Serum Amylase and Lipase Levels in Acute Patients with Pancreatitis Versus Nonpancreatic Abdominal Pain

血清澱粉酶及解脂酶在急性胰臟炎及非胰性腹痛病人之變化

王鴻源(Horng-Yuan Wang) ； 林芳傑(Fung-J Lin) ； 陳泰嘉(Tai-Chia Chen) ； 張明輝(Ming-Huey Chang) ； 林錫泉(Shee-Chan Lin) ； 週孫衍(Shou-Chuan Shih) ； 施壽全(Chin-Roa Kao) ； 高進祿(Sun-Yen Chou)

《中華民國急救加護醫學會雜誌》 7卷3期 (1996/09) Pp. 93-99

https://doi.org/10.30018/JECCM.199609.0001

摘要

血清澱粉酶在急性胰臟炎及因其他原因引起腹痛之病人皆可升高，但在急性胰臟炎之病人也常可見正常之血清澱粉酶。最近，有文獻提到以血清解脂酶來診斷急性胰臟炎有較高之診斷率。因此我們對急性胰臟炎及非胰性腹痛之兩組病人檢查其血清澱粉酶及解脂酶，以探討其變化並且比較兩者之診斷價值。共47例急性胰臟炎及30例非胰性腹痛病人列入研究，結果發現在急性胰臟炎病人中有4例(8.5%)之血清澱粉酶為正常，而幾乎全部病人的血清解脂酶皆升高。在非胰性腹痛病人中，有11例(36.7%)有升高之血清澱粉酶，而只有4例(13.3%)有升高之血清解脂酶。在非胰性腹痛病人中有10例(33.3%)病例，其上升之血清澱粉酶值與在急性胰臟炎病人之血清澱粉酶值重疊，但只有1例(3.3%)，其上升之血清解脂酶值與急性胰臟炎之血清解脂酶值重疊。血清解脂酶對於診斷急性胰臟炎之敏感性，特異性及正確性分別為100%，86.7%及94.8%，其較血清澱粉酶之91.5%，63.3%及80.5%有較好之診斷率。如果將正常值提高1.3倍則有較高之診斷價值，分別為血清解脂酶之100%，96.7%及98.7%；血清澱粉酶之89.4%，90%及89.6%。

關鍵字

澱粉酶 ； 解脂酶 ； 急性胰臟炎 ； 非胰性腹痛

並列摘要

The serum amylase level may be elevated in acute pancreatitis, as well as other conditions which may present with abdominal pain. Conversely, normoamylasemia in acute pancreatitis is not uncommon. Some authors have suggested that serum lipase is a better serum masker for the diagnosis of acute pancreatitis. We conducted a study to evaluate: (1). the differences in serum amylase and lipase levels between patients with acute pancreatitis and those with nonpancreatic abdominal conditions. (2). the diagnostic accuracy of serum amylase and lipase levels between these two groups. The serum amylase and lipase levels were estimated in 47 patients with acute pancreatitis and 30 patients with nonpancreatic abdominal pain. Four (8.5%) patients had normoamylasemia in the acute pancreatitis group, however, almost all the patients in this group had elevated serum lipase levels. Elevated serum amylase levels in eleven (36.7%) and serum lipase levels in four (13.3%) patients were noted in the nonpancreatic abdominal pain group. Ten (33.3%) patients in the nonpancreatic abdominal pain group had serum amylase levels that overlapped those found in the acute pancreatitis patients. Only one (3.3%) patient in this group had serum lipase level that overlapped those found in acute pancreatitis patients. The sensitivity, specificity and the accuracy of the serum lipase levels in the diagnosis of acute pancreatitis were 100%, 86.7% and 94.8%, respectively. These were better than those of the serum amylase levels of 91.5%, 63.3% and 80.5%, respectively. If a higher cutoff value was chosen, that was 1.3 times the upper limit of normal, the sensitivity, specificity and the accuracy for serum lipase would be 100%, 96.7% and 98.7%, respectively and serum amylase 89.4%, 90% and 89.6%, respectively.

並列關鍵字

amylase ； lipase ； acute pancreatitis ； nonpancreatic abdominal pain