RESEARCHES ON THE ACTIVITY OF SOME ENZYMES WITH DIAGNOSIS VALUE IN SUBJECTS SUFFERING FROM HEPATIC CIRRHOSIS

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1 RESEARCHES ON THE ACTIVITY OF SOME ENZYMES WITH DIAGNOSIS VALUE IN SUBJECTS SUFFERING FROM HEPATIC CIRRHOSIS ANCA MIRELA AMARIEI 1, ELENA CIORNEA 1, GABRIELA DUMITRU 1* Keywords:, alkaline phosphatase, transaminases, -glutamyl-transferase Abstract: The study discusses the experimental investigations devoted to the activity of some seric enzymes with diagnosis value in the pathology of the liver (alkaline phosphatase, alanin- and aspartat-aminotransferase, glutamyl-transferase) in male and female persons belonging to 5 categories of age (31-40 years, years, years, years and, respectively, years) diagnosed with, and treated in the Mavromati Districtual Hospital and the Lux Ro Medical Center of Boto ani. With the exception of the first category of age, where no major deviations from the physiologically normal values were noticed, all the other investigated subjects show values higher than the superior limit of the reference interval while, statistically, the values of the seric enzymes are highly significant (p<0.001), with the exception of those of aspartat-aminotransferase (in the years group) and of -glutamyltransferase (the year group), which are insignificant. INTRODUCTION Hepatic cirrhosis is a diffuse hepatic disease, a chronic, progressive and irreversible pain of the liver, characterized histologically by the association of the hepatocytary necrosis with extended fibrosis and nodular regeneration, loss of liver s normal architecture and altered vascularization. The tridimensional structure of the hepatic lobe is deeply deteriorated, causing alteration of vascular, lymphatic and biliary polarity (Rojkind, 1992; Benhamou et al., 1994). The pathogenesis of cirrhosis includes, apart from the cellular source of fibrosis, some vascular/ischemic mechanisms. Fibrogenesis through cellular mechanism is responsible for the accumulation of fibrosis in the precirrhotic stages of the cirrhogeneous hepatopathies, cirrhosis as such being caused by necroses/fibroses accompanying the ischemic disease (vascular obstruction) of the hepatic parenchyma (Wanless et al., 2000). Parenchymatous decompensation is manifested through signs of hepatic insufficiency (Fontana, 2003), while vascular decompensation through the semiological signs of portal hypertension (Huy et al., 2002). Hepatic cirrhosis is the common final route of several causes; practically, it is the final stage of most of the chronic hepatopathies, being included among the first ten causes of mortality. In the industrialized countries of Europe and North America, it constitutes the third cause of death (following cardiovascular diseases and cancer) for the years group of age; cirrhosis represents the most frequent non-neoplasic cause of decease in the digestive field (Gherasim, 2000). About 10% of the chronic viral B hepatitis and about 20% of the viral C and ethylic ones evolve towards (Negur, 2008). MATERIALS AND METHOD The investigations, performed on a number of 136 patients (87 females and 49 males) diagnosed with hepatic cirrhosis, with ages between 31 and 86 years, have been developed in the clinical laboratories of the Mavromati Districtual Hospital of Boto ani and Lux Ro Medical Center of Boto ani. The activity of some enzymes with diagnosis value in the pathology of the liver (alkaline phosphatase, alanin- and aspartate-aminotransferase, -glutamyl-transferase) was determined with a Hitachi 912 ISE biochemical analyzer. Mention should be made of the fact that all results obtained have been statistically processed, and the standard deviation, standard error, the coefficient of variation of the mean value, Student test and probability were calculated, for giving a global imagine upon the dispersion degree of the thus obtained results, and for establishing the value most close to the real one (Judet, 1970, V leanu and Hîncu, 1990). RESULTS AND DISCUSSION The liver plays a central role in maintaining homeostasis, so that, not surprisingly, the occurrence of some clinically important hepatic diseases is accompanied by diverse metabolic 49

2 Anca Mirela Amariei et al Researches on the activity of some enzymes with diagnosis value in subjects suffering from disorders. Even if some functions are more sensitive than others, the liver possesses considerable reserves, so that the minimum or even moderate cell lesions are not reflected in measurable metabolic changes. Nevertheless, various defects, depending on the nature and extension of the initial lesion, may be observed. The biochemical functions in which the liver plays a major role include: the intermediary metabolism of aminoacids and carbohydrates; synthesis and degradation of proteins and glycoproteins; the metabolism and degradation of hormones and drugs; adjustment of lipid metabolism and of cholesterol (Pa paran, 2009). The metabolic disorders are more obvious in patients with advanced hepatic diseases, yet the manifestations are similar, whichever the etiology of the initial lesion. Similar modifications may be observed even if to a different extent - in patients with severe chronic hepatitis, micronodular cirrhosis and postnecrotic cirrhosis. As many of the liver s functions may be affected to a different extent in certain patients, no test, considered separately, can effectively measure its global functioning. A first objective of the present study was to determine the activity of alanin- and aspartat-aminotransferases in patients of various ages, the piridoxal-phosphate-dependent enzymes, known as especially important for the proteic metabolisms, the activity of aminotransferases in the blood serum representing a faithful index of the acuteness of the pathological processes produced at hepatic level (Cojocaru, 2009). Consequently, as illustrated in figures 1-2, female subjects suffering from hepatic cirrhosis evidenced higher average values of aminotransferases, for almost all categories of age under analysis, comparatively with the values of the normal interval. Thus, the years group of age registered an average ALAT value of U/L while, in the same group, the average value of the ASAT enzyme was of 26 U/L. In female patients from the years group, the mean values of ALAT were of U/L, while the mean values of ASAT were of U/L. For female patients from the years group of age, the mean ALAT values were of U/L, and the mean ASAT values were of U/L. For female patients belonging to the years group, the mean ALAT values were of U/L, while the mean ASAT ones recorded U/L. For the last category of age, of years, ALAT registered a mean value of U/L, while ASAT showed a mean value of U/L. Female patients from the and, respectively, years of age evidenced mean values for the plasmatic activity of ALAT and ASAT within the limits of the reference interval. In all these groups of patients, ASAT activity registered higher mean values than those of ALAT activity, the ASAT/ALAT ratio being supraunitary. 50

3 U/L 60 U/L years years years years years years years years years years Category of ages Category of ages Females Males Females Males Fig.1. Alanin-aminotransferase activity in patients of different ages diagnosed with Fig.2. Aspartat-aminotransferase activity in patients of different ages diagnosed with According to literature data, sometimes, in, the ALAT values are either normal or increased during activity attacks, while the ASAT/ALAT ratio >1 (Negur, 2008). The present investigations show that these two cytolysis enzymes have increased moderately in the patients here analyzed, the ALAT activity registering double average values, comparatively with the superior limit of the normal values for the years group, while the ASAT activity recorded double average values comparatively with the superior limit of the normal values for the and, respectively, years groups. Male subjects showed increased mean values of aminotransferases, in most of the groups of age considered in the study, comparatively with the values of the normal interval. Thus, the years group of age registered a mean ALAT value of U/L while, in the same group, the mean value of the ASAT enzyme was of U/L. For the male patients belonging to the years group, the mean ALAT values were of 46.1 U/L, while the mean ASAT values were of U/L. The mean ALAT values in the male patients from the years group were of U/L, while the mean ASAT values registered U/L. In the years category of age, the mean ALAT values were of U/L, and the mean ASAT ones - of U/L. For the last category of age, of years, ALAT had a mean value of U/L, while ASAT showed a mean value of U/L. Male patients affected with hepatic cirrhosis, belonging to the 31-40, and, respectively, years of age, showed mean values for the plasmatic activity of ALAT within the limits of the reference interval. As to the plasmatic activity of ASAT, it recorded normal mean values in the years group of age. For all groups of age under consideration, the ASAT activity registered higher mean values, comparatively with the ALAT activity, the ASAT/ALAT ratio being supraunitary. With reference to the activity of the cholestase enzymes in female patients, alkaline phosphatase showed moderately increased mean value for all groups of age, as follows: U/L at group years, U/L at the years one, U/L at years, U/L at group years (the most pronounced increase) and U/L, respectively, for the last group of age, years (fig. 3). As to the activity of alkaline phosphatase in men, moderately increased mean values were observed in the following groups of age: U/L in the years group, U/L in the years one, U/L in the years group and U/L, respectively, for the last group of age, that of years. This time, too, the most pronounced increase in the activity 51

4 Anca Mirela Amariei et al Researches on the activity of some enzymes with diagnosis value in subjects suffering from of this enzyme was observed in the subjects from the years group of age while, for the years group, the plasmatic activity of alkaline phosphatase was situated between the limits of the reference interval U/L U/L years years years years years Category of ages Females Males years years years years years Category of ages Females Males Fig.3. Alkaline-phosphatase activity in patients of different ages diagnosed with Fig. 4. -Glutamyl-transferase activity in patients of different ages diagnosed with Literature data show that, in, an increased activity of alkaline phosphatase may be observed, as well as a higher plasmatic activity of GGT (Negur, 2008). In a last series of experiments, the activity of -glutamyl-transferase, an enzyme specific to liver and to the biliary ducts, was determined, once known that its level is increased in the tumoral cells of the hepatoma, in the hepatocytes compressed by hepatic tumors and also in the regenerative areas of the cirrhotic liver, the higher seric level of the enzyme being also provoked by the injuring of the cell membrane through toxic (alcohol included) or ischemic infections, or by enzyme s detachment from the level of the cell membrane, as a result of the action of biliary acids (Marshall and Bangert, 2008). Thus, in women, -glutamyl-transferase registered increased mean values in all four categories of age under analysis, as follows: U/L in the years group, U/L in the years one, U/L in the years group, U/L in the years group and, respectively, U/L in the last group of age, years. The highest increase of enzymatic activity was registered for the years group, and the lowest for the years one. Generally, in these patients, the mean values of the glutamyl-transferase activity were 2 times (group years) and, respectively, almost 3 times (group years) higher than the superior limit of the reference interval (fig. 4). In male patients, the dynamics of the plasmatic activity of this cholestase enzyme registered increased average values in the following categories of age, as follows: 56.7 U/L at the years group, U/L at the years group, U/L in the years group and, respectively, U/L in the last group of age: years. The highest increase of activity was recorded for the years group of age, the lowest one in the years group while, in the patients of the years group, the average values of the enzymatic activity were double, comparatively with the superior limit of the reference interval. 52

5 Table I. The values of some statistical indices and relative activity of some enzymes with diagnosed value in female sex persons with FA ALAT ASAT GGT Groups of ages (years) No. patients Relative values (%) ± % ± ES CV% t p p< p< p< p< p< p< p< p< p< p< p< p> <p< p< p< p<0.001 Once known that the quantitative analytical determinations require different operations, performed in a certain succession, which represent an equal number of possible errors, the obtained result being a parameter close to the exact value, the experimental results were subjected to subsequent statistical processing, for attaining an as high as possible certainty degree of the obtained values. Statistically, in female patients, the values recorded by the seric enzymes studied for all categories of age are highly significant, p<0.001, with the exception of the ASAT values registered in the years category of age, and of GGT from the years group, which are insignificant (table I). Statistically, the values recorded by the here studied seric enzymes in all categories of age, in male patients, are highly significant (table II). Table II. The values of some statistical indices and relative activity of some enzymes with diagnosed value in male sex persons with FA Groups of ages (years) No. patients Relative values (%) ± % ± ES CV% t p p< p< p< p< p<

6 Anca Mirela Amariei et al Researches on the activity of some enzymes with diagnosis value in subjects suffering from Groups of ages (years) No. patients Relative values (%) ± % ± ES CV% t p ALAT <p<0.01 ASAT GGT p< p< p< <p< p< p< p< p< p< p<0.001 A comparative analysis on the relative activity of the seric enzymes studied, in patients of both sexes, leads to the following conclusions: the activity of alkaline phosphatase registered the lowest relative value in male patients (125.71%), for the years group of age, while the highest relative value in female subjects (253.41%) occurred for the years group of age (being 2.5 times higher comparatively with the values of the reference interval). The activity of alanin-aminotransferase registered the highest relative value in male patients (479.64%), for the years group of age, while the lowest relative value for the same subjects (91.79%) appeared for the years category of age. The activity of aspartat-aminotransferase had the highest value - 5 times higher than the values of the reference interval and, respectively, the lowest relative value in male patients %) in the years group of age and %, respectively, in the years group. The activity of -glutamyl-transferase registered the highest relative value in female patients (574.36%), for the years group of age, and the lowest relative value - in male subjects (74.39%), for the years group of age. CONCLUSIONS The comparative analysis of the results obtained on the activity of the enzymes with diagnosis value in evidenced significant differences vs. the physiologically normal interval, on one side, as a function of age and, on the other, as a function of sex, in the case of amino-transferases the ASAT/ALAT ratio being, each time, a supraunitary one. Statistical processing of the obtained results revealed the existence of certain activities of the seric enzymes under investigation, highly significant for all categories of age (p<0.001), with the exception of the years and, respectively, years (female subjects) categories of age, in which the values of aspartat-aminotransferase and of -glutamyl-transferase were insignificant (p>0.5, respectively 0.2<p<0.5). REFERENCES Benhamou, J.P., Bircher, J., Mc Intyre, N. (1994): Hepatologie clinique, Medecine Sciences Flammarion, Paris, p Cojocaru, D. C. (2009): Enzimologie practic, Ed. Tehnopress, Ia i. 54

7 Fontana, R. (2003): Management of patients with decompensated HBV cirrhosis, Seminars in liver disease, 23, 1: Gherasim, L., (sub red.) (2000): Medicina intern - Bolile digestive hepatice i pancreatice, vol. III, Editura Medical, Bucure ti, p. 725 Huy, A.Y., Chan, A.L., Leung, N.V. (2002): Survival and pronostic indicators in patients with hepatitis B virus related cirrhosis after onset of hepatic decompensation, J. Clin. Gastroenterol., 34: Judet, E. (1970): Qualitates kontrolle im Klinisch chemischen Laboratorium, Sonder chuck aus der Krankenhausarze H., 9:23-28 Marshall, J. W., Bangert, K. S. (2008): Clinical biochemistry. Metabolical and clinical aspects, Second edition, Churchill Livingstone Elsevier Negur, Anca-Mihaela (2008): Introducere în biochimia clinic, Editura Tehnopress, Ia i, p Pa paran Anca Mirela (2009): Aspecte fiziologice i biochimice implicate în unele afec iuni hepatice la om. Tez de doctorat, Universitatea Alexandru Ioan Cuza Ia i. Rojkind, M. (1992): Fibrogenesis in cirrhosis, Pharmacol.&Therap., 53, 1: V leanu, I., Hîncu, M. (1990): Elemente de statistic general, Editura Litera, Bucure ti, p. 25, 74 Wanless, I.R., Nakashima, E., Sherman, M. (2000): Regression of human cirrhosis. Morhologic features and the genesis of incomplete septal cirrhosis, Arch. Pathol. Med. Lab., 124: Alexandru Ioan Cuza University of Jassy, Romania *gabriela.dumitru@uaic.ro 55

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