胰酶标志物临床研究现状

doi:10.3969/j.issn.1673-8640.2025.09.016

摘要/Abstract

摘要：

胰腺是人体的重要消化器官之一，其分泌的酶类可分为糖类分解酶[如淀粉酶（AMY）、麦芽糖酶]、蛋白质分解酶（如胰蛋白酶、弹性蛋白酶、凝乳蛋白酶、羧肽酶A、羧肽酶B）和脂肪分解酶[如脂肪酶（LPS）、磷脂酶A2（PLA2）]。AMY、LPS等胰酶目前已作为胰腺相关疾病的生物标志物广泛应用于临床。血清弹性蛋白酶1不仅对急、慢性胰腺炎的诊断有重要的参考价值，与肿瘤标志物联合应用还可大幅提高早期胰腺癌（如早期胰头癌）的阳性检出率。另外，粪便样本中的弹性蛋白酶1可作为评估胰腺外分泌功能的生物标志物。血清胰蛋白酶可用于预测内镜逆行胰胆管造影术（ERCP）后胰腺炎的发生，且预测效能优于AMY。文章对AMY、LPS、胰蛋白酶、弹性蛋白酶等主要胰酶标志物的临床研究现状进行综述，重点综述弹性蛋白酶1和胰蛋白酶的临床研究进展，以期为胰腺疾病的临床诊断和胰腺外分泌功能的评估提供参考。

关键词: 胰酶标志物, 弹性蛋白酶1, 胰蛋白酶, 淀粉酶, 脂肪酶

Abstract:

The pancreas is one of the important digestive organs in the human body. The enzymes secreted by it can be classified into carbohydrate-degrading enzymes [such as amylase （AMY），maltase]，protein-degrading enzymes （trypsin，elastase，chymotrypsin，carboxypeptidase A，carboxypeptidase B） and fat-degrading enzymes [lipase （LPS），phospholipase A2 （PLA2）]. Currently，pancreatic enzymes like AMY and LPS have been widely used as biomarkers for pancreatic-related diseases in clinical practice. Serum elastase 1 not only has significant reference value for the diagnosis of acute and chronic pancreatitis，but also，when combined with tumor markers，can significantly increase the positive determination rate of early pancreatic cancer （early pancreatic head cancer）. Moreover，elastase 1 in fecal samples can be used as a biomarker for evaluating pancreatic exocrine function. Serum trypsin can be used to predict pancreatitis after endoscopic retrograde cholangiopancreatography （ERCP），and its predictive efficacy is superior to AMY. This review presents the current clinical research status of main pancreatic enzyme markers such as AMY，LPS，trypsin and elastase，and focuses on summarizing the clinical research progress of elastase 1 and trypsin，providing references for clinical diagnosis of pancreatic diseases and assessment of pancreatic exocrine function.

Key words: Pancreatic enzyme marker, Elastase 1, Trypsin, Amylase, Lipase

中图分类号:

R446.1

陈福君, 陈毛明. 胰酶标志物临床研究现状[J]. 检验医学, 2025, 40(9): 918-924.

CHEN Fujun, CHEN Maoming. Status of clinical research on pancreatic enzyme markers[J]. Laboratory Medicine, 2025, 40(9): 918-924.

图/表 2

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项目	样本类型	敏感性	急性胰腺炎			慢性胰腺炎（功能不全）	胰腺癌
项目	样本类型	敏感性	早期	中后期	重症预测	慢性胰腺炎（功能不全）	胰腺癌
AMY
唾液AMY	血	一般	☆	×	×	☆	×
胰AMY	血	一般	☆	☆	×	☆	☆
尿AMY	尿液	一般	×	☆	×	×	×
LPS	血	灵敏	☆☆	☆	×	×	☆
胰蛋白酶	血	灵敏	☆☆	☆☆	☆	☆☆	☆
胰蛋白酶原-2	尿液	灵敏	☆	☆	×	×	×
弹性蛋白酶1	血	灵敏	☆	☆☆	×	×	☆☆☆①
弹性蛋白酶1	粪便	灵敏	☆	☆	×	☆☆	☆
PLA2	血	灵敏	☆	☆	☆☆☆	☆	☆

项目	样本类型	敏感性	急性胰腺炎			慢性胰腺炎（功能不全）	胰腺癌
项目	样本类型	敏感性	早期	中后期	重症预测	慢性胰腺炎（功能不全）	胰腺癌
AMY
唾液AMY	血	一般	☆	×	×	☆	×
胰AMY	血	一般	☆	☆	×	☆	☆
尿AMY	尿液	一般	×	☆	×	×	×
LPS	血	灵敏	☆☆	☆	×	×	☆
胰蛋白酶	血	灵敏	☆☆	☆☆	☆	☆☆	☆
胰蛋白酶原-2	尿液	灵敏	☆	☆	×	×	×
弹性蛋白酶1	血	灵敏	☆	☆☆	×	×	☆☆☆①
弹性蛋白酶1	粪便	灵敏	☆	☆	×	☆☆	☆
PLA2	血	灵敏	☆	☆	☆☆☆	☆	☆