Kazmierczak S C, Van Lente F
Department of Biochemistry, Cleveland Clinic Foundation, OH 44106.
Clin Chem. 1988 May;34(5):916-9.
We investigated the incidence and possible mechanisms of postoperative hyperamylasemia in 101 patients after cardiac surgery. Amylase (EC 3.2.1.1) activities in serum were increased in 36% of patients after bypass surgery, 59% of patients after valve replacement, and in 69% of patients after combined bypass and valve replacement. Lipase (EC 3.1.1.3) activity was increased in 30% of all patients. We found enzymatic evidence for pancreatitis in six patients. Thirty-six patients showed increased salivary (S-type) amylase activity, with a positive correlation (r = 0.55, P less than 0.001) between the severity of pleural effusions and the peak S-type amylase activity. Hyperamylasemia after cardiac surgery is apparently often related to absorption of S-type amylase from pleural fluid and (or) from aspirated salivary secretions. Monitoring patients for postsurgical pancreatitis necessitates assay of amylase isoenzymes to distinguish abnormalities resulting in release of pancreatic (P-type) amylase from those involving release of S-type amylase.
我们对101例心脏手术后患者术后高淀粉酶血症的发生率及可能机制进行了研究。搭桥手术后36%的患者、瓣膜置换术后59%的患者以及搭桥联合瓣膜置换术后69%的患者血清淀粉酶（EC 3.2.1.1）活性升高。所有患者中有30%脂肪酶（EC 3.1.1.3）活性升高。我们发现6例患者有胰腺炎的酶学证据。36例患者唾液（S型）淀粉酶活性升高，胸腔积液严重程度与S型淀粉酶活性峰值之间呈正相关（r = 0.55，P < 0.001）。心脏手术后的高淀粉酶血症显然常与胸腔积液中S型淀粉酶和（或）吸入的唾液分泌物中S型淀粉酶的吸收有关。监测患者术后胰腺炎需要检测淀粉酶同工酶，以区分导致胰腺（P型）淀粉酶释放的异常情况与涉及S型淀粉酶释放的异常情况。
