- 期刊
The Diagnostic Significance of Serum Guanase Activity in Various Liver Diseases
血清鳥糞酶活性對於各種肝病之診斷意義
摘要
烏糞酶(guanase)是肝內氨合成過程的一個酵素，主在催化烏糞素(guanine)水解成黃嘌吟(xanthine)。它主要存於肝細胞之細胞質，在腦及腎組織亦有分佈。文獻報告認為這個酵素的測定，對於肝病的診斷有頗佳之特異性。為了明瞭血清烏糞酶對於各種肝病之診斷意義與價值，本院腸胃科自民國74年8月起，採用「游離氨直接色析法」，對137例病人，包括肝病與非肝病者，實行室腹血清烏糞酶之定量。 血清烏糞酶在21例正常對照組為1.4±2.1 IU/L（平均值士標準差）, 13例急性肝炎為12.0±13.9 IU/L, 22例慢性活動性肝炎為8.1±8.8 IU/L, 5例慢性小葉性肝炎為2.3±1.4 IU/L, 3例乙型肝炎帶原者為0.6±1.1 IU/L, 3例酒精性肝病為7.0±2.9 IU/L, 11例肝硬化為3.9±4.5I U/L, 18例原發性肝癌為3.1±3.2 IU/L, 6例外科性黃疸為3.3±3.2 IU/L, 6例內科性黃疸為6.1±3.6 IU/L, 17例正常肝功能之腦中風為1.22±2.2 IU/L, 12例急性心肌梗塞為1.21±1.8 IU/L。血清鳥糞酶在急性肝炎與慢性活動性肝炎增加最為明顯，在急性心肌梗塞、腦中風、乙型肝炎帶原者未見增加，而在其他肝病則呈中至輕度之增加。 急性肝炎與慢性活動性肝炎二組與正常對照組、乙型肝炎帶原者、慢性小葉性肝炎、原發性肝癌、外科性黃疸、中風、急性心肌梗塞等組，均呈統計學有意義之差別，但二組彼此之間無差異。內科性與外科黃疸亦無統計學上之差異。 血清鳥糞酶與氨基轉移酶呈良好之線性相關，尤其見於急性肝炎之病人。烏糞酶雖存於肝、腎與腦中，但中風病人之血清烏糞酶值未見上昇；且急性心肌梗塞所致氨基轉移酶增高之病人，其血清烏糞酶仍在正常範圍內。可見在某些情況下，血清烏糞酶比氨基轉移酶對於診斷肝病，有較少之偽陽性率，同時它可反映肝炎之活動性，可作為肝病之輔助檢查。
並列摘要
We measured serum guanase activity with free ammonium direct coloremetric method in 116 patients with various diseases and in 21 healthy controls to evaluate the clinical application of this enzyme. The serum guanase activity in controls was 1.4±2.1 IU/L (mean±S.D.). The serum levels of this enzyme were markedly elevated in patients with acute hepatitis B (12.0±13.9 IU/L) and chronic active hepatitis B (8.1±8.8 IU/L), mildly or moderately increased in chronic lobular hepatitis B (2.3±1.4 IU/L), alcoholic hepatitis (7.0±2.9 IU/L), cirrhosis of liver (3.9±4.5 IU/L), primary hepatocellular carcinoma (3.1±3.2 IU/L), intrahepatic cholestasis (6.1±3.6 IU/L) and ext rahepatic cholestasis (3.3±3.4 IU/L). In contrast, serum guanase activity was normal in patients with a variety of non-liver-related diseases including acute myocardial infarction (without congestive liver) and apoplexy, although the serum aminotransferase levels were increased in the group of acute myocardial infarction. Close correlations were found between serum guanase activities and serum aminotransferase levels, especially in patients with acute hepatitis B. These findings suggest that serum guanase activity can reflect the degree of hepatic injury. And under some condition, it has less false-positive rate than serum aminotransferase in diagnosis of liver damage. Thus it can serve as a supplemental test for liver injury.