切换至 "中华医学电子期刊资源库"

第五届中国出版政府奖音像电子网络出版物奖提名奖

中国科技核心期刊

中国科学引文数据库(CSCD)来源期刊

中华重症医学电子杂志 ›› 2017, Vol. 03 ›› Issue (02) : 138 -142. doi: 10.3877/cma.j.issn.2096-1537.2017.02.012

所属专题: 重症医学 文献

观点

重症患者伴高淀粉酶和/或高脂肪酶血症:急性胰腺炎?
黄东亚1, 苗毅1, 蒋奎荣1, 李强1,()   
  1. 1. 21002 南京医科大学第一附属医院胰腺中心
  • 收稿日期:2016-10-24 出版日期:2017-05-28
  • 通信作者: 李强

Hyperamylasemia and/or hyperlipasemia in ICU: acute pancreatitis?

Dongya Huang1, Yi Miao1, Kuirong Jiang1, Qiang Li1,()   

  1. 1. Department of Pancreas Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
  • Received:2016-10-24 Published:2017-05-28
  • Corresponding author: Qiang Li
  • About author:
    Corresponding author: Li Qiang, Email:
引用本文:

黄东亚, 苗毅, 蒋奎荣, 李强. 重症患者伴高淀粉酶和/或高脂肪酶血症:急性胰腺炎?[J/OL]. 中华重症医学电子杂志, 2017, 03(02): 138-142.

Dongya Huang, Yi Miao, Kuirong Jiang, Qiang Li. Hyperamylasemia and/or hyperlipasemia in ICU: acute pancreatitis?[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2017, 03(02): 138-142.

重症患者常出现高胰酶血症(高淀粉酶和/或高脂肪酶血症)。除急性胰腺炎(acute pancreatitis,AP)外,ICU病房内许多非胰腺疾病也伴有胰酶升高。一方面,血淀粉酶和血脂肪酶升高对AP诊断特异度的不足可引起误诊。另一方面,由于重症患者的合并症较多,病情较重,及时识别AP较为困难。对ICU内高胰酶血症的准确理解,及时的识别AP尤为重要。

Hyperamylasemia and hyperlipasemia are frequently encountered in critically ill patients. Elevation in serum levels of pancreatic enzymes (hyperamylasemia and/or hyperlipasemia) can occur in any Intensive Care Unit (ICU) patient either as a result of true acute pancreatitis (AP) or as a manifestation of a nonpancreatic disease. On the one hand, AP can be misdiagnosed because neither amylase nor lipase is specific for pancreatitis. On the other hand, it is often not possible to discriminate true pancreatitis from complex and severe patients. It is essential to understand different non-pancreatic conditions where there is elevation of pancreatic enzymes and to identify true AP in critically ill patients without typical clinical features.

1
Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus[J]. Gut, 2012, 62(1): 102-111.
2
Hardt PD, Mayer K, Ewald N. Exocrine pancreatic involvement in critically ill patients[J]. Curr Opin Clin Nutr Metab Care, 2009, 12(2): 168-174.
3
Basnayake C, Ratnam D. Blood tests for acute pancreatitis[J]. Aust Prescr, 2015, 38(4): 128-130.
4
Batra HS, Kumar A, Saha TK, et al. Comparative study of serum amylase and lipase in acute pancreatitis patients[J]. Indian J Clin Biochem, 2015, 30(2): 230-233.
5
Alam A, Rahman MFU, Rahman M, et al. A case of acute pancreatitis with normal serum lipase[J]. Bangladesh Med J, 2016, 43(3): 162-164.
6
Limon O, Sahin E, Kantar FU, et al. A rare entity in ED: Normal lipase level in acute pancreatitis[J]. Turk J Emerg Med, 2016, 16(1): 32-34.
7
Singh A, Shrestha M, Anand C. Acute pancreatitis with normal amylase and lipase-an ED dilemma[J]. Am J Emerg Med, 2016, 34(5): 940-945.
8
Shafqet MA, Brown TV, Sharma R. Normal lipase drug-induced pancreatitis: a novel finding[J]. Am J Emerg Med, 2015, 33(3): 475-476.
9
Zafar W, Chaucer B, Davalos F, et al. Scrotal swelling and normal lipase, a rare presentation of acute pancreatitis[J]. Am J Emerg Med, 2016, 34(4): 763-765.
10
Weaver DW, Busuito MJ, Bouwman D L, et al. Interpretation of serum amylase levels in the critically ill patient[J]. Crit Care Med, 1985, 13(7): 532-533.
11
Lankisch PG, Doobe C, Finger T, et al. Hyperamylasaemia and/or hyperlipasaemia: incidence and underlying causes in hospitalized patients with non-pancreatic diseases[J]. Scand J Gastroenterol, 2009, 44(2): 237-241.
12
Azzopardi E, Lloyd C, Teixeira SR, et al. Clinical applications of amylase: Novel perspectives[J]. Surgery, 2016, 160(1): 26-37.
13
Hameed AM, Lam VW, Pleass HC. Significant elevations of serum lipase not caused by pancreatitis: a systematic review[J]. HPB (Oxford), 2015, 17(2): 99-112.
14
Yadav D, Nair S, Norkus EP, et al. Nonspecific hyperamylasemia and hyperlipasemia in diabetic ketoacidosis: incidence and correlation with biochemical abnormalities[J]. Am J Gastroenterol, 2000, 95(11): 3123-3128.
15
Nair S, Yadav D, Pitchumoni CS. Association of diabetic ketoacidosis and acute pancreatitis: observations in 100 consecutive episodes of DKA[J]. Am J Gastroenterol, 2000, 95(10): 2795-2800.
16
Noble M, Moreno E, Khodaee M. Severe Acute Necrotizing Pancreatitis in a Patient with Diabetic Ketoacidosis[J]. Am J Med, 2016, 129(8): e121-e123.
17
Chen Y, Lu G, Ke L, et al. Clinical characteristics of patients with concomitant diabetic ketoacidosis and acute pancreatitis[J]. Pancreatology, 2016, 16(1): S24.
18
Liu KJ, Atten MJ, Lichtor T, et al. Serum amylase and lipase elevation is associated with intracranial events[J]. Am Surg, 2001, 67(3): 215-220.
19
Lee CC, Chung WY, Shih YH. Elevated amylase and lipase levels in the neurosurgery intensive care unit[J]. J Chin Med Assoc, 2010, 73(1): 8-14.
20
Scholten JG, Buijs E. Acute pancreatitis after propofol administration[J]. Ned Tijdschr Geneeskd, 2014, 158: A7115.
21
Adam DJ, Milne AA, Evans S M, et al. Serum amylase isoenzymes in patients undergoing operation for ruptured and non-ruptured abdominal aortic aneurysm[J]. J Vasc Surg, 1999, 30(2): 229-235.
22
Boddie DE, Couper GW, Watson H, et al. Isoenzyme analysis of hyperamylasaemia associated with ruptured abdominal aortic aneurysms[J]. J R Coll Surg Edinb, 1998, 43(5): 306-307.
23
Wachal K, Krasiński Z, Szmyt K, et al. Acute pancreatitis complicated by rupture of abdominal aortic aneurysm[J]. Gastroenterology Rev, 2016, 11(2): 136-138.
24
Singh RP, Garg N, Nar AS, et al. role of amylase and lipase levels in diagnosis of blunt trauma abdomen[J]. J Clin Diagn Res, 2016, 10(2): C20-C23.
25
Cote GA, Gottstein JH, Daud A, et al. The role of etiology in the hyperamylasemia of acute liver failure[J]. Am J Gastroenterol, 2009, 104(3): 592-597.
26
Chen CC, Wang SS, Chen TW, et al. Serum procarboxypeptidase B, amylase and lipase in chronic renal failure[J]. J Gastroenterol Hepatol, 1996, 11(5): 496-499.
27
Shibasaki T, Matsuda H, Ohno I, et al. Significance of serum lipase in patients undergoing hemodialysis[J]. 1996, 16: 309-314.
28
Masoero G, Bruno M, Gallo L, et al. Increased serum pancreatic enzymes in uremia: relation with treatment modality and pancreatic involvement[J]. Pancreas, 1996, 13(4): 350-355.
29
Manjuck J, Zein J, Carpati C, et al. Clinical significance of increased lipase levels on admission to the ICU[J]. Chest, 2005, 127(1): 246-250.
30
Malinoski DJ, Hadjizacharia P, Salim A, et al. Elevated serum pancreatic enzyme levels after hemorrhagic shock predict organ failure and death[J]. J Trauma, 2009, 67(3): 445-449.
31
Chaari A, Abdel HK, Bousselmi K, et al. Pancreatic injury in patients with septic shock: A literature review[J]. World J Gastrointest Oncol, 2016, 8(7): 526-531.
32
Warshaw AL, O′Hara PJ. Susceptibility of the pancreas to ischemic injury in shock[J]. Ann Surg, 1978, 188(2): 197-201.
33
Klar E, Messmer K, Warshaw AL, et al. Pancreatic ischaemia in experimental acute pancreatitis: mechanism, significance and therapy[J]. Br J Surg, 1990, 77(11): 1205-1210.
34
Woods GN, Saitman A, Gao H, et al. A young woman with recurrent gestational hypercalcemia and acute pancreatitis caused by CYP24A1 deficiency[J]. J Bone Miner Res, 2016, 31(10): 1841-1844.
35
Sam R, Vaseemuddin M, Siddique A, et al. Hypercalcemia in patients in the burn intensive care unit[J]. J Burn Care Res, 2007, 28(5): 742-746.
36
Mutlu GM, Mutlu EA, Factor P. GI complications in patients receiving mechanical ventilation[J]. Chest, 2001, 119(4): 1222-1241.
37
Jones MR, Hall OM, Kaye AM, et al. Drug-induced acute pancreatitis: a review[J]. Ochsner J, 2015, 15(1): 45-51.
38
Blasco-Perrin H, Glaser B, Pienkowski M, et al. Gadolinium induced recurrent acute pancreatitis[J]. Pancreatology, 2013, 13(1): 88-89.
39
Schneider L, Hackert T, Longerich T, et al. Effects of gadolinium chloride and glycine on hepatic and pancreatic tissue damage in alcoholic pancreatitis[J]. Pancreas, 2010, 39(4): 502-509.
[1] 陆婷, 范晴敏, 王洁, 万晓静, 许春芳, 董凤林. 超声引导下经皮穿刺置管引流对重症急性胰腺炎的疗效及应用时机的选择[J/OL]. 中华医学超声杂志(电子版), 2024, 21(05): 511-516.
[2] 张洁, 罗小霞, 余鸿. 系统性免疫炎症指数对急性胰腺炎患者并发器官功能损伤的预测价值[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 68-71.
[3] 康婵娟, 张海涛, 翟静洁. 胰管支架置入术治疗急性胆源性胰腺炎的效果及对患者肝功能、炎症因子水平的影响[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 667-670.
[4] 党军强, 杨雁灵, 汪庆强, 尚琳, 朱磊, 项红军. 主动经皮穿刺引流治疗重症急性胰腺炎并发急性坏死物积聚的疗效分析[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 671-674.
[5] 邵世锋, 肖钦, 沈方龙, 张迅, 郝志鹏, 伍正彬, 谢晓娟, 王耀丽. 老年胸主动脉钝性伤的重症救治分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 762-767.
[6] 方开萱, 翟亚奇, 张贯军, 陈升鑫, 陈德鑫, 刘文静, 梁雅文, 李明阳. 内镜逆行胰胆管造影术治疗胰腺分裂症的安全性与远期疗效[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(05): 284-289.
[7] 赵月, 田坤, 张宗明, 郭震天, 刘立民, 张翀, 刘卓. 降钙素原对老年急性重度胆囊炎发生的预测价值[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 801-806.
[8] 史清泉, 苗彬, 王烁, 陶琳, 沈晨. miR-181a-5p 靶向ATG5 抑制雨蛙素诱导的大鼠胰腺腺泡细胞AR42J自噬的机制研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 524-530.
[9] 曾明芬, 王艳. 急性胰腺炎合并脂肪肝患者CT 与彩色多普勒超声诊断参数与其病情和预后的关联性研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 531-535.
[10] 沈炎, 张俊峰, 唐春芳. 预后营养指数结合血清降钙素原、胱抑素C及视黄醇结合蛋白对急性胰腺炎并发急性肾损伤的预测价值[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 536-540.
[11] 杨爽, 余宏亮, 谢敏. CT 与超声检查对急性胰腺炎合并脂肪肝的诊断价值[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 541-544.
[12] 丛黎, 马林, 陈旭, 李文文, 张亮亮, 周华亭. 改良CT严重指数联合炎症指标在重症急性胰腺炎患者胰腺感染预测及预后评估中的研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(05): 432-436.
[13] 刘春峰, 徐朝晖, 施红伟, 陈瑢, 马腾飞, 李鹏飞, 袁蓉, 陈建荣, 徐爱明. 机械通气患者肌肉减少症的诊断及其对预后的影响[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 820-825.
[14] 张平骥, 徐钰, 李天水, 庞文翼, 符师宁, 张梦圆. 重症患者镇静治疗现状及期望的调查研究[J/OL]. 中华临床医师杂志(电子版), 2024, 18(06): 562-567.
[15] 李璇, 邓岚, 郭微, 邓永梅, 刘杰昕. 标准化皮肤管理流程在防治脑卒中患者失禁相关性皮炎中的应用[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(05): 479-482.
阅读次数
全文


摘要