Tietz N W, Huang W Y, Rauh D F, Shuey D F
Clin Chem. 1986 Feb;32(2):301-7.
We evaluated the clinical utility of some recently developed laboratory methods, including total amylase by three methods; isoamylase by inhibition and isoelectric focusing; lipase by pH-Stat and turbidimetry; and immunoreactive trypsin. All methods correlated highly positively with hyperamylasemia due to primary acute pancreatitis. Pancreatic-type isoamylase determinations have the greatest clinical usefulness, because total amylase, lipase, and immunoreactive trypsin are increased in a relatively high percentage of other abdominal diseases. Increases in the last-mentioned enzymes in nonpancreatic abdominal disease may be the result of injuries to the pancreas secondary to the primary disease, which are being detected with these highly sensitive methods. Because of the high clinical sensitivity of lipase and immunoreactive trypsin determinations, a normal result tends to exclude acute pancreatitis. Hyperamylasemia seen in lung carcinoma is due to increase in an amylase isoenzyme similar to the salivary-type amylase. The method for pancreatic-type isoamylase based on selective inhibition is satisfactory for routine clinical laboratory use.
我们评估了一些最近开发的实验室检测方法的临床实用性，包括三种方法检测总淀粉酶；通过抑制法和等电聚焦法检测同工淀粉酶；通过pH稳态法和比浊法检测脂肪酶；以及检测免疫反应性胰蛋白酶。所有方法与原发性急性胰腺炎所致的高淀粉酶血症均呈高度正相关。胰腺型同工淀粉酶检测具有最大的临床实用性，因为在其他腹部疾病中，相对较高比例的患者总淀粉酶、脂肪酶和免疫反应性胰蛋白酶也会升高。非胰腺性腹部疾病中上述酶的升高可能是原发性疾病继发胰腺损伤的结果，而这些高灵敏度方法能够检测到这种损伤。由于脂肪酶和免疫反应性胰蛋白酶检测具有较高的临床敏感性，检测结果正常往往可以排除急性胰腺炎。肺癌患者出现的高淀粉酶血症是由于一种类似于唾液型淀粉酶的淀粉酶同工酶增加所致。基于选择性抑制的胰腺型同工淀粉酶检测方法适用于临床实验室常规使用。
