪酶非特异性升高的发生率及幅度，并将其升高与已知的DKA代谢紊乱相关联。
方法
对135例患者的150次连续性DKA发作进行评估，于入院时及24小时后检测血清淀粉酶、脂肪酶及DKA的生化指标。患者按以下标准分组：1）明确的非特异性淀粉酶升高（CNSA）：淀粉酶升高<正常上限的3倍且脂肪酶正常或<正常上限的3倍；2）明确的非特异性脂肪酶升高（CNSL）：脂肪酶升高<正常上限的3倍且淀粉酶正常或<正常上限的3倍；3）可能的非特异性淀粉酶或脂肪酶升高（PNSA或PNSL）：淀粉酶或脂肪酶升高>正常上限的3倍，或两者均升高且腹部CT正常。
结果
淀粉酶和脂肪酶水平升高范围分别为111至1257 IU/L（正常范围30 - 110 IU/L）和25至529 IU/dl（正常范围<24 IU/dl）（CT证实的AP患者16例，已排除）。非特异性淀粉酶升高（CNSA + PNSA）共25例（16.6%），其中CNSA 10例（占所有DKA的6.6%或淀粉酶升高病例的27%），PNSA 15例（占所有DKA的10%或淀粉酶升高病例的41%）。非特异性脂肪酶升高（CNSL + PNSL）共36例（24%），其中CNSL 23例（占所有DKA的15.3%或所有脂肪酶升高病例的47%），PNSL 13例（占所有DKA的8.7%或所有脂肪酶升高病例的26.5%）。多元回归分析显示，pH值和血清渗透压与淀粉酶升高显著相关。脂肪酶升高仅与血清渗透压呈正相关。
结论
在DKA患者中，16% - 25%的病例存在淀粉酶和脂肪酶的非特异性升高。淀粉酶升高与pH值和血清渗透压相关，而脂肪酶升高仅与血清渗透压相关。仅基于淀粉酶或脂肪酶升高（即使超过正常上限的3倍）来诊断AP是不合理的。
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