肝损伤酶活性联合检测在肝胆疾病诊断中的临床意义

目的观察不同类型肝胆疾病诊断中肝损伤酶活性联合检测的临床意义。方法选取2015年11月至2016年11月收治的肝胆疾病患者226例作为肝胆疾病组,入组病例的疾病类型:急性肝炎43例,慢性肝炎52例,肝硬化49例,肝癌11例,胆囊结石30例,梗阻性黄疸41例。另选取同期该院健康体检者35例作为健康对照组,将其肝损伤酶活性检测结果予以对照解析。结果肝胆疾病组与健康对照组丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、乳酸脱氢酶、腺苷脱氨酶、线粒体天门冬氨酸转移酶、碱性磷酸酶、γ-谷氨酰转肽酶、5′-核苷酸酶的升高程度有所不同,差异有统计学意义(P0.05),疾病类型不同,肝损伤酶活性升高程度也不相同。结论肝损伤酶活性联合检测,有利于更直接、快速、准确地从肝脏酶学角度对肝胆组织受损程度予以判断,但肝胆功能不能全部由肝损伤酶决定。     

要重视血清酶学测定的标准化工作

目前临床以血清丙氨酸氨基转移酶（ALT）、天（门）冬氨酸氨基转移酶（AST）、乳酸脱氢酶（LDH）、肌酸激酶（CK）、γ-谷氨酰基转移酶（γCT）、碱性磷酸酶（ALP）、淀粉酶（AMS）、脂肪酶（LPS）、腺苷脱氨酶（ADA）和胆碱酯酶（ChE）应用最为广泛.血清酶测定有免疫学方法和催化活性浓度测定法两种。正常人血中酶的含量一般都在pg或ng水平,以免疫学方法直接测定困难,测定过程缓慢又难以标准化。     

232例肝胆疾病患者血清肝酶谱分析

目的了解临床上各型肝胆疾病患者血清中肝胆系酶活性的状况。方法选取经临床确诊的肝胆疾病患者232例,空腹抽取静脉血做肝酶谱[丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、γ-谷氨酰转移酶（γ-GGT）及碱性磷酸酶（ALP）]活性检测,并对检测结果进行统计分析。结果所选4种肝酶活性的定量检测值在各类肝胆疾病中均有不同程度的增高,与正常值比较,差异有统计学意义（P〈0．05）,同一类肝酶其活性在不同疾病中所反映出的特异性也各不相同。结论肝胆疾病患者在有条件时应尽可能做全套肝酶谱检测,以便临床全面、动态地观察疾病状况。     

澳大利亚室间质量评价限在我国常规化学室间质量评价中的应用

目的 探讨澳大利亚质量评价限在我国常规化学室间质量评价中的应用.方法通过组织全国常规化学室间质评,对所检测的项目包括钾、钠、氯、钙、磷、葡萄糖、尿素、尿酸、肌酐、清蛋白、总胆固醇、三酰甘油、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、总胆红素、碱性磷酸酶、淀粉酶、肌酸激酶、乳酸脱氢酶、铁、镁、酸性磷酸酶和γ-谷氨酰基转移酶进行评价,并对结果进行分析.结果 以澳大利亚质量评价限作为室间质量评价限.评价项目除了碱性磷酸酶、钙、铁和酸性磷酸酶以外,钾、钠、氯、磷、葡萄糖、尿素、尿酸、肌酐、清蛋白、总胆固醇、三酰甘油、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、总胆红素、淀粉酶、肌酸激酶、乳酸脱氢酶、镁和γ-谷氨酰基转移酶评价项目有80％以上实验室能通过评价限.结论 常规化学室间质量评价计划的结果表明大部分的评价项目有80％的实验室都能够达到澳大利亚室间质量的评价限,所以澳大利亚评价限适用于我国常规化学的室间质评.     

142例肝病患者肝酶谱的变化分析

作者对来自病房和门诊已确诊为肝病的142例患者进行了肝酶谱[包括丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、乳酸脱氢酶（LDH）、碱性磷酸酶（AI。P）、γ-谷氨酰转肽酶（γ-GT）]测定,并对部分病例进行了随访分析,现报道如下。     

上海市临床检验中心多个项目可溯源至国际标准

正为建立检验医学的量值溯源,实现检验结果互认,上海市临床检验中心于2004年启动了参考体系建设,于2011年获得国际临床化学与检验医学联合会HbA1c一级参考实验认证,成为发展中国家第一家IFCC参考实验室。光谱法项目如碱性磷酸酶、丙氨酸氨基转移酶、淀粉酶、天门冬氨酸氨基转移酶、肌酸激酶、γ-谷氨酰基转移酶、乳酸脱氢酶和质谱法项目如糖化血红蛋白和肌酐,已通过中国合格评定国家认可委员会ISO17025/ISO15195认可,并经国际同行评审,上述项目已进入检验医学溯源联合委员会参考实验     

胸腔积液酶活性的诊断价值

已知胸腔积液含乳酸脱氢酶、苹果酸脱氢酶、谷胱甘肽还原酶、γ-谷氨酰转移酶、门冬氨酸转氨酶、丙氨酸转氨酶、脂酶、胆碱酯酶、碱性磷酸酶、酸性磷酸酶、淀粉酶、腺苷脱氨酶、精氨酸酶、透明质酸酶、血管紧张素转化酶、溶菌酶、β-葡萄糖苷酸酶、亮氨酰氨肽酶、醛缩酶和磷酸己糖异构酶等,共计数十种。现将其中有肯定诊断价值者介绍如下。乳酰脱氢酶(EC.1.1.27,LDH) LDH是含锌的结合蛋白,分子量135,000,以辅酶Ⅰ(NAD~ )为辅酶,催化乳酸与丙酮酸之间的氧化还原反应,是糖酵解和糖异生的一种重要酶。由亚基H(心型)肽链和M(肌型)肽链组成五个类型的四聚     

酶活性测定结果相对一致的可行性探讨

目的应用新鲜混合定值人血清作为校准品,探讨各医院之间临床常用酶[丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)、γ-谷氨酰基转移酶(GGT)、乳酸脱氢酶(LDH)、肌酸激酶(CK)]活性测定结果相对一致的可行性。方法将cfas校准品中6个酶活性的定值传递给新鲜混合人血清,然后以此作为校准品,校准分析系统后再测定标本值。结果应用上述方法后,30所医院间6个酶活性测定结果的可比性明显提高,各级医院之间6个酶活性测定结果的平均变异系数(CV)显著下降,均值和定值亦趋向一致。结论应用新鲜混合定值人血清作为校准品,使各医院之间酶活性测定结果相对一致是可行的。     

2007-2008年度重庆市临床化学室间质量评价结果总结

通过对2007-2008年重庆市临床化学室间质量评价结果分析，找出存在的问题和提出解决办法，促使参加临床化学室间质量评价的单位不断提高检验质量，更好地为广大患者服务。2007-2008年重庆市临床检验中心组织全市临床化学室间质评活动4次，发放了20个批号进口质控血清，评价项目有钾、钠、氯、钙、磷、血糖、尿素、肌酐、尿酸、总蛋白、清蛋白、胆固醇、三酰甘油、高密度脂蛋白胆固醇、胆红素、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶共17项，自愿调查项目有碱性磷酸酶、淀粉酶、磷酸肌酸激酶、乳酸脱氢酶、γ-谷氨酰基转移酶、镁、直接胆红素、铁、α-羟丁酸脱氢酶共10项。     

抑肽酶对实验性慢性肝损伤的保护作用

目的探讨抑肽酶对实验鼠慢性肝细胞损伤的保护作用。方法利用四氯化碳建立Wister大鼠慢性肝损伤实验动物模型，并给予抑肽酶观察其对实验鼠血清丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、白蛋白（ALB）、白蛋白臁蛋白（A／G）、唾液酸（SA）、胆碱酯酶（CHE）、碱性磷酸酶（ALP）、γ-谷氨酰转移酶（γ-G）、总胆红素（TBIL）含量、肝组织羟脯氨酸（hydroxyproline，Hyd）含量及肝组织的病理改变的影响。结果抑肽酶明显降低血清ALT、AST、ALP、γ-G、T-BIL，明显增高血清ALB、A／G、SA、CHE值。肝组织Hyd含量明显降低。鼠肝组织病理性改变明显减轻。结论抑肽酶对大鼠慢性肝损伤具有明显的保护作用。     

Enzyme changes and morphometric analysis of bile ducts in experimental bile duct obstruction.

Chronic bile duct obstruction causes a marked proliferation of bile ductules within the rat liver plus an increase in the activities of hepatic gamma-glutamyl transpeptidase, 5'-nucleotidase and alkaline phosphatase. To determine if the increase in the activities of these enzymes within the liver simply reflects the increase in bile duct mass, we subjected rats to bile duct ligation for periods up to one week and compared the activities of these enzymes within liver tissue with bile duct volume, determined by morphometric analysis. The activities of two enzymes not useful in the diagnosis of chronic cholestasis, aspartate aminotransferase (GOT) and alanine aminotransferase (GPT), were also measured. There was no correlation between the proliferation of bile ductules and the activity of any of these enzymes. Bile duct volume increased 4.9-fold within 24 h after ligation and rose steadily, reaching a value of 13 times control in one week. Alkaline phosphatase activity increased 3.6-fold within 24 h after bile duct ligation and then was relatively constant. Gamma-glutamyl transpeptidase and 5'-nucleotidase activity both fell 24 h after ligation but were slightly increased after 48 h. Enzyme activities of each were almost twice control at 120 and 168 h. Alanine aminotransferase activity fell steadily during the period of bile duct ligation, while aspartate aminotransferase was unchanged. The change in gamma-glutamyl transpeptidase and 5'-nucleotidase activity within the liver cannot be due simply to hypertrophy of bile duct epithelium.     

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).     

Establishment of reference intervals for enzyme catalytic activity concentration measurements at 37 degrees C--a practical approach

The change from measuring enzyme catalytic activity concentrations from 25 degrees C to 37 degrees C in the German Federal Republic has led to the need for new reference ranges for defined patient groups and for healthy individuals. Up to now, these are only present as tentative values and are incomplete, especially for children. This article describes a method for deriving reference ranges from results obtained from measurement at 25 degrees C and 37 degrees C and the use of percentiles to establish values for 37 degrees C. A total of 1,111,378 data from 507,305 patients were used to establish reference ranges for the following 11 enzymes at 37 degrees C using the test kits from Roche Diagnostics measured on the Modular analyser: acid phosphatase, alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, cholinesterase, creatine kinase, creatine kinase - MB subunit, gamma glutamyl transpeptidase, glutamate dehydrogenase, lactate dehydrogenase and lactate dehydrogenase - isoenzyme 1. The computed reference ranges from the data used gave rise to reference ranges, some of which were in agreement with the data from the producer, some of which, however, showed deviations from the values given by the producer. Ranges for newborns, children and adolescents could be computed with the prerequisite that ranges for 25 degrees C were available and that these had been established and validated. This method of establishing reference ranges for catalytic enzyme activities can be used for all producers, providing the number of data used is sufficient to allow for valid statistical analysis.     

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)     

Biochemical changes in liver and blood during liver fattening in rats

Excessive fat accumulation in the liver is a common metabolic disorder seen in humans and animals. Fatty liver was induced in the rat by feeding the animals with a sucrose rich diet containing 1% orotic acid for 2-3 weeks. In the sera from fatty liver rats there were significant changes in the level of alanine aminotransferase (+ 68.7%), malic dehydrogenase (+ 77.8%), gamma-glutamyl transpeptidase (- 53.4%) and total lipids (+ 26.6%). There were small to no changes in the levels of aspartate aminotransferase, glucose-6-phosphate dehydrogenase, lactic dehydrogenase, aldolase, malic enzyme, 6-phosphogluconic acid dehydrogenase, alkaline phosphatase and albumin. In fatty liver, significant differences were seen in the levels of glucose 6-phosphate dehydrogenase (+ 235%), malic enzyme (+ 170%), gamma-glutamyl transpeptidase (+ 113%), 6-phosphogluconate dehydrogenase (+ 63%), aspartate aminotransferase (+ 35.6%), malic dehydrogenase (+ 38%), lactic dehydrogenase (+ 37%), and alanine aminotransferase (- 23%). Comparison of the non-fatty part with the fatty part of the fatty liver showed larger changes in the non-fatty part of the liver, suggesting that during the fattening process, there is an induction of enzymes in the liver reaching a peak prior to lipid accumulation, declining thereafter during liver fattening. The increase in NADPH-generating lipogenic enzymes suggests that accumulated fat in the liver is at least partially from de-novo increased synthesis in the liver.     

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。     

40例酒精性脂肪肝患者血清酶指标检测分析

目的探讨酒精性脂肪肝(AFID)患者血清酶在病程中的变化规律及临床意义。方法对80例非酒精性脂肪肝(NAFID)、40例AFID、60例非脂肪肝(健康对照组)的血清酶等,进行测定分析。结果 AFID组血清丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、谷氨酰转肽酶(GGT)、天门冬氨酸氨基转移酶线粒体同工酶(mAST)、谷氨酸脱氢酶(GLDH)均显著高于健康对照组,差异有统计学意义(P0.01)。AFID组ALT、AST与NAFID组差异无统计学意义(P0.05),但AFID组的mAST、mAST/AST、GGT、GLDH均显著高于NAFID组,差异有统计学意义(P0.01)。结论 ALT、AST、GGT、mAST、GLDH活性测定有助于AFID的评估,有助于AFID的诊断及鉴别,具有重要的临床意义。     

血清总胆汁酸与传统肝功能酶学指标在肝胆疾病中的比较

目的探讨血清总胆汁酸(TBA)水平在肝硬化、肝癌和梗阻性黄疸中的临床价值。方法采用酶循环法对120例肝胆疾病患者(病例组)和80例健康体检者(健康对照组)进行TBA水平检测,同时检测丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)、γ-谷氨酰基转移酶(GGT)的活性,并对检测结果进行比较分析。结果肝硬化组、肝癌组、梗阻性黄疸组血清TBA水平均明显高于健康对照组,差异有统计学意义(P<0.01);并且肝硬化组和梗阻性黄疸组的TBA水平明显高于肝癌组,差异有统计学意义(P<0.01);血清TBA在肝硬化、肝癌及梗阻性黄疸中的阳性率分别为100%、80%、100%,并且明显高于传统肝功能酶学指标,差异有统计学意义(P<0.01)。结论 TBA是反映肝细胞损伤、胆道梗阻的良好指标,其灵敏度、特异性都优于常规肝功能酶学检测项目,对肝胆疾病早期诊断、病情监测具有重要的临床价值。     

Arginase, a new marker of mammary carcinoma.

Activities of arginase, alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase were determined in sera obtained in a group of healthy women, women with verified carcinoma of the breast, benign mastopathy, a group of patients with carcinoma of various organs and a group of patients with acute viral hepatitis. Preoperative values of serum arginase activity in patients with breast carcinoma were up to 4-fold those found in healthy women. Sensitivity of the test was 86%. After the surgery, the activity decreased abruptly during the first week and normalised within 15-30 days. In benign diseases of the breast, the activity of arginase was normal. Serum arginase activity is raised in both benign and malignant liver diseases, however, the quotients alanine aminotransferase/arginase, aspartate aminotransferase/arginase and alkaline phosphatase/arginase differ significantly. Thus, use of alanine aminotransferase/arginase quotient implies a high degree of confidence in differentiating between increased arginase activity in mammary carcinoma (alanine aminotransferase/arginase = 0.572 +/- 0.278) and high arginase activity in hepatitis (alanine aminotransferase/arginase = 12.226 +/- 1.822).     

Time course of serum protein changes after strenuous exercise of the forearm flexors.

The time course of changes in serum proteins and other blood constituents after eccentric exercise of the forearm flexors by six nonweight-trained female subjects (age, 19.7 +/- 1.9 years) was investigated. Eccentric muscle actions are those in which the muscle lengthens as it exerts force, as when a person lowers a weight. Serum levels of creatine kinase, lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, gamma-glutamyl transpeptidase, myoglobin, as well as urea nitrogen, uric acid, creatinine, calcium, and phosphorus were examined before and for 6 days after exercise. Creatine kinase increased dramatically (peak value ranged from 6740 to 24,200 U/L) and aspartate aminotransferase, lactate dehydrogenase, alanine aminotransferase, and myoglobin followed the same time course as creatine kinase, but their peak values were lower. These proteins did not increase significantly until 48 hours after exercise and reached peak values 3 to 5 days after exercise. Alkaline phosphatase, gamma-glutamyl transpeptidase, uric acid, urea nitrogen, creatinine, calcium, and phosphorus showed no change. There is either a delay in muscle protein release by damaged muscle fibers, or the proteins are unable to leave the interstitial area for the 24 to 48 hour period after exercise. Because of the long delay, care should be taken when blood protein levels are interpreted in persons who have exercised strenuously (even if only for a short period of intense effort) several days before any diagnostic tests are performed.