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Urinary isoamylases in the diagnosis of chronic pancreatitis.

1967; BMJ; Volume: 8; Issue: 4 Linguagem: Inglês

10.1136/gut.8.4.402

1468-3288

Swee Eng Aw, J R Hobbs, I. D. P. Wootton,

Pancreatitis Pathology and Treatment

EDITORIAL COMMENT The proportion of pancreatic to salivary isoenzymes of alpha amylase has been measured in 24-hour samples of urine and the absolute value of the isoenzymes calculated from urinary amylase values.In seven of eight patients exocrine deficiency of the pancreas was accompanied by an altered ratio of pancreatic to salivary isoamylases.The quantitation of isoenzymes in body fluids has obvious applications in the diagnosis of disease.a-Amylase (E.C. 3.2.1.1.), of molecular weight 50,000, also occurs in multiple molecular forms.This heterogeneity was initially discovered in animals and later extended to man.The evidence has been principally electrophoretic (N0rby, 1964; Muus and Vnenchak, 1964: Berk, Searcey, Hayashi, and Ujihira, 1965; Kamaryt and Laxova, 1965;Aw, 1966).Extracts of salivary glands and pancreas, saliva, serum, and urine were shown to contain cathodally running bands of amylolytic activity differing only slightly in mobility.Recently the isoenzymes of amylase (isoamylases) from human pancreas, saliva, and milk have been partially purified with the use of Deae Sephadex and gel filtration thus demon- strating a chromatographic heterogeneity as well (Aw and Hobbs, 1966).Urinary isoamylases are separable into 'pancreatic' and 'salivary' according to their electrophoretic mobilities compared with marker pancreatic and salivary enzymes.This organ specificity may, in fact, be oversimplified (see Discussion).It is well known that patients with chronic pancreatitis more often than not have serum and urinary amylase values within normal limits.We were interested in studying urinary isoamylase patterns and in finding out whether patients with exocrine pancreatic deficiency exhibited a decrease in the activity of the pancreatic zone. MATERIALSTwenty-four-hour urine collections, preserved with toluene, were obtained from three groups of people.GROUP 1 Twenty-nine patients with no history or other evidence of exocrine pancreatic disease: this group also included five normal individuals.Total was 34.GROUP 2 Seven cases of chronic pancreatitis diagnosed on the basis of history, clinical findings, and one or more of the following-pancreatic pseudocyst or calcifi- cation on radiographs, abnormal glucose tolerance curves, subnormal pancreatic function tests, and findings at operation.A patient who had total pancreatectomy for carcinoma of the pancreas.Total was eight.