Warshaw A L, Lee K H
Gastroenterology. 1976 Sep;71(3):388-91.
Amylase isoenzymes, separated by polyacrylamide gel electrophoresis, were measures in 25 normal persons (mean amylase to creatinine clearance ratio 3.0%), 15 patients with acute pancreatitis (mean clearance ratio 9.5%, P less than 0.0001), and 6 patients with hyperamylasemia due to common duct stones (mean clearance ratio 4.1%). Two isoamylases (P1, P2) resembling pancreatic isoenzymes and three isoamylases (S1, S2, S3) resembling salivary isoenzymes appeared regularly in normal serum and urine. Salivary amylases predominated in serum, but pancreatic amylases predominated in urine. This finding is consistent with renal clearance of pancreatic amylases exceeding that of salivary amylases under normal conditions. In patients with pancreatitis or common duct stones, essentially all of the increased amylase activity in serum and urine was due to pancreatic isoamylases (P1 and P2) in their normal proportions. No new or altered amylase isoenzymes were detected. The fraction of pancreatic amylases in the serum or urine was identical for the two diseases. Whereas the difference in amylase to creatinine clearance ratios observed between the two groups of patients is not a function of different amylase isoenzymes presented to the kidney, we conclude that the increased amylase clearance in acute pancreatitis is caused by an alteration of renal transfer of amylase, either at the glomerulus or tubule.
通过聚丙烯酰胺凝胶电泳分离的淀粉酶同工酶，在25名正常人（淀粉酶与肌酐清除率均值为3.0%）、15名急性胰腺炎患者（清除率均值为9.5%，P小于0.0001）以及6名因胆总管结石导致高淀粉酶血症的患者（清除率均值为4.1%）中进行了测定。两种类似胰腺同工酶的异淀粉酶（P1、P2）以及三种类似唾液同工酶的异淀粉酶（S1、S2、S3）在正常血清和尿液中规律出现。唾液淀粉酶在血清中占主导，但胰腺淀粉酶在尿液中占主导。这一发现与正常情况下胰腺淀粉酶的肾脏清除率超过唾液淀粉酶的情况一致。在胰腺炎或胆总管结石患者中，血清和尿液中淀粉酶活性的增加基本上都归因于正常比例的胰腺异淀粉酶（P1和P2）。未检测到新的或改变的淀粉酶同工酶。两种疾病的血清或尿液中胰腺淀粉酶的比例相同。鉴于两组患者之间观察到的淀粉酶与肌酐清除率差异并非是由于呈现给肾脏的不同淀粉酶同工酶所致，我们得出结论，急性胰腺炎中淀粉酶清除率的增加是由肾小球或肾小管处淀粉酶肾脏转运的改变引起的。
