谷氨酸脱氢酶、胆碱酯酶在高血清丙氨酸转氨酶肝病患者鉴别诊断中的应用

目的探讨谷氨酸脱氢酶(GDH)、胆碱酯酶(CHE)在高血清丙氨酸转氨酶(ALT)患者鉴别诊断中的应用价值。方法收集103名健康者和108例高ALT患者的血清标本,在BayerADVIA1650型全自动生化分析仪上同时测定GDH、CHE的活性。结果在急性病毒性肝炎、急性缺血性肝炎、急性中毒性肝坏死时GDH均明显升高,与正常对照组差异有显著性(P<0.01),其中以急性缺血性肝炎升高的幅度最大,其和急性中毒性肝坏死的阳性率均可达100%。CHE只有在急性中毒性肝坏死时才明显下降(P<0.01)。结论联合检测GDH、CHE活性将有助于鉴别诊断高血清ALT肝病患者,对指导临床治疗具有重要意义。     

慢性肾脏病患者若干血清酶的变化及临床意义

目的探讨慢性肾脏病（CKD）3～5期患者血清酶的变化及其临床意义。方法273例CKD患者根据肾小球滤过率分为三组,检测其血清酶指标,包括天门冬氨酸氨基转移酶（aspartate aminotransferase,AST）、丙氨酸氨基转移酶（alanine aminotransferase,ALT）、肌酸激酶（creatinekinase,CK）、乳酸脱氢酶（lactate dehydrogenase,LDH）、碱性磷酸酶（alkaline phosphatase,ALP）,各组间进行比较,并分别与70例健康体检者（健康对照组）进行比较。结果CKD5期患者的CK、LDH水平高于健康对照组及CKD3、4期;CKD3～5期患者血清ALP水平高于健康对照组,AST水平低于健康对照组;ALT在本研究中各组间差异无统计学意义。结论CKD患者部分血清酶水平不同于健康对照组,这种变化可能与慢性肾脏病患者肾性骨病、贫血、感染等有关,可对疾病临床诊断产生一定的影响。     

Automated kinetic assays for routine determination of adenosine deaminase and guanase activities of human serum

The LKB 8600 Reaction Rate Analyser has been modified to permit automatic determination of adenosine deaminase and guanase activities of human serum. Adenosine and 8-azaguanine are the respective substrates. Liberation of ammonia by enzyme action is monitored at 340 nm by coupling the reaction to the NADH-linked reductive amination of 2-oxoglutarate catalysed by glutamate dehydrogenase, ADP being included to stabilise and activate the latter enzyme. Control values are determined before addition of the specific substrate. Detailed notes on the technique are given and the preparation of a suitable quality control serum is described.The methods yield results in excellent agreement with those provided by manual techniques based on the same methodology. Within-batch precision of slightly elevated activities is between 7–8% as measured by the coefficient of variation, and 3–4% for moderately raised activities. Between-batch precision is only slightly poorer. Carry-over is negligible. Reference limits for the 97.5-percentile are 33 U/1 for adenosine deaminase and 2.5 U/1 for guanase at 37°. The methods presented can readily be Actapted to other commercially-available automatic enzyme analysers, and a batch of 100 tests and controls can be completed in 4 h.     

Metabolic changes during prolonged total parenteral nutrition in intensive care.

Intensive care patients receiving prolonged total parenteral nutrition (TPN) developed alterations of liver function tests, seen in the activity of certain serum enzymes. Hepatomegaly and jaundice sometimes appeared. The changes in chemical pathology were in serum transaminases activity (GOT, GPT, GDH); alkaline phosphatase and gamma-glutamyltranspeptidase as indices of cholestasis; lactate dehydrogenase, hydroxybutyrate dehydrogenase and creatine phosphokinase, as enzymes related to energy metabolism; pseudocholinesterase, as a protein metabolism-related enzyme. The possible causes of these alterations in critically ill patients undergoing TPN are considered and a functional final metabolic interpretation is proposed.     

血必净对急性有机磷农药中毒患者多脏器损伤的保护作用及其机制

目的 探讨血必净注射液对急性有机磷农药中毒(AOPP)患者多脏器损伤的保护作用及其机制.方法 将56例AOPP患者(均为口服中毒)随机分为两组:常规治疗组(28例)均给予彻底洗胃、胆碱酯酶复能剂、阿托品及对症支持治疗,血必净治疗组(28例)在常规治疗的基础上加用血必净注射液.观察两组治疗前和治疗1、3、5、7 d后血清胆碱酯酶(AChE)活性、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、尿素氮(BUN)、肌酐(Cr)及内毒素(LPS)、肿瘤坏死因子(TNF)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)水平的变化.结果 治疗3 d后,与常规治疗组比较,血必净治疗组AChE活性明显好转(P<0.05),AST、ALT、CK-MB、LDH、BUN、Cr及LPS、TNF、IL-6、IL-8水平明显降低(P<0.05,P<0.01);治疗7 d后,血必净治疗组上述指标基本恢复正常,与常规治疗组比较差异有统计学意义(P<0.01).结论 血必净注射液对AOPP患者多脏器具有保护作用,其机制主要通过减少炎症介质的分泌来实现.     

Dipeptidyl aminopeptidase IV in hospitalized patients and in galactosamine hepatitis of the rat: Activity and lectin affinity chromatography in serum and hepatic plasma membranes

The activity of dipeptidyl aminopeptidase IV was studied in the sera of 378 hospitalized patients. The mean activity of dipeptidyl aminopeptidase IV was elevated significantly in patients with neoplasmata and hepatitis, but not in patients with liver cirrhosis. Significant correlations (p less than 0.001) existed with gamma-glutamyl transferase, glutamate dehydrogenase, alkaline phosphatase and leucine aminopeptidase. A significant correlation with lactate dehydrogenase existed only in patients with neoplasmata. Principal component analysis, performed with aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, leucine aminopeptidase, lactate dehydrogenase and dipeptidyl aminopeptidase IV, revealed correlations between the activities of aspartate aminotransferase and alanine aminotransferase, and between alkaline phosphatase and leucine aminopeptidase, but neither dipeptidyl aminopeptidase IV nor lactate dehydrogenase showed any correlation with either of these two groups. In lectin affinity chromatography with concanavalin A and wheat germ lectin sepharose, serum dipeptidyl aminopeptidase IV from liver cirrhosis patients showed the same binding pattern as that from healthy subjects. The activity and glycosylation of dipeptidyl aminopeptidase IV in serum and hepatic plasma membranes was investigated in rats, following the induction of hepatitis with galactosamine. In the serum, dipeptidyl aminopeptidase IV activity was elevated as early as 6 h after galactosamine injection, and the elevated activity persisted until the 7th day. At the same time dipeptidyl aminopeptidase IV activity was also elevated in the hepatic plasma membrane. Ninety eight percent of hepatic dipeptidyl aminopeptidase IV bound to concanavalin A as well as to wheat germ lectin and this value was unchanged during hepatitis. In the serum of control rats, 90% of dipeptidyl aminopeptidase IV bound to concanavalin A but only 39% to wheat germ lectin.(ABSTRACT TRUNCATED AT 250 WORDS)     

Serum creatine phosphokinase isozymes in hypothyroidism, convulsion, myocardial infarction and other diseases

Serum creatine phosphokinase isozymes were studied by agar gel electrophoresis in 7 cases of hypothyroidism, 5 cases of generalized convulsions, 4 cases of myocardial infarction, 7 cases of cerebrovascular disease, 3 cases of shock and 4 cases of other diseases.Sera of patients with myocardial infarction were found to have both the muscle type (MM) and muscle-brain hybrid type (MB) fractions, while sera of patients with generalized convulsions and skeletal muscle injuries were found to have only the MM fraction, in which the elevated creatine phosphokinase (CPK) is thought to be due to leakage from skeletal muscles. Only the MM type was seen in sera of patients with hypothyroidism, cerebrovascular disease, shock and some other diseases, in which the elevated serum CPK activities in these cases as well as in generalized convulsion and skeletal muscle injuries is thought to be also derived from the skeletal muscles.Our results suggest that serum CPK isozyme study is useful in identifying those organs responsible for the elevated serum CPK.     

Creatine kinase isoenzymes of mitochondrial origin in human serum.

We measured creatine kinase (EC 2.7.3.2) activity in 1009 serum samples from 538 patients in the intensive-care units of the University of Texas Medical Branch hospitals. Creatine kinase isoenzymes migrating cathodal to skeletal muscle creatine kinase (CK-MM) on cellulose acetate electrophoresis were found in sera from 14 of the 538 patients. Creatine kinase, lactate dehydrogenase (EC 1.1.1.27), aspartate aminotransferase (EC 2.6.1.1), and alanine aminotransferase (EC 2.6.1.2) activities were abnormally increased in these 14 patients. Liver lactate dehydrogenase isoenzyme (LDH5) and cardiac creatine kinase isoenzyme (CK-MB) were abnormally increased in 12 and eight of these patients, respectively. Ten of the 14 patients died during their hospital admission. We believe the creatine kinase isoenzymes that migrated cathodal to skeletal muscle creatine kinase (CK-MM) were of mitochondrial origin.     

Study of serum argininosuccinate lyase determination for diagnosis of liver diseases

The objectives of this research were to establish an automatic analysis method for the determination of serum argininosuccinate lyase (ASL) and to investigate the value of serum ASL test in the diagnosis of various liver disorders. According to the chemical reaction catalyzed by ASL, an enzyme-coupled reaction system was designed, and a methodology evaluation of this method was performed. A total of 291 patients with various liver diseases, 247 patients with nonliver disease and 32 healthy controls, were recruited, their serum levels of ASL and traditional hepatopathy markers, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyltransferase (GGT), lactate dehydrogenase (LDH), alkaline phosphatase (ALP), and total bilirubin (TBil), were all determined, and their diagnostic values in liver diseases were analyzed and compared. Liver biopsy and the score of histopathological inflammation grading were performed in 31 patients with hepatopathy to explore the correlation between serum ASL level and hepatic histopathological change. A continuous monitoring assay method of serum ASL activity was established, which could be performed with automatic biochemistry analyzer. Methodological evaluation exhibited that the precision of this method was good indicated by the 4.0% intraassay coefficient of variation (CV), and 5.9% interassay CV. The mean recovery was 100.5%, linear range was from 0 to 167.7 U/L, and the lowest detection limit was approximately 0 U/L. All of the tested hepatopathy markers listed above were significantly increased in the liver disease group. However, levels of traditional markers of hepatopathy were all significantly increased at different degrees (all P<0.001) in patients with nonliver diseases; in contrast, there were no significantly increased ASL levels in all non-hepatopathy groups (P=0.335). The receiver operating characteristic (ROC) curve showed that the sensitivity and specificity of ASL were 100% and 91.1% (cutoff value=8 U/L), respectively, in the assessment of liver diseases. In contrast, ALT levels were 97.6% and 24.7%, and AST levels were 83.8% and 28.3% (both cutoff values=40.0 U/L), respectively. A positive correlation (r=0.417, P=0.019) was observed between serum ASL levels (86.9+/-26.5) and scores of histopathological inflammation grading (SHIG) (9.83+/-3.36). The sensitivity and specificity of ALS is much higher than that of ALT and AST for the diagnosis of liver diseases. ASL may be a more valuable marker for estimating hepatopathy.     

Hepatic infarction: biochemical study of a case

Hepatic infarction was observed post mortem in a 27-year-old man who died of aortic dissection. Blood had been sampled at admission and 12 and 19 hours later. Values for aspartate aminotransferase and alanine aminotransferase in serum were markedly above normal, whereas those for alkaline phosphatase and gamma-glutamyltransferase were only marginally increased. A threefold-increased creatine kinase was ascribable solely to isoenzyme CK-3, suggesting muscle breakdown. Moreover, total lactate dehydrogenase activity was increased threefold, accounted for by a ninefold increase in LD-5 isoenzyme. Those enzyme activities in serum that evidently are associated with acute hepatocellular necrosis increase quickly in hepatic infarction, and CK isoenzyme assay is a useful adjunct if LD-5 increases are significant.     

Mitochondrial enzymes in human serum: comparative determinations of glutamate dehydrogenase and mitochondrial aspartate aminotransferase in healthy persons and patients with chronic liver diseases

We measured the activities of two mitochondrial enzymes, the mitochondrial form of aspartate aminotransferase (EC 2.6.1.1) and glutamate dehydrogenase (EC 1.4.1.2), in the serum of apparently healthy persons (n = 84) and patients suffering from chronic liver diseases (n = 43). The distribution of activities for glutamate dehydrogenase, but not mitochondrial aspartate aminotransferase, was sex-dependent. The upper limits of the reference intervals (99th percentile) at 37 degrees C were 3.2 U/L for mitochondrial aspartate aminotransferase, 6.4 U/L for glutamate dehydrogenase (women), and 11.0 U/L for glutamate dehydrogenase (men); there was a weak correlation between the activities of both mitochondrial enzymes (r = 0.439). In patients with chronic liver diseases we found a greater increase in the activity of glutamate dehydrogenase than of mitochondrial aspartate aminotransferase and the correlation between the two mitochondrial enzymes was stronger. The diagnostic sensitivity and specificity of either mitochondrial enzyme was less than that of total aspartate aminotransferase, alanine aminotransferase (EC 2.6.1.2), or gamma-glutamyltransferase (EC 2.3.2.2).     

Macroenzyme as a cause of unexplained elevation of aspartate aminotransferase

Aspartate aminotransferase (AST) can exist as a macroenzyme by forming a complex with an immunoglobulin. This immunoglobulin-complexed macromolecule can cause an elevation in serum AST activity, which may be detected on routine blood chemistry analysis and erroneously considered to indicate the presence of liver disease. Clinicians should be aware of this phenomenon so patients are not subjected to unnecessary procedures. In patients with unexplained AST elevation, liver and muscle disease can be biochemically excluded by the finding of normal serum levels of alanine aminotransferase and creatine kinase. The presence of macro-AST can be determined by exclusion chromatography, electrophoresis, and activation assays with pyridoxal 5-phosphate. The elevated AST values can persist for many years.     

Lipid- and lipoprotein values in octo- and nonagenarians free from overt degenerative arterial disease

To investigate the reason for the increased activities of gamma-glutamyltransferase in the serum of renal transplant recipients, the activity of this enzyme was determined together with the alanine aminotransferase and alkaline phosphatase activity in serum (as an index of liver damage) and the urinary excretion of D-glucaric acid (as an index of microsomal enzyme induction) in 63 renal transplant recipients. Forty-one patients had increased activities of gamma-glutamyltransferase. Increased D-glucaric acid excretion was found only in ten patients having elevated alanine aminotransferase and/or alkaline phosphatase in seven cases and gamma-glutamyltransferase in eight cases. Therefore, the increased gamma-glutamyltransferase activities in renal transplant recipients can be primarily considered as a consequence of hepatobiliary dysfunction and not of enzyme induction.     

Elevated serum enzymes in patients with wasp/bee sting and their clinical significance.

Seventeen patients who had been admitted to hospital for wasp/bee sting were studied. Mild pyrexia was encountered in 7 patients, rash/urticaria in 3, angioneurotic oedema in 2, oliguria in 2, microscopic haematuria and albuminuria in 3, transient hypotension in 1. However, there were frequent elevations of serum glutamic-oxaloacetic transaminase (9 out of 17 patients), serum creatine phosphokinase (14 out of 17 patients) and serum lactate dehydrogenase (8 out of 14 patients), indicating presence of damage to muscle fibres. This was confirmed by the histological findings of a muscle-biopsy from the most severe case. Elevation of serum glutamic-pyruvic transaminase was found in 6, and elevation of serum isocitrate dehydrogenase in 5 out of 14 patients, suggesting presence of liver damage. The above enzyme elevations appeared short-lived except in the clinically most severe patient (case 9) who developed acute tubular necrosis. All patients except the latter suffered no clinical sequelae and there was no correlation between their clinical condition and the presence or degree of elevations of serum enzymes.     

Effects on analgesic and antirheumatic drugs on the assay of serum enzymes

Interference by some commonly used analgesic and antirheumatic drugs in the spectrophotometric and colorimetric assays of serum enzymes was examined. None of the investigated methods was significantly influenced by caffeine, phenacetin, ibuprofen or indomethacin. Acetylsalicylic acid affected the continuous assays of creatine kinase and lactate dehydrogenase (with pyruvate as substrate), and the colorimetric assay of alanine aminotransferase. Aminophenazone interfered with the colorimetric method for determination of aspartate aminotransferase and alanine aminotransferase, while phenobarbital interfered only with the continuous method for lactate dehydrogenase (with L-lactate as substrate). Ketoprofen interfered with the colorimetric assays of lactate dehydrogenase and aspartate aminotransferase, while diclofenac affected the continuous assay of aspartate aminotransferase. None of the tested drugs interfered with the continuous methods for the determination of alkaline phosphatase and alpha-hydroxybutyrate dehydrogenase.     

Black-white differences in serum creatine phosphokinase (CPK) activity

The mean serum creatine phosphokinase activities of hospitalized black male and female, and white male and female psychiatric patients were established. The effects of both race and sex on mean serum creatine phosphokinase activities were both highly significant. Black males had significantly higher mean serum creatine phosphokinase activity than white males, black females and white females. White males and black females had significantly higher mean serum creatine phosphokinase levels than white females but were not significantly different from each other. Age, height and weight did not contribute to the difference between races. There was a trend for mean serum creatine phosphokinase activity to be greater for dark skinned black males than light skinned black males but this trend was not present in black females. The standard deviation of each subject's mean serum creatine phosphokinase activity was highly correlated with the mean. The levels of serum creatine phosphokinase activity found in these subjects were significantly greater than those previously observed with the method of Rosalki (J. Lab. Clin. Med., 69 (1967) 696).     

进行性肌营养不良误诊断为病毒性肝炎的分析

进行性肌营养不良是一种X性连锁隐性遗传疾病,其中以假性肥大型多见,大多有家族史,病程中常伴发肝功能异常。近年来,我科收治了11例因肝功能异常而疑肝炎患儿,符合进行性肌营养不良的诊断标准[1],现报告如下。1资料与方法11例进行性肌营养不良为1998年1月至2005年9月本院儿肝科     

Serum level of ornithine carbamoyltransferase is influenced by the state of Kupffer cells

BACKGROUND: The ratio of ornithine carbamoyltransferase (OCT) to alanine aminotransferase (ALT) or glutamate dehydrogenase (GDH) in serum has been suggested as an indicator for the diagnosis of hepatocellular carcinoma and alcoholic liver disease, respectively. However, the mechanisms responsible for the increase in these ratios are still unclear. METHODS: Wistar rats were pretreated with lipopolysaccharide (LPS) or gadolinium chloride (GD) before being administered with thioacetamide (TAA, 200 mg/kg, ip). Serum OCT and ALT levels were compared with control values. Half-lives of the enzymes in circulation were evaluated after the intravenous injection of the purified enzymes into rats with or without the pretreatment. RESULTS: The serum level of OCT at 24 h after the administration of TAA was significantly lower in the LPS-treated group, and not influenced by pretreatment with GD. The half-life of OCT was prolonged from 1.06+/-0.14 to 2.07+/-0.29 h (p<0.05) by the pretreatment with GD, but not influenced by the administration of LPS. No change was observed in the clearance of GDH or ALT among the pretreatments. CONCLUSIONS: Leakage into and clearance from the circulation of OCT are influenced by whether Kupffer cells are activated or not. OCT alone or in combination with other markers may be a useful indicator for Kupffer cell activation as well as mitochondrial damage in hepatic cells.     

精神病病人血清酶测定的临床价值

目的 探讨精神病病人血清中肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）、乳酸脱氢酶（LD）和天门冬氨酸氨基转移酶（AST）检测的临床意义.方法 采集85例精神病病人和90例健康人空腹静脉血,在全自动生化分析仪上测定CK、CK-MB、LD和AST 水平.结果 精神病组血清CK、CK-MB、LD和 AST水平均高于正常对照组,差异有显著性（t=2.101～8.557,P〈0.05）.结论 精神病病人血清中CK、CK-MB、 LD和AST显著增加.     

Changes of platelets, serum lactic dehydrogenase, gamma-glutamyltranspeptidase, choline esterase and creatine phosphokinase levels in patients with Cushing's syndrome

In order to identify non-endocrine laboratory tests of diagnostic value in Cushing's syndrome, we measured platelet counts and serum myogenic and hepatic enzyme levels in 10 patients with Cushing's syndrome and compared the findings with those of 15 obese patients without Cushing's syndrome. Patients with Cushing's syndrome had increased numbers of platelets, moderately elevated serum lactic dehydrogenase and gamma-glutamyltranspeptidase levels, and significantly lower creatine phosphokinase and choline esterase activities compared with those of obese control patients. We concluded that when several of these abnormal values were seen in obese patients the levels of suspicion for Cushing's syndrome should be high.