Kim D K, Schwartz M K, Sherlock P
Surg Gynecol Obstet. 1980 Jan;150(1):49-53.
The pancreas can be studied for obstructive disease by measuring serum lipase levels in the two stage provocative test. The test is nonspecific but noninvasive and applicable to all stages of pancreatic diseases. In this test, the pancreas is stimulated twice in two hour intervals before measuring the serum enzyme levels: first, with pancreozyin and secretin--the stage 1 test and, second, with pancreozymin, secretin, betazole hydrochloride and morphine sulfate--the stage 2 test. Among the pancreatic enzymes measured, lipase was most reliable. Serum lipase level elevation in the stage 1 test indicates a pancreatic abnormality and it completes the test. Patients who fail to respond to the stage 1 test have either a normal pancreas or pancreatic insufficiency and need the stage 2 test for differential diagnosis. In the stage 2 test, the serum lipase level is elevated in patients with a normal pancreas but not in those with pancreatic insufficiency. As a preliminary study, ten patients with carcinoma of the pancreas, two with pancreatitis and ten in the control group were studied. All patients with a known pancreatic disease demonstrated an abnormality in the test. Two of ten in the control group also had abnormal results. The two stage provocative test may be used prior to undertaking more invasive examinations, such as an arteriogram, in patients who are suspected of having pancreatic disease, yet other tests have failed to indicate it.
可通过在两阶段激发试验中测量血清脂肪酶水平来研究胰腺的阻塞性疾病。该试验不具有特异性，但为非侵入性，适用于胰腺疾病的所有阶段。在该试验中，在测量血清酶水平之前，每隔两小时对胰腺进行两次刺激：首先，使用胰酶泌素和促胰液素——第一阶段试验；其次，使用胰酶泌素、促胰液素、盐酸倍他唑和硫酸吗啡——第二阶段试验。在所测量的胰腺酶中，脂肪酶最为可靠。第一阶段试验中血清脂肪酶水平升高表明胰腺异常，该试验即完成。对第一阶段试验无反应的患者胰腺要么正常，要么存在胰腺功能不全，需要进行第二阶段试验以进行鉴别诊断。在第二阶段试验中，胰腺正常的患者血清脂肪酶水平升高，而胰腺功能不全的患者则不然。作为一项初步研究，对10例胰腺癌患者、2例胰腺炎患者和10例对照组患者进行了研究。所有已知患有胰腺疾病的患者在试验中均表现出异常。对照组的10例中有2例结果也异常。对于疑似患有胰腺疾病但其他检查未能显示的患者，在进行更具侵入性的检查（如动脉造影）之前，可使用两阶段激发试验。
