Clinical efficacy of serum lipase subtype analysis for the differential diagnosis of pancreatic and non-pancreatic lipase elevation
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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 efficacy 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.
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 efficacy 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 (20)
- Banks PA, "Classification of acute pancreatitis: 2012: revision of the Atlanta classification and definitions by international consensus", Gut, 62, pp.102~111 (2013)
- Liu KJ, "Serum amylase and lipase elevation is associated with intracranial events", Am Surg, 67, pp.215~219 (2001)
- Gumaste VV, "Serum lipase levels in nonpancreatic abdominal pain versus acute pancreatitis", Am J Gastroenterol, 88, pp.2051~2055 (1993)
- Yadav D, "Nonspecific hyperamylasemia and hyperlipasemia in diabetic ketoacidosis:incidence and correlation with biochemical abnormalities", Am J Gastroenterol, 95, pp.3123~3128 (2000)
- Bokemeyer B, "Asymptomatic elevation of serum lipase and amylase in conjunction with Crohn’s disease and ulcerative colitis", Z Gastroenterol, 40, pp.5~10 (2002)
- Yadav D, "A critical evaluation of laboratory tests in acute pancreatitis", Am J Gastroenterol, 97, pp.1309~1318 (2002)
- Matull WR, "Biochemical markers of acute pancreatitis", J Clin Pathol, 59, pp.340~344 (2006)
- Treacy J, "Evaluation of amylase and lipase in the diagnosis of acute pancreatitis", ANZ J Surg, 71, pp.577~582 (2001)
- Gomez D, "Retrospective study of patients with acute pancreatitis: is serum amylase still required?", BMJ Open, 2, pp.e001471~ (2012)
- Lippi G, "Laboratory diagnosis of acute pancreatitis: in search of the Holy Grail", Crit Rev Clin Lab Sci, 49, pp.18~31 (2012)
- Shah AM, "Acute pancreatitis with normal serum lipase: a case series", JOP, 11, pp.369~372 (2010)
- Aoubala M, "Interfacial binding of human gastric lipase to lipid monolayers, measured with an ELISA", Biochemistry, 34, pp.10786~10793 (1995)
- Beisson F, "Methods for lipase detection and assay: a critical review", Eur J Lipid Sci Technol, 102, pp.133~153 (2000)
- Lessinger JM, "Determination of lipase catalytic activity in two reference materials:BCR 693 and BCR 694 by titrimetry at constant pH", Clin Chem Lab Med, 42, pp.62~66 (2004)
- Panteghini M, "The never-ending search of an acceptable compromise for pancreatic lipase standardisation", Clin Chem Lab Med, 50, pp.419~421 (2012)
- Doolittle MH, "Immunodetection of lipoprotein lipase: antibody production, immunoprecipitation, and Western blotting techniques", Methods Mol Biol, 109, pp.215~237 (1999)
- Giller T, "Two novel human pancreatic lipase related proteins, hPLRP1and hPLRP2: differences in colipase dependence and in lipase activity", J Biol Chem, 267, pp.16509~16516 (1992)
- Eydoux C, "Human pancreatic lipase-related protein 2: tissular localization along the digestive tract and quantification in pancreatic juice using a specific ELISA", Biochim Biophys Acta, 1760, pp.1497~1504 (2006)
- Lowe ME, "Properties and function of pancreatic lipase related protein 2", Biochimie, 82, pp.997~1004 (2000)
- Carriere F, "Quantitative study of digestive enzyme secretion and gastrointestinal lipolysis in chronic pancreatitis", Clin Gastroenterol Hepatol, 3, pp.28~38 (2005)