Eckfeldt J H, Kolars J C, Elson M K, Shafer R B, Levitt M D
Arch Pathol Lab Med. 1985 Apr;109(4):316-9.
Though the serum total amylase test has been used for the diagnosis of pancreatitis for over 50 years, both its clinical sensitivity and specificity are far from perfect. We first present the results of serial serum total amylase, pancreatic isoamylase, lipase, and immunoreactive trypsin tests in nine patients during the week after their admission to the hospital with a diagnosis of acute pancreatitis, and then compare the serum total amylase, lipase, and immunoreactive trypsin levels in the initial serum submitted for amylase analysis from 100 patients because of the clinical suspicion of acute pancreatitis. In the former group of patients, the serum total amylase test was the least sensitive of the tests for pancreatitis after the first hospital day. In the latter group of patients, the largest discordance was found in patients with elevated serum total amylase levels, but normal lipase and immunoreactive trypsin levels. In 90% of these discordant cases, the elevation of serum total amylase was due to salivary amylase, yielding a maximum clinical specificity of only 71% for serum total amylase. Based on these data, we conclude that alternate tests deserve careful consideration as replacements for the serum total amylase test.
尽管血清总淀粉酶检测用于诊断胰腺炎已有50多年，但它的临床敏感性和特异性都远非完美。我们首先呈现9例诊断为急性胰腺炎入院一周内患者的系列血清总淀粉酶、胰腺同工淀粉酶、脂肪酶和免疫反应性胰蛋白酶检测结果，然后比较100例因临床怀疑急性胰腺炎而提交进行淀粉酶分析的初始血清中的血清总淀粉酶、脂肪酶和免疫反应性胰蛋白酶水平。在前一组患者中，入院第一天后血清总淀粉酶检测对胰腺炎的敏感性最低。在后一组患者中，血清总淀粉酶水平升高但脂肪酶和免疫反应性胰蛋白酶水平正常的患者差异最大。在这些差异病例中，90%血清总淀粉酶升高是由于唾液淀粉酶所致，血清总淀粉酶的最大临床特异性仅为71%。基于这些数据，我们得出结论，替代检测值得仔细考虑以取代血清总淀粉酶检测。
