Abstract
We compared results of measurements of total serum amylase, pancreatic isoamylase, and lipase measurements in patients with hyperamylasemia. Serial measurements of these three enzyme levels in patients recovering from acute pancreatitis indicated that pancreatic isoamylase and lipase were elevated above normal to a greater extent and remained elevated much longer than did the total amylase. This finding indicates an appreciable sensitivity advantage of the pancreatic isoamylase and lipase over total amylase measurement during the recovery phase of pancreatitis. Comparison of pancreatic isoamylase and lipase levels in selected sera indicated a good correlation (r=0.84) between these two measurements in patients who did not have macroamylasemia. Lipase was normal in sera with amylase elevations due solely to salivary isoamylase. Thus, in nonmacroamylsemic sera, pancreatic isoamylase and lipase appear to be roughly interchangeable markers of the level of pancreatic enzymes in the blood. An advantage of the lipase assay is that this enzyme is normal in hyperamylasemia caused by macroamylasemia, whereas the inhibitor assay indicates that the pancreatic isoamylase is elevated. Development of automated assays for either pancreatic isoamylase or lipase should lead to the routine use of one of these assays in place of the present reliance on total amylase measurements in the diagnosis of pancreatitis.
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References
Heffernon JJ, Fridhandler L, Berk JE, Shimanura J: Assay of amylase and isoamylase activities in serum and urine. Modification in methods and range of normal values. Am J Gastroenterol 67:473–477, 1977
Levitt MD, Ellis C, Engel RR: Isoelectric focusing studies of human serum and tissue isoamylases. J Lab Clin Med 90:141–152, 1977
Berk JE, Fridhandler L, Webb SF: Does hyperamylasemia in drunken alcoholics signify pancreatitis? Am J Gastroenterol 71:557–562, 1979
Dutta SK, Douglass W, Smalls UA, et al: Prevalence and the nature of hyperamylasemia in acute alcoholism. Dig Dis Sci 26:136–141, 1981
Levitt MD, Ellis CJ, Meier PB: Extrapancreatic origin of chronic unexplained hyperamylasemia. N Engl J Med 302:670–671, 1980
Berk JE, Simon D, Fridhandler L: Inhibitor test for amylase isoenzymes. Am J Gastroenterol 75:128–131, 1981
Ellis C, Koehler DF, Eckfeldt MD, Levitt MD: Evaluation of an inhibitor assay to determine serum isoamylase distribution. Dig Dis Sci 27:897–901, 1982
Lifton LJ, Slickers KA, Pragay DA, Katz LA: Pancreatitis and lipase. A reevaluation with a five-minute turbidimetric lipase determination. JAMA 229:47–50, 1974
Patt HH, Kramer SP, Woel G, et al.: Serum lipase determination in acute pancreatitis. Arch Surg 92:718–723, 1966
Seward CW: Diagnosing pancreatitis the first day: A comparison of urinary amylase and serum enzymes in pancreatic dysfunction. South Med J 63:285–289, 1970
Song H, Tietz NW, Tan C: Usefulness of serum lipase, esterase, and amylase estimation in the diagnosis of pancreatitis-a comparison. Clin Chem 16:264–268, 1970
Shimamura J, Fridhandler L, Berk JE: Does human pancreas contain salivary type isoamylase? Gut 16:1006–1009, 1975
Lehrner LM, Ward JC, Karn RC, et al: An evaluation of the usefulness of amylase isozyme differentiation in patients with hyperamylasemia. Am J Clin Pathol 66:576–587, 1976
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Supported by Veterans Administration Research Funds and National Institutes of Health grant 13309-15.
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Kolars, J.C., Ellis, C.J. & Levitt, M.D. Comparison of serum amylase pancreatic isoamylase and lipase in patients with hyperamylasemia. Digest Dis Sci 29, 289–293 (1984). https://doi.org/10.1007/BF01318510
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DOI: https://doi.org/10.1007/BF01318510