Tetrault G A
Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha 68198-3135.
Clin Chem. 1991 Mar;37(3):447-51.
For patients with symptoms of pancreatitis, measurement of amylase in serum reportedly is more sensitive than that of lipase in acute pancreatitis, whereas lipase reportedly is more specific. However, serum lipase activities exceeding the upper reference limit (URL) have been reported for many patients who did not have pancreatitis. I reviewed the serum lipase and amylase concentrations of 493 consecutive inpatients and emergency department patients for whom both tests were ordered. Serum lipase and amylase activities, determined with an Ektachem 700 analyzer, were less than or equal to URL for 390 patients (83%) and greater than URL for 103. Medical records of 101 of these 103 were reviewed; 18 had acute or chronic relapsing pancreatitis. In this latter group, serum lipase values greater than URL had 100% sensitivity and 84% specificity; those of serum amylase greater than URL had 72% sensitivity and 88% specificity. However, the test combination of serum lipase greater than URL and serum amylase less than or equal to URL also occurred in 84% of the patients in which review of the medical records revealed nonpancreatic gastrointestinal or hepatobiliary disorders as the primary problem (n = 55). Therefore, serum lipase activity measured with the Ektachem assay is also often increased in patients with intra-abdominal disorders that appear to be nonpancreatic.
据报道，对于有胰腺炎症状的患者，在急性胰腺炎中，血清淀粉酶的检测比脂肪酶更敏感，而据报道脂肪酶更具特异性。然而，许多没有胰腺炎的患者也报告了血清脂肪酶活性超过参考上限（URL）。我回顾了493例连续住院患者和急诊科患者的血清脂肪酶和淀粉酶浓度，这些患者都进行了这两项检测。用Ektachem 700分析仪测定的血清脂肪酶和淀粉酶活性，390例患者（83%）小于或等于URL，103例大于URL。对这103例中的101例患者的病历进行了回顾；18例有急性或慢性复发性胰腺炎。在后一组中，血清脂肪酶值大于URL的敏感性为100%，特异性为84%；血清淀粉酶大于URL的敏感性为72%，特异性为88%。然而，在84%的病历审查显示非胰腺性胃肠或肝胆疾病是主要问题的患者中（n = 55），也出现了血清脂肪酶大于URL且血清淀粉酶小于或等于URL的检测组合。因此，用Ektachem检测法测定的血清脂肪酶活性在看似非胰腺性的腹腔内疾病患者中也常常升高。
