Danev, I.

Rateva, R.

Rusinov, E.

Varbanov, G.

English

Varna Medical University Press: Journals

CHANGES OF T H E SERUM ENZYME L E V E L IN PATIENTS WITH L I V E R CARCINOMA E . Rus inov , G . Varbanov , R . Pa t eva , I . Danev K e y - w o r d s : se rum enzymes — l i v e r c a r c i n o m a — ex t rahepa t i c cholestasis — diagnosis Recently, the enzyme diagnostics of l iver diseases develops very intensively in the view of optimal use of enzyme sets and constellations for the needs of c l i -nical practice. (3, 6—10). Concerning the acute and chronic l iver diseases there are relat ively a few enzymes only which have a greater diagnostic importance. Out of the cytoplasmic enzymes both S G O T and S G P T are most significant, out of cellular membrane ones the following enzymes have to be pointed: G G T P , A P , L A P and 5'-nudeotidase. A s regards the ergastoplasmic reticulum enzymes both cholinesterase and CP1 are considered to be most significant. Nowadays, the incidence of metastatic and primary liver carcinoma increa-ses. As regards many European countries the patients wi th primary l iver carci-noma are at an average about 2,5 % out of a l l cancer patients but in Bulgaria this percentage is 8,5 % . Concerning Varna city and, especially Bourgas district this ratio is considerably higher (up to 19 % ) . I n some African countries over 80 % of malignant diseases are due to primary liver carcinoma (4, 5, 11, 16). Of course, the laparoscopy and the purposeful l iver biopsy are most important for diag-nosis of hepatic carcinoma (2, 5, 11, 16), but they can't be performed in every one patient. That ' s why besides c l in ical examination the laboratory tests, espe-c ia l ly of G G T P , S G O T , S G P T , A P , L A P and cholinesterase, play" an essential role in these cases. The so-called Weber's triad is described in patients wi th l iver carcinoma. I t consists of: 1, Increase of excretory cholestatic enzymes. G G T P increases com-monly more that 20 times which is due to the cholestasis and to the intensive synthesis in surrounding parenchyma and even in neoplastic tissue (6, 8, 12, 14v 15) A P is usually increased more than 10 times (6, 8, 13). L A P ac t iv i ty is more frequently positive than A P one and more rarely than G G T P one. (6, 8 ) . The increase of G G T P , A P and L A P is less expressed in cases of benign extra-hepatic cholestasis (6, 8) . 2. A cytolysis and a necrosis wi th moderately increa-sed S G O T and S G P T levels can be found out in most patients wi th l iver carcinoma ( 1 , 8, 14, 17). 3. The reduced hepatic function is manifested wi th strongly dimi-nished cholinesterase. I ts level decreases later and less expressed in the cases wi th metastatic than in those wi th primary l iver carcinoma (6, 8, 10, 14, 17). The aim of our work was to investigate the changes of serum enzymes in patients w i th l iver carc in)ma. Material and methods The serum enzymes were studied by using standard methods in the Central biochemical laboratory, Distr ict hospital, Varna c i ty . Enzyme levels are given according to S I bioconstants. The investigation covers 48 patients w i th l iver Changes of the serum enzyme l e v e l in . 57 carcinoma (primary and secondary). They were 25 males and 23 females aged between 23 and 75 years, at an average 57,5 years. 16 patients wi th choledo-cholithiasis and extrahepatic cholestasis were also examined. They were 6 males and 10 females aged 26—74 years, at an average 55,2 years. As controls, 26 heal-thy individuals (12 males and 14 females aged between 18 and 72 years, at an average 37,5 years) were also studied. A n y patients were either laparoscopically and, or laparotomically verified and then histologically examined. The variat ion analysis was used in statistical data processing. Results and discussion Table 1 demonstrates that levels of any serum enzymes ( G G T P , S G O T , S G P T , A P , and L A P ) are rel iably increased in patients wi th l iver carcinoma as T a b l e 1 Patients' groups/ Enzymes Healthy Liver carcinoma x f m % increased enzyme levels G G T P S G O T S G P T A P L A P C h o l i n -esterase 25 25 25 23 12 15 1 7 , 6 4 - 3 , 0 6 1 0 , 0 8 - 1 , 4 6 1 1 , 4 8 - 1 , 5 8 3 2 , 9 6 - 2 , 3 9 1 5 , 2 5 - 1,09 4 ,59=-0 ,30 41 48 48 48 11 36 4 2 0 . 2 - 44 ,06 3 9 , 6 - 3,17 4 0 , 7 3 - 4,18 2 3 2 . 3 - 20,06 4 9 , 3 - 8,13 2 , 6 3 - 0 , 2 6 < 0 , 0 0 1 < 0 , 0 0 1 < 0 , 0 0 1 < 0 , 0 0 1 < 0 , 0 0 1 < 0 , 0 1 92,68 81,25 66,67 95,83 90,91 77,78 ompared wi th those of the controls. G G T P increase is most expressed — more han 20 times, followed by A P one (more than 7 times), L A P one (more than 3 times) and both S G O T and S G P T ones (about 4 times). However, cholinesterase is reduced by approximately 40 %. Most frequently, G G T P , A P an L A P are changed. Our results coincide wi th those of many other authors ( 1 , 6, 8, 12—15, 17). The comparison of serum enzyme levels in l iver carcinoma patients w i t h those of cases wi th extrahepatic choledocholithiatic cholestasis (see table 2 ) T a b l e 2 Patients' groups/ Enzymes G G T P S G O T S G P T A P L A P C h o l i n -esterase Liver carcinoma with cholestasis 22 25 25 25 4 x + m 5 0 1 , 5 - 6 5 , 6 4 8 , 4 - 4 , 4 8 4 8 , 4 - 6 , 3 7 2 9 1 , 2 - 2 8 , 9 5 7 , 2 - 1 5 , 6 2 , 0 9 - 0 , 3 2 Extrahepatic benign cholestasis 14 15 16 15 5 10 x+m 4 8 9 , 5 - 8 2 , 1 3 48,9 — 7,50 7 4 , 7 - 1 1 , 3 1 2 0 2 , 5 - 2 5 , 8 4 79,2 — 25,80 2,25—"0,31 1 58 Е- Rus inov , G . Varbanov, R. Pateva , I . D a n e v shows that there are reliable differences only of A P levels which are higher in l i ­ver carcinoma patients while S G P T levels are lower. Some other investigators report similar data (6, 8) . The juxtaposition of serum enzyme levels in hepatic carcinoma pa­tients wi th or without hyperbilirubinaemia (see table 3) demonstrates a statistically T a b l e 3 Patients* groups/ Enzymes Liver carcinoma with Liver carcinoma with increased bilirubin normal bilirubin P n x ± m n x + m G G T P S G O T S G P T A P L A P Chol ines terase 22 25 25 25 4 18 5 0 1 , 5 - 6 5 , 6 4 8 , 4 - 4 , 4 8 4 8 , 7 ± 6 , 3 7 2 9 1 , 2 - 2 8 , 9 5 7 , 2 - 1 5 , 6 2 , 0 9 - 0 , 3 2 19 23 23 23 7 18 3 2 1 , 5 - 4 7 , 7 0 30,0_= 3,71 3 1 , 7 - 4 ,96 168,3—20.71 41 ,3—10,34 3, 1 - 0,30 < 0 , 0 5 < 0 , 0 l < 0 , 0 5 < 0 , 0 1 > 0 , 1 0 > 0 , 1 0 reliably higher ac t iv i ty of G G T P , S G O T , S G P T and A P in patients w i t h hyper­bil irubinaemia while the changes of L A P and cholinesterase levels are statisti­cal ly unsignificant. The more considerable changes of serum enzyme act iv i ty in l iver carcinoma patients wi th hyperbilirubinaemia are most probably due as wel l to the malignant process in hepatocytes, as to the cholestasis itself. Bearing in mind that hepatocytic G G T P ac t iv i ty is already increased at early carcino­genesis stages, we accept that its isolated increase even before the appearance of hyperbilirubinaemia has, undoubtedly, a great diagnostic significance. On the basis of our study the following conclusions could be drawn: 1. The excretory cholestatic enzymes ( G G T P , A P and L A P ) have the grea­test diagnostic value in l iver carcinoma patients. They are increased in more than 90 % of the cases while the changes of the act iv i ty of cholinesterase und transa­minases are more unsignificant. 2. There is no essential difference between the ac t iv i ty of serum enzymes in l iver carcinoma patients and that in choledocholithiatic cholestasis ones. That ' s why they can't be used as reliable test for differential diagnosis of malig­nant and benign cholestasis. 3. S G O T and S G P T ac t iv i ty is higher in advanced hepatic carcinoma pati­ents w i th manifested jaundice as compared wi th those without icterus. R E F E R E N C E S 1. Б о н д а р ь , З . А . К л и н и ч е с к а я г е п а т о л о г и я . M . , М е д и ц и н а , 1970, 407 с . — 2. Б р а и л с к и , X . Съвр. мед., 1974, 7, 47—50 . — З . Б р а и л с к и , X . В : Б о л е с т и н а ч е р н и я д р о б и ж л ъ ч н и т е п ъ т и щ а . С , 1971, 623—647. — 4. Б р а и л с к и , X . В : П р о б ­л е м и н а х е п а т о л о г и я т а . С , 1974, 3 9 — 6 5 . — 5. Б р а и л с к и , X . В : С ъ в р е м е н н и п р о б л е м и в г а с т р о е н т е р о л о г и я т а . С , 1979, 197—214. — 6. Д а н е в , С . Е н з и м н а д и а ­г н о с т и к а . С , М е д и ц и н а и ф и з к у л т у р а , 1974, с . 247. — 7. Д а н е в , С , Е . Ц в е т а ­н о в а . В : Н а ц . к о н г р . к л и н , л а б о р . , I I . С , 1975, — 8. Д а н е в , С , Д . Д о ч е в . В : С ъ в р е м е н н и п о с т и ж е н и я в г а с т р о е н т е р о л о г и я т а . С , 1977, 196—212. — 9. М а л е е в , А . , С. С т о я н о в . Х р о н и ч н и х е п а т и т и . С , М е д и ц и н а и ф и з к у л т у р а , 1974, с . И З . — 10. Т а ­ш е в , Т . В р о д е н и и п р и д о б и т и е н з и м о п а т и и . С , М е д и ц и н а и ф и з к у л т у р а , 1976, 9 — 4 5 , 277—310 . — 11 . Н е n n i n g, Н . , D . L o o k Н . Н . В г a u п . Z . Gastroenterol., 10, Changes of the serum enzyme leve l i n . 1972, 4 З З — 4 3 6 . — 12. Kokot, F . , Z . S l e d z i n s k i . Z . Klin. Chem. Klin. Biochem. 12, 1974, 374—384. — 13. M c K e n z i e , D . , A . H e n d e r s o n . Clin. Chim. Acta, 62, 1975, 447—450. - 14. R o l s a l s k i , S. Adv. Clin. Chem., 17, 1975, 53—107 . — 15. S c h m i d t , E . , F . S c h m i d t . I n : Gal lenwegeleber . S t u t t g a r t , G . T h i e m e , 1973, 3 2 — 5 0 . — 16. S i e v e r s , B . U . Acta Hepato-Gastroenterol, 20, 1973, 6, 4 8 9 — 4 9 7 . — 17. W a l l n o f e r , H., E . S c h m i d t , F . S c h m i d t . Synops i s der L e b e r k r a n k h e i -ten . S tu t tga r t , G . T h i e m e , 1974. И З М Е Н Е Н И Я У Р О В Н Я С Ы В О Р О Т О Ч Н Ы Х Э Н З И М О В У Б О Л Ь Н Ы Х Р А К О М П Е Ч Е Н И Е . Русинов, Г. Варбанов, Пашева Р Е З Ю М Е А в т о р а м и и с с л е д о в а н ы э н з и м ы 48 б о л ь н ы х р а к о м п е ч е н и , 16 б о л ь н ы х д о б р о к а ч е с т в е н н ы м х о л е л и т и а з о м с э к с т р а г е п а т а л ь н ы м х о л е с т а з о м и 25 з д о р о в ы х л и ц . Н а и б о л ь ш е й д и а г н о с т и ­ч е с к о й ц е н н о с т ь ю о т л и ч а ю т с я и з м е н е н и я а к т и в н о с т и Г Т Т П , А Ф и Л А П , п о в ы ш е н н ы х б о л е е чем у 90 % б о л ь н ы х р а к о м п е ч е н и . М е н ь ш у ю д и а г н о с т и ч е с к у ю ц е н н о с т ь и м е ю т с ы в о р о т о ч ­н а я х о л е э с т е р а з а , а т а к ж е С Г О Т и С Г П Т . 

CHANGES OF THE SERUM ENZYME LEVEL IN PATIENTS WITH LIVER CARCINOMA

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CHANGES OF THE SERUM ENZYME LEVEL IN PATIENTS WITH LIVER CARCINOMA

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