Clinical efficacy of serum lipase subtype analysis for the differential diagnosis of pancreatic and non-pancreatic lipase elevation = Clinical efficacy of serum lipase subtype analysis for the differential diagnosis of pancreatic and non-pancreatic lipase elevation

다국어 초록 (Multilingual Abstract)

Background/Aims: Non-pancreatic elevations of serum lipase have been reported, and differential diagnosis is necessary for clinical practice. This study aimed to evaluate the clinical effi cacy of serum lipase subtype analysis for the differential diagnosis of pancreatic and non-pancreatic lipase elevation. Methods: Patients who were referred for the serum lipase elevation were prospectively enrolled. Clinical findings and serum lipase subtypes were analyzed and compared by dividing the patients into pancreatitis and non-pancreatitis groups. Results: A total of 34 patients (12 pancreatitis vs. 22 non-pancreatitis cases) were enrolled. In univariate analysis, the fraction of pancreatic lipase (FPL) in the total amount of serum lipase subtypes was statistically higher in patients with pancreatitis ([median, 0.004; interquartile range [IQR], 0.003 to 0.011] vs. [median, 0.002; IQR, 0.001 to 0.004], p = 0.04). Based on receiver operating characteristic curve analysis for the prediction of acute pancreatitis, FPL was the most valuable predictor (area under the receiver-operating characteristic curve [AUROC], 0.72; 95% confidence interval [CI], 0.54 to 0.86; sensitivity, 83.3%; specificity, 63.6%; positive predictive value, 55.6%; negative predictive value, 97.5%). In multivariate analysis, a cut-off value higher than 0.0027 for the FPL was associated with acute pancreatitis (odds ratio, 8.3; 95% CI, 1.3 to 51.7; p = 0.02). Conclusions: The results did not support that serum lipase subtype analysis could replace standard lipase measurement for the diagnosis of acute pancreatitis. However, the test demonstrated adequate sensitivity for use in triage or as an add-on test for serum lipase elevation.

참고문헌 (Reference)

1 Giller T, "Two novel human pancreatic lipase related proteins, hPLRP1and hPLRP2: differences in colipase dependence and in lipase activity" 267 : 16509-16516, 1992

2 Panteghini M, "The never-ending search of an acceptable compromise for pancreatic lipase standardisation" 50 : 419-421, 2012

3 Gumaste VV, "Serum lipase levels in nonpancreatic abdominal pain versus acute pancreatitis" 88 : 2051-2055, 1993

4 Liu KJ, "Serum amylase and lipase elevation is associated with intracranial events" 67 : 215-219, 2001

5 Gomez D, "Retrospective study of patients with acute pancreatitis: is serum amylase still required?" 2 : e001471-, 2012

6 Carriere F, "Quantitative study of digestive enzyme secretion and gastrointestinal lipolysis in chronic pancreatitis" 3 : 28-38, 2005

7 Lowe ME, "Properties and function of pancreatic lipase related protein 2" 82 : 997-1004, 2000

8 Yadav D, "Nonspecific hyperamylasemia and hyperlipasemia in diabetic ketoacidosis:incidence and correlation with biochemical abnormalities" 95 : 3123-3128, 2000

9 Beisson F, "Methods for lipase detection and assay: a critical review" 102 : 133-153, 2000

10 Lippi G, "Laboratory diagnosis of acute pancreatitis: in search of the Holy Grail" 49 : 18-31, 2012

11 Aoubala M, "Interfacial binding of human gastric lipase to lipid monolayers, measured with an ELISA" 34 : 10786-10793, 1995

12 Doolittle MH, "Immunodetection of lipoprotein lipase: antibody production, immunoprecipitation, and Western blotting techniques" 109 : 215-237, 1999

13 Eydoux C, "Human pancreatic lipase-related protein 2: tissular localization along the digestive tract and quantification in pancreatic juice using a specific ELISA" 1760 : 1497-1504, 2006

14 Treacy J, "Evaluation of amylase and lipase in the diagnosis of acute pancreatitis" 71 : 577-582, 2001

15 Lessinger JM, "Determination of lipase catalytic activity in two reference materials:BCR 693 and BCR 694 by titrimetry at constant pH" 42 : 62-66, 2004

16 Banks PA, "Classification of acute pancreatitis: 2012: revision of the Atlanta classification and definitions by international consensus" 62 : 102-111, 2013

17 Matull WR, "Biochemical markers of acute pancreatitis" 59 : 340-344, 2006

18 Bokemeyer B, "Asymptomatic elevation of serum lipase and amylase in conjunction with Crohn’s disease and ulcerative colitis" 40 : 5-10, 2002

19 Shah AM, "Acute pancreatitis with normal serum lipase: a case series" 11 : 369-372, 2010

20 Yadav D, "A critical evaluation of laboratory tests in acute pancreatitis" 97 : 1309-1318, 2002