Clink D W, Bouwman D L, Weaver D W
J Surg Res. 1983 Jun;34(6):576-80. doi: 10.1016/0022-4804(83)90113-0.
To evaluate a preliminary correlation of hyperamylasemia to upper gastrointestinal bleeding, total serum amylase and serum isoamylase profiles were determined in 50 patients with upper gastrointestinal bleeding. Etiologies of the bleeding were determined in 46 patients including gastritis or duodenitis in 25, gastric ulcers in 12, duodenal ulcers in 3, Mallory-Weiss tears in 3, gastric carcinoma in 2, and esophageal varices in 1. Gastritis or duodenitis was seen incidentally in 14 more patients. Hyperamylasemia was seen in 38 patients, most commonly being due to a rise of both nonpancreatic and pancreatic isoamylases (18 patients). In 13 patients it was due to an elevation of nonpancreatic amylase alone, and in 7 patients secondary to elevated pancreatic isoamylase alone. Acute pancreatitis raises only the pancreatic component and cannot explain the hyperamylasemia in most of these patients. Hyperamylasemia did not correlate to etiology of the bleeding; gastritis or duodenitis present in the majority of these patients appears to be the unifying factor. Since both nonpancreatic and pancreatic amylases are present in the duodenum and the stomach with pyloric reflux, reabsorption of intraluminal amylase across damaged mucosa is postulated as a mechanism to explain the observed isoamylase patterns. The possibility of decreased amylase clearance as an explanation is unlikely. An alternative central nervous system mechanism might be invoked. It is concluded that hyperamylasemia is a complex event which the use of isoamylase analysis is beginning to elucidate. The hyperamylasemia seen commonly in patients presenting with upper gastrointestinal bleeding does not imply the presence of acute pancreatitis.
为评估高淀粉酶血症与上消化道出血之间的初步相关性，对50例上消化道出血患者测定了血清总淀粉酶和血清同工淀粉酶谱。确定了46例患者的出血病因，其中25例为胃炎或十二指肠炎，12例为胃溃疡，3例为十二指肠溃疡，3例为马洛里-魏斯撕裂，2例为胃癌，1例为食管静脉曲张。另有14例患者偶然发现有胃炎或十二指肠炎。38例患者出现高淀粉酶血症，最常见的原因是非胰腺和胰腺同工淀粉酶均升高（18例）。13例患者仅因非胰腺淀粉酶升高，7例患者仅因胰腺同工淀粉酶升高。急性胰腺炎仅使胰腺成分升高，无法解释这些患者中大多数的高淀粉酶血症。高淀粉酶血症与出血病因无关；这些患者中大多数存在的胃炎或十二指肠炎似乎是统一因素。由于十二指肠和胃中存在非胰腺和胰腺淀粉酶，伴有幽门反流，推测腔内淀粉酶通过受损黏膜的重吸收是解释观察到的同工淀粉酶模式的一种机制。淀粉酶清除率降低作为一种解释的可能性不大。可能涉及另一种中枢神经系统机制。得出的结论是，高淀粉酶血症是一个复杂事件，同工淀粉酶分析的应用开始对其进行阐明。在上消化道出血患者中常见的高淀粉酶血症并不意味着存在急性胰腺炎。
