Schmidt J, Lewandrowski K, Fernandez-del Castillo C, Mandavilli U, Compton C C, Warshaw A L, Rattner D W
Department of Surgery, Massachusetts General Hospital, Boston 02114.
Dig Dis Sci. 1992 Sep;37(9):1426-33. doi: 10.1007/BF01296014.
The association of serum amylase activity with the extent of pancreatic injury in acute pancreatitis is unclear. To clarify this relationship, we induced acute pancreatitis ranging from mild to lethal in 118 Sprague-Dawley rats (350-450 g). This was achieved by controlled intraductal infusion of low- or high-dose bile salt, with or without enterokinase, followed by intravenous cerulein or saline for 6 hr. Serum amylase was measured at baseline and 6 hr. Pancreatic histopathology was evaluated by two blinded pathologists employing total surface scoring (N = 118) and morphometric 20-field documentation (N = 22). Serum amylase correlated best with edema (r = 0.61) and fat necrosis (r = 0.58), less well with acinar necrosis (r = 0.53) and inflammation (r = 0.50), and poorly with hemorrhage (r = 0.33) and perivascular infiltrate (r = 0.31). Inasmuch as edema and fat necrosis are not important determinants of severity, these observations could explain the poor prognostic value of serum amylase activity in patients with acute pancreatitis.
血清淀粉酶活性与急性胰腺炎胰腺损伤程度之间的关联尚不清楚。为了阐明这种关系，我们在118只体重350 - 450克的斯普拉格 - 道利大鼠中诱导出从轻度到致死性的急性胰腺炎。通过控制向导管内输注低剂量或高剂量胆盐，添加或不添加肠激酶，随后静脉注射雨蛙素或生理盐水6小时来实现。在基线和6小时时测量血清淀粉酶。由两名盲法病理学家采用全表面评分（N = 118）和形态计量20视野记录（N = 22）对胰腺组织病理学进行评估。血清淀粉酶与水肿（r = 0.61）和脂肪坏死（r = 0.58）的相关性最佳，与腺泡坏死（r = 0.53）和炎症（r = 0.50）的相关性次之，与出血（r = 0.33）和血管周围浸润（r = 0.31）的相关性较差。由于水肿和脂肪坏死并非严重程度的重要决定因素，这些观察结果可以解释血清淀粉酶活性在急性胰腺炎患者中预后价值不佳的原因。
