McAb免疫抑制法检测α-淀粉酶同工酶及其临床意义

目的使用免疫抑制法检测α-淀粉酶同工酶胰腺淀粉酶（P-AMY），以评价其诊断急性胰腺炎的临床价值。方法对55例急性胰腺炎，81例急性胆囊炎的血清和尿液α-AMY总活性及P-AMY活性和P／α比值进行了对比研究。结果血清和尿液P-AMY的参考范围为6-46U／L和58-398U／L，急性胰腺炎组血清α.P-AMY.P／α及尿液α.P-AMY均较急性胆囊炎组病人有高度显著性差异（P＜0.01），但两组病人尿液P／α比值无显著性差异（P＞0.05）。急性胆囊炎病人血清α.P-AMY，P／α及尿液α.P-AMY校正常健康人无显著性差异（P＞0.05），但两组病人尿液P／α比值有显著性差异（P＜0.05）。在136例病人中，急性胰腺炎病人血清P-AMY的诊断特异性效率最高，分别为92.6％和89％。结论该方法检测P-AMY准确，特异，快速，可作为急性胰腺炎的诊断和鉴别诊断的重要依据。     

血清淀粉酶和脂肪酶联合测定在急性胰腺炎诊断中的意义

目的 探讨血清淀粉酶（AMY）和脂肪酶（LIP）测定在急性胰腺炎诊断中的价值。方法 对54例急性胰腺炎患者、58例胆结石患者、47例肾结石患者和50例健康对照组人员进行血清淀粉酶（AMY）和脂肪酶（LIP）测定。结果 54例急性胰腺炎中血清淀粉酶和脂肪酶升高的敏感性分别为87．0％和92．6％；联合测定AMY和LIP单项指标阳性率为98．1％；105例非急性胰腺炎患者中，AMY阳性的有12例，LIP阳性的有10例，AMY和LIP的特异性分别为88．6％和90．5％，AMY和LIP同时阴性的特异性为100％。结论 联合测定血清AMY和LIP可提高急性胰腺炎诊断的敏感性和特异性，对急性胰腺炎具有重要的诊断意义。     

血清淀粉酶和脂肪酶联合检测在急性胰腺炎诊断中的应用

目的：分析血清淀粉酶（AMY）和脂肪酶（LPS）检测方式在急性胰腺炎诊断中的价值。方法选取2010年5月至2012年5月收治的急性胰腺炎患者50例,同时选取健康受检者50例作为对照组,行AMY与LPS检测,分析AMY和LPS检测的结果,以及不同检测方式用于诊断的灵敏度、准确度、特异度。结果 AMY 与 LPS 水平由高到低为：重度急性胰腺炎（SAP）组、轻度急性胰腺炎（MAP）组、对照组;检测准确度、特异度以及灵敏度的比较：AMY、LPS联合检测与单测AMY、LPS比较各诊断效能指标均明显更高,差异有统计学意义（P＜0．05）;且LPS与AMY检测相比,以上各诊断指标值均更高,差异有统计学意义（P＜0．05）。结论 AMY联合LPS检测方式在诊断急性胰腺炎中,具有显著的应用价值,值得积极推广。     

血清淀粉酶同工酶在急性胰腺炎诊断中的应用

急性胰腺炎是一种常见的急腹症。实验室检测方面。血清淀粉酶（AMY）的测定对该病诊断有较高的敏感性．一般认为在80％～95％。但其特异性不高，有报道认为只有57％。临床上有些疾病有时也会引起血AMY升高，这就给诊断上带来了困难。健康人群血清AMY主要来自胰腺和腮腺的分泌，只有很少一部分来自卵巢、输卵管、肺、肠道等器官组织分泌。血清中AMY主要包括两种同工酶：即胰腺同工酶（P-AMY）主要来源于胰腺。和胰腺同工酶（S-AMY）主要来源于胰腺和其他组织。其中胰腺同工酶（P-AMY）对急性胰腺炎诊断具有较高的特异性。     

血清淀粉酶和脂肪酶联合检测在小儿胰腺炎诊断中的应用

目的探讨血清淀粉酶（AMY）和脂肪酶（LPS）联合测定在小儿急性胰腺炎（CAP）诊断中的价值。方法同时测定36例CAP患儿患病不同时间（2～4h、4～8h、16～24h、2～4d、6～8d）的血清、尿AMY和LPS,并以50例其他疾病的患儿作为对照。结果AMY及LPS的阳性率随着发病时间的延长有逐步升高的趋势。在2—4h时AMY、LPS联合检测,阳性率可增至27．8％（10／36）。4～8h时LPS阳性率明显高于AMY;2—4d后,AMY阳性率明显低落,而LPS的阳性率尚保持较高水平。LPS对CAP的诊断特异性明显高于AMY。结论血清AMY和LPS联合测定可为小儿胰腺炎提供重要的诊断依据。     

以BG5P为基质的抑制法测定淀粉酶同工酶

已知人α-淀粉酶(EC3、2、1、1,AMY)存在由胰腺分泌的P-AMY 和唾液分泌的S-AMY 两种同工酶。对于高AMY 血症,测定总AMY,同时淀定AMY 同工酶对了解胰、唾液腺的状态或产生异性AMY 及巨淀粉酶血症等是非常必要的。过去AMY 同工酶测定多用电泳法。一种新的测定α-AMY 的合成基质4-硝基酚6-0-苯基α-麦芽戊糖苷(BG5P),在AMY 作用下水     

血清淀粉酶和脂肪酶联合测定在急性胰腺炎诊断中的意义

目的探讨血清淀粉酶(AMY)和脂肪酶(LPS)测定在急性胰腺炎诊断中的价值。方法对51例急性胰腺炎患者、418例其他原因所致急腹症患者和78例健康对照组人员进行血清淀粉酶和脂肪酶测定。结果 51例急性胰腺炎患者中,AMY和LPS升高的敏感性分别为86.3%和92.2%。418例非急性胰腺炎的急腹症患者中,AMY、LPS升高和二者均升高的特异性分别为90.4%、91.7%和100%。结论联合测定血清AMY和LPS可提高急性胰腺炎诊断的敏感性和特异性,对急性胰腺炎的快速诊断具有重要意义。     

血清淀粉酶和脂肪酶联合检测在急性胰腺炎诊断中的应用

目的分析血清淀粉酶(AMY)和脂肪酶(LPS)检测方式在急性胰腺炎诊断中的价值。方法选取2012年1月至2014年2月收治的100例急性胰腺炎患者和100例健康体检者行AMY与LPS检测,分析检测结果及其灵敏度、准确度、特异度。结果重度急性胰腺炎组与轻度急性胰腺炎组患者的AMY、LPS水平高于对照组,差异有统计学意义(P0.05);重度急性胰腺炎组AMY、LPS水平比轻度急性胰腺炎组高,差异有统计学意义(P0.05);AMY、LPS联合检测的准确度、特异度、灵敏度高于两者单独检测结果。结论 AMY联合LPS检测可以为急性胰腺炎提供重要的诊断依据。     

C反应蛋白、淀粉酶及脂肪酶联合检测在急性胰腺炎早期诊断中的作用

目的：探讨针对急性胰腺炎患者开展 C 反应蛋白、淀粉酶与脂肪酶联合检测的早期诊断价值,以及对病变程度的评估效果。方法选取该院2012年3月至2014年3月收治的急性胰腺炎患者71例,其中轻型胰腺炎患者60例,重型胰腺炎患者11例,同时以30例非急性胰腺炎急腹症患者作为对照 A 组,并选取同期于本院体检合格的健康成年人50例作为对照 B 组。分别开展 C 反应蛋白、淀粉酶以及脂肪酶的临床检测,并将获取结果进行比较与分析。结果急性胰腺炎患者血清淀粉酶水平为（759．42±721．63）U／L,血清脂肪酶水平为（1624．34±1598．25）U／L,均高于对照 A 组与对照 B 组,差异有统计学意义（P ＜0．05）。但患者的 C 反应蛋白水平为（44．61±34．21）mg／L,与对照 B 组比较差异无统计学意义（P ＞0．05）。三种指标联合检测用于早期急性胰腺炎诊断的灵敏度为95．9％,特异度为100．0％,准 确 度为96．9％,均高于其他检测方式,差 异有统计学意义（P ＜0．05）。结论针对急性胰腺炎患者开展 C 反应蛋白、淀粉酶与脂肪酶联合检测,不但具有明确的早期诊断效果,而且对疾病程度的判断具有参考价值。     

非胰腺炎高脂血症孕妇不同孕期血淀粉酶水平变化及其与血脂水平的关系

目的探讨非胰腺炎高脂血症孕妇处于不同孕期时外周血淀粉酶水平的变化及其与血脂水平的关系。方法采用横断面研究分析法将986名孕妇按孕期分为早、中、晚孕期3组,同时选取非孕体检健康女性200名为对照组,同时检测总胆固醇(TC)、三酰甘油(TG)及α-淀粉酶(α-AMY)的水平,对检测结果进行统计分析。结果中、晚孕组TG水平分别为(2.17±0.62)、(2.73±0.58)mmol/L,高于对照组(1.16±0.54)mmol/L;晚孕组α-AMY水平为(78.42±19.41)U/L,与对照组(50.92±18.93)U/L相比,差异有统计学意义(P0.05),外周血中α-AMY的水平与TG水平具有相关性(r=0.56,P0.05)。妊娠期妇女外周血晚孕组α-AMY水平为(78.42±19.41)U/L,与中孕组(57.19±17.62)U/L相比,差异有统计学意义(P0.05)。其中,晚孕组2名孕妇并发急性胰腺炎。妊娠期妇女外周血α-AMY与TG这两个变量之间存在中度正相关关系(r=0.56,P0.05)。结论孕晚期妇女外周血α-AMY水平的升高可能是由高脂血症导致胰腺高负荷引起,对于妊娠后期高血脂孕妇建议产前检查血淀粉酶水平,可以对妊娠期急性胰腺炎进行早期诊断,正确评估病情并尽早采取干预措施,提高母婴预后。     

Clinical evaluation of a pancreatic lipase mass concentration assay.

An immunoactivation assay for determining pancreatic lipase mass concentration was clinically evaluated and compared with results obtained by measuring total amylase and pancreatic amylase activity. A group of 30 patients with pancreatitis was compared with a control group of 32 patients in which this disease was suspected but excluded. Both lipase mass concentration and pancreatic amylase activity exhibit good sensitivity (0.93 each) and specificity (0.94 and 0.97, respectively) at cutoff concentrations of 200 micrograms/L and 200 U/L, respectively. The median increase in lipase mass concentration (37.1 times the upper limit of the reference interval) in the pancreatitis group was higher than that for either total amylase or pancreatic amylase activity (5.94 and 14.5 times, respectively) but showed a similar time to peak value. We conclude that the lipase assay is the method of choice for diagnosing pancreatitis.     

Biochemical evaluation of patients with acute pancreatitis.

In this study we determined the clinical accuracy of alpha2-macroglobulin, alpha-amylase, C-reactive protein, lipase, non-esterified fatty acids, pancreatic alpha-amylase and phospholipase A in the diagnosis and prognosis of acute pancreatitis in a group of patients with acute abdominal pain using receiver operator characteristic curve analysis. We investigated 59 patients with acute pancreatitis and 72 patients with extrapancreatic diseases of gastrointestinal origin. On the basis of initial enzyme activities, at cut-offs of 245 U/l for amylase, 656 U/l for lipase, and 182 U/l for pancreatic alpha-amylase, the diagnostic efficiencies were 0.993, 0.980, and 0.975, respectively. Receiver operator characteristic curve analysis showed the same diagnostic accuracies. We evaluated the accuracy of serum alpha2-macroglobulin, C-reactive protein, non-esterified fatty acids and phospholipase A for differentiation between acute necrotizing pancreatitis and acute oedematous pancreatitis. C-reactive protein had the highest prognostic accuracy of the parameters studied (the area under curve = 0.9082) and at a cut-off value of 126 mg/l, sensitivity and specificity were 0.759 and 0.912, respectively. The role of the clinical laboratory in the investigation of patients with acute pancreatitis continues to evolve and biochemical parameters are a good diagnostic and prognostic option.     

Diagnostic value of measuring pancreatic isoamylase with a double-monoclonal antibody immunoassay in serum of hospitalized hyperamylasemic patients

We evaluated the diagnostic utility of measuring pancreatic isoamylase (P-AMY) with a double-monoclonal antibody technique in a population of 43 consecutive hospitalized hyperamylasemic patients in comparison with serum pancreatic lipase (LPS) activity. In 27 cases (62.8%), the final diagnosis was acute pancreatitis. Predictive values were calculated for P-AMY and LPS activities, and a P-AMY percentage was calculated for selected decision levels. The maximal diagnostic efficiency was 0.930, 0.814, and 0.767 for LPS, P-AMY activity, and P-AMY percentage, respectively, indicating that serum LPS measurement was clinically superior to P-AMY for distinguishing patients with or without pancreatitis. Measurement of both P-AMY activity and percentage in serum did not significantly improve diagnostic accuracy.     

Lipase isoforms and amylase isoenzymes: assays and application in the diagnosis of acute pancreatitis.

Pancreatic juice and serum from patients with acute pancreatitis contain three enzymes that have lipolytic activity: L1 and L2, which are pancreatic isoenzymes or isoforms of lipase (EC 3.1.1.3), and L3, which is probably pancreatic carboxyl ester lipase, also known as cholesterol esterase (EC 3.1.1.13). These enzymes are readily separated electrophoretically on agarose and can be developed with an overlay of Kodak Ektachem lipase slide material. The latter acts as a dry-reagent developing substrate, with the enzymes producing blue bands in the slide material. We found L1 in about one-half of normal persons, L2 in none, and L3 in all. We assayed for amylase (EC 3.2.1.1), amylase isoenzymes, lipase, and lipase isoforms in the sera of 100 patients with suspected acute pancreatitis. L2 lipase has the greatest diagnostic efficiency for the diagnosis of pancreatitis, compared with total amylase, P3 amylase, and total lipase. Lipase and L2 could replace amylase, an inefficient test, for the diagnosis of patients with suspected acute pancreatitis. In patients receiving organ transplants, a serum amylase value of greater than 300 U/L or a lipase of greater than 1000 U/L discriminated well between patients with and without complications and (or) acute rejection.     

Diagnostic and prognostic utility of phospholipase A activity in patients with acute pancreatitis: comparison with amylase and lipase.

We compared the diagnostic and prognostic utility of phospholipase A (PLA; EC 3.1.1.4) for acute pancreatitis with that of amylase and lipase by analysis of sera from 151 consecutive patients presenting with abdominal pain in whom assays of serum amylase and (or) lipase had been ordered. We determined the diagnostic accuracy for both the initial and the peak enzyme activities. Maximal diagnostic accuracy obtained for the initial activities of amylase, lipase, and PLA was 0.83, 0.83, and 0.76 at cutoff values of 650, 650, and 41 U/L, respectively. Use of peak enzyme activities showed maximal diagnostic accuracy of 0.85, 0.86, and 0.73 at cutoff values of 650, 1050, and 42 U/L, respectively. Receiver-operator characteristic curve analysis revealed the diagnostic performance of amylase and lipase to be similar, whereas that of PLA was almost random and not incremental. As with amylase and lipase, PLA activities in sera showed no relation to patients' survival; three patients who died after an attack of acute pancreatitis failed to demonstrate the dramatic increases in PLA activity previously described. We conclude that assessing the severity of acute pancreatitis by using enzyme activities still remains problematical. Measurements of amylase or lipase activities provide similar diagnostic discrimination when appropriate cutoff values are used and remain the methods of choice for diagnosis of acute pancreatitis.     

Diagnostic value of measuring pancreatic lipase and the P3 isoform of the pancreatic amylase isoenzyme in serum of hospitalized hyperamylasemic patients

We assayed amylase (AMY) isoenzymes by cellulose acetate electrophoresis and determined pancreatic lipase (LPS) activity by a turbidimetric colipase-supplemented method in 54 hospitalized hyperamylasemic patients (32 men and 22 women; mean age 61.5, SD 16, years). In AMY isoenzyme analysis, use of a value for P3 isoform greater than 14 U/L as a positive test for acute pancreatitis gave a diagnostic efficiency of 92.6%, a predictive value of a positive test result of 90.5%, and a predictive value of a negative test of 100%. Four of 12 patients with other, nonpancreatic abdominal diseases had false-positive test results. LPS activity (cutoff limit, 700 U/L) was as effective as P3 isoform in distinguishing patients with acute pancreatitis (sensitivity, 100%) from those without acute pancreatitis (specificity, 81.3%). Thus, P3 isoform and LPS appear to be interchangeable markers of pathological release of pancreatic enzymes into the bloodstream during acute pancreatitis. This finding decreases the need for the expensive radiological procedures currently required to confirm this diagnosis. In particular, negative results virtually exclude acute pancreatitis.     

The Clinical Significance of Hyperamylasemia in Organophosphate Poisoning

Abstract

Objective: Hyperamylasemia with a presumptive diagnosis of acute pancreatitis has been reported following organophosphate poisoning but there are no large-scale studies incorporating more specific diagnostic criteria. Methods; Retrospective review of the medical records of 159 patients with a diagnosis of organophosphate poisoning over 3 years. Serum amylase, pancreatic amylase, salivary amylase, lipase and cholinesterase levels, and the clinical manifestations were analyzed. Results; Serum amylase data was available for 121 of the 159 study patients. Hyperamylasemia (amylase ≥ 360 U/L) was found in 44 patients (36%). Lipase was measured in 28 patients with hyperamylasemia; 9 of 28 had hyperlipasemia (lipase ≥ 380 U/L). The finding of hyperamylasemia was closely related to clinical severity and presence of shock. A presumptive diagnosis of painless acute pancreatitis was diagnosed by hyperlipasemia associated with hyperamylasemia, clinical severity, serum LDH, and leukocyte counts. Two patients with presumptive pancreatitis died. Shock, coma, and hypoalbuminemia were the factors predicting fatality. Conclusions: Hyperamylasemia is frequent in severe organophosphate poisoning. However, hyperamylasemia is not synonymous with acute pancreatitis and pancreatic amylase is not a reliable parameter in the diagnosis of organophosphate-induced pancreatitis due to its low sensitivity and specificity. Lipase assay is indicated in patients with hyperamylasemia for early diagnosis of pancreatitis. Proper image studies and even pathological examination are also needed to confirm the extent of pancreatic injury. With prompt diagnosis and appropriate treatment, a complete recovery can be anticipated unless the patient has otherwise unrelated complications.     

Measuring carboxypeptidase A activity with a centrifugal analyzer: analytical and clinical considerations

This adaptation of a commercially available kit for automated measurement of carboxypeptidase A (CPA; EC 3.4.17.1) activity in serum with the Cobas Bio centrifugal analyzer extends the linear range to an activity concentration of 82 U/L. Results obtained by the described method correlated closely (r = 0.98) with those by the manual kit method. The reference interval for 150 apparently normal individuals was 0.12-0.91 U/L. Total CVs of the method ranged from 4.0% to 13.1%. Bilirubin and glucose decreased the CPA activity in serum by as much as 98% and 26%, respectively. Substantial CPA activity was found in pancreatic tissue, with little activity in intestinal tissue. CPA activity was not as widely distributed in extra-pancreatic tissues as were amylase and lipase activities. Peak activities of CPA, amylase, and lipase in the sera of patients with acute pancreatitis were significantly correlated (r = 0.45 to 0.78, P less than 0.05-0.01). The optimized diagnostic efficiency of CPA for acute pancreatitis was 0.85 at a cutoff value of 5 U/L. Amylase and lipase exhibited similar optimized efficiencies, and parallel testing did not significantly improve diagnostic accuracy. We conclude that automated analysis for CPA activity, even in the absence of interferences, does not add to the diagnostic information provided by the widely available assays for amylase and lipase activity.     

血清淀粉酶和脂肪酶在急性胰腺炎中的应用

同时测定临床疑为急性胰腺炎的99例患者的淀粉酶、脂肪酶,运用统计学方法,分别计算出其灵敏度、特异度、准确度并比较。结果淀粉酶与脂肪酶联合测定的灵敏度、特异度、准确度,明显优于单独测定淀粉酶或脂肪酶。结论联合测定有利于实验室时AP的早期诊断。