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KMID : 0376119830100010025
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Medical Journal of the Red Cross Hospital
1983 Volume.10 No. 1 p.25 ~ p.28
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A Clinical Study of Lipase Activity Test
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Abstract
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The measurement of serum lipase activity has never gained the popularity of amylase assays because it is a time-consuming, technically involved procedure that has often yielded inappropriate results. Properly performed, however, it should be just as useful as an amylase determination in the diagnosis of acute pancreatitis.
The original method was that of Cherry and Crandall, 54 who emphasized that pancreatic lipase acted on glycerol esters of long-chain fatty acids but had little effect on short-chain esters of glycerol and butyric acid. The Cherry-Crandall technique employed a 24-hour incubation of serum with olive oil emulsion, followed by titration to measure the fatty acids liberated.
A great deal of confusion arose from the misinterpretation of an observation made by Simon. Flexner in 1897. He incubated buffer with bits of necrotic peritoneal fat from patients with pancreatitis and suggested that the characteristic odor was due to the release of butyric acid.
Workers, acting on this observation, devised assays for "lipase" that used ethyl butyrate as a, substrate. Although technically easier,; due to the water solubility of the substrate, these techniques were not measuring true lipase but were assessing esterase activity. The reputed lack of clinical usefulness of lipase determinations can be attributed to the widespread application of these: inappropriate techniques. 55.56
Over the years many changes have been, made in the approach of Cherry and Crandall. 57-61 These Include optimizing the PH, oil-to-water ratio, and temperature, cleaning up the substrate, and using different end point measuring systems. The basic method is´ not altered,. however. An initial incubation of serum with olive oil emulsion generates fatty acids. These are separated from the substrate using solvent partition,. and the fatty acids are quantities titrimetrically or spectrophotometrically.
Chemically, serum lipase levels are elevated in acute pancreatitis, acute pneumonia, chronic pneumonia, G-B System Disease, Stomach ulcer, intestinal cancer, Hepatoma, and rarely in liver cirrhosis.
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