血清磷脂酶A2、淀粉酶、脂肪酶和尿淀粉酶活性与急性胰腺炎严重程度的关系

A Mäkelä, T Kuusi, T Schröder
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摘要

目的:比较血清磷脂酶A2活性与常规酶测定作为急性胰腺炎严重程度的指标。设计:前瞻性研究。地点:芬兰大学医院。对象:连续80例急性胰腺炎患者。干预措施:入院后一周每天抽取血清和尿液样本。主要观察指标:血清磷脂酶A2、淀粉酶、脂肪酶和尿淀粉酶活性。结果:入院时,所有患者血清淀粉酶和脂肪酶活性均平行升高。然而,急性暴发性胰腺炎患者的平均血清磷脂酶A2活性比病情较轻的患者高3倍。在严重疾病期间,磷脂酶A2的活性保持较高,而其他酶的活性在第一周明显下降。与其他酶活性相反,血清磷脂酶A2的活性与急性胰腺炎的严重程度密切相关。在60℃下加热45分钟,使非胰腺耐热性磷脂酶A2失活,使血清总磷脂酶A2活性比胰腺组织匀浆中的酶活性更低,这表明血清中存在胰腺外磷脂酶A2。受试者工作特征(ROC)曲线证实了血清磷脂酶A2活性的高敏感性和特异性,曲线下平均(SEM)面积为0.870(0.062),而其他酶活性的曲线下最高面积为0.52(0.089)。结论:与淀粉酶和脂肪酶活性相比,血清磷脂酶A2活性的测定对于评估急性胰腺炎的严重程度非常重要,从而可以给予最佳治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Serum phospholipase A2, amylase, lipase, and urinary amylase activities in relation to the severity of acute pancreatitis.

Objective: To compare serum phospholipase A2 activity with measurements of conventional enzymes as an indicator of the severity of acute pancreatitis.

Design: Prospective study.

Setting: University hospital, Finland.

Subjects: 80 Consecutive patients with acute pancreatitis.

Interventions: Serum and urine samples were taken daily for a week after admission.

Main outcome measures: Serum phospholipase A2, amylase, lipase, and urinary amylase activities.

Results: On admission, the serum amylase and lipase activities increased in parallel in all patients. However, the mean serum phospholipase A2 activity was three times higher in the patients with acute fulminant pancreatitis than in those with milder disease. The phospholipase A2 activity remained high during the course of the severe disease, whereas the other enzyme activities decreased appreciably during the first week. In contrast to the other enzyme activities that of serum phospholipase A2 correlated well with the severity of the acute pancreatitis. Heating at 60 degrees C for 45 minutes to inactivate the non-pancreatic thermolabile phospholipase A2 reduced the total serum phospholipase A2 activity more than the enzyme activity in the homogenates of pancreatic tissue, which suggests that extrapancreatic phospholipase A2 is present in serum. The receiver operating characteristic (ROC) curves confirmed the high sensitivity and specificity of serum phospholipase A2 activity with a mean (SEM) area under the curve up to 0.870 (0.062) compared with the other enzyme activities of which the highest area under the curve was 0.52 (0.089).

Conclusions: In contrast to amylase and lipase activities, measurement of serum phospholipase A2 activity is important in the assessment of the severity of acute pancreatitis so that optimal treatment may be given.

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