Kolars J C, Ellis C J, Levitt M D
Dig Dis Sci. 1984 Apr;29(4):289-93. doi: 10.1007/BF01318510.
We compared results of measurements of total serum amylase, pancreatic isoamylase, and lipase measurements in patients with hyperamylasemia. Serial measurements of these three enzyme levels in patients recovering from acute pancreatitis indicated that pancreatic isoamylase and lipase were elevated above normal to a greater extent and remained elevated much longer than did the total amylase. This finding indicates an appreciable sensitivity advantage of the pancreatic isoamylase and lipase over total amylase measurement during the recovery phase of pancreatitis. Comparison of pancreatic isoamylase and lipase levels in selected sera indicated a good correlation (r = 0.84) between these two measurements in patients who did not have macroamylasemia. Lipase was normal in sera with amylase elevations due solely to salivary isoamylase. Thus, in nonmacroamylsemic sera, pancreatic isoamylase and lipase appear to be roughly interchangeable markers of the level of pancreatic enzymes in the blood. An advantage of the lipase assay is that this enzyme is normal in hyperamylasemia caused by macroamylasemia, whereas the inhibitor assay indicates that the pancreatic isoamylase is elevated. Development of automated assays for either pancreatic isoamylase or lipase should lead to the routine use of one of these assays in place of the present reliance on total amylase measurements in the diagnosis of pancreatitis.
我们比较了高淀粉酶血症患者血清总淀粉酶、胰腺同工淀粉酶和脂肪酶的测量结果。对急性胰腺炎恢复期患者这三种酶水平的连续测量表明，胰腺同工淀粉酶和脂肪酶高于正常水平的程度更大，且持续升高的时间比总淀粉酶长得多。这一发现表明，在胰腺炎恢复期，胰腺同工淀粉酶和脂肪酶相对于总淀粉酶测量具有明显的敏感性优势。对选定血清中胰腺同工淀粉酶和脂肪酶水平的比较表明，在没有巨淀粉酶血症的患者中，这两种测量结果之间具有良好的相关性（r = 0.84）。在仅因唾液同工淀粉酶导致淀粉酶升高的血清中，脂肪酶正常。因此，在非巨淀粉酶血症血清中，胰腺同工淀粉酶和脂肪酶似乎大致可相互替代作为血液中胰腺酶水平的标志物。脂肪酶检测的一个优点是，在巨淀粉酶血症引起的高淀粉酶血症中该酶正常，而抑制剂检测表明胰腺同工淀粉酶升高。开发胰腺同工淀粉酶或脂肪酶的自动化检测方法应会导致在胰腺炎诊断中常规使用其中一种检测方法来取代目前对总淀粉酶测量的依赖。
