آنزيم شناسي باليني

1. آنزيم شناسي باليني

2. Transaminases • GOT or AST • GPT or ALT

3. AST ALT

4. روش هاي اندازه گيري • كالريمتريك • فتومتريك

5. مقادير نرمال

6. CPK • Mg coenzyme • Inhibitors: Ca, Zn, Cu, Mn, iodoacetate • Activators: N-acetylcysteine • CK-MB- α2 glubolin

7. CK

9. Aldolase • ALD A : FDP • ALD B : F1P • ALD C : ? • Disease of Skeletal muscle 10-50 times • Duchenne disease • Myasthenia gravis & MS • In MI 5-8 times • Pattern parallel AST • Injection of cortisone & ACTH 10-18 times

10. LDH • pH optimum in L P = 8.8-9.8 • pH optimum in P L = 7.8 • Inhibitors: reagents against thiol (Hg), Borate & Oxalate, EDTA • HBDH = LD1

12. ALP • Isoenzyme: liver, bone, intestinal, placental, renal • Activators: Mg, Co, Mn • Inhibotors: phosphate, borate, oxalate, cyanide • 56º & 65º • Urea inhibition • Phe inhibited intestinal & placental

13. 5‘-Nucleotidase (NTP) • Localized in cytoplasmic cell membrane • pH optimum = 6.6 – 7 • In hepatobiliary disease increased 2-6 times • increase: stone, tumor, biliary cirrhosis • In early hepatitis NTP normal or slightly elevated • In hepatobiliary disease ALP & NTP elevated similarly

14. In hepatobiliary disease ALP & NTP elevated similarly In Skeletal disease, late pregnancy, childhood ALP increased & NTP normal Comparison of ALP & NTP

15. Gamma-glutamyl transferase (GGT) • GGT present in all cells except muscle • Small in cytosol & large fraction in cell membrane • GGT elevated in all liver disease • GGT more sensitive than ALP, NTP, LAP, GOT, GPT in obstructive jaundice • Normal: skeletal disease, children older than 1 y, pregnancy

16. Comparison of GGT, ALP & NTP

17. Amylase • Amylase hydrolased α-1,4 linkage • Types of amylase: • Beta: plant & bacterial. Terminal reducing, splits a maltose at a time • Alpha: animal & human. Random hydrolased α-1,4 linkage

18. Human amylase • pH optimum = 6.9 – 7 • Q10 =1.6 , up to 50° active • Calcium metalloenzyme • Activator ions: chloride, bromide, nitrate, phosphate • MW= 55000 – 60000 • Electrophoresis: β & γ globulins

19. Types of human amylase • P – type & S – Type (ptyalin) • Macroamylase : usually S-type with IgA, IgG or other normal proteins

20. Causes of hyperamylasemia • Pancreatic disease (P) • Renal insufficiently (mixed) • Mumps (s) • Diabetic ketoacidosis (M) • Acute alcoholism (M) • Medicinal opiates (p) • Heroin lung (s)

21. Amylase/creatinine clearance ratio (ACCR) • ACCR (%) = (urine clearance of amylase/ urine clearance of creatinine) X 100 • ( urine amylase (U/L) X serum creatinine (mg/L) / serum amylase (U/L) X urine creatinine (mg/L) X 100 • Normal ACCR = 2 – 5 % • Acute pancreatitis > 8% • Macroamylasemia < 2%

22. Lipase • Glycoprotein • MW = 54000 • Concentration lipase in pancreas ~ 20000 serum • alpha position carbons • Lipase activated by NaCl

23. Cholinesterase • Choline esterase I = true cholinesterase • RBC, lung, spleen, nerve endings, gray matter of the brain • Choline esterase II = pseudocholinesterase • Serum, Liver, pancreas, heart, white matter of the brain

24. Cholinesterase • Liver function • Insecticide poisoning • Normal range • 4000-12000 U/L • Level at birth = ¼ adults • In 2 month = adults

25. Cholinesterase • 30-50% decrease • Acute & chronic hepatitis • 50-70% decrease • Advanced cirrhosis & carcinoma • Decrease slightly in pregnancy

26. Acid phosphatase ایزوآنزیم های زیادی دارد که مهمترین آنها ایزوآنزیم پروستاتیک است. در تشخیص اختلالات خوش خیم و بدخیم پروستات نقش دارد. ایزوآنزیم پروستاتیک حساس به تارتارات است. نگهداری سرم حتی در یخچال سبب کاهش فعالیت اسید فسفاتاز می گردد. بهترین راه نگهداری نمونه جهت انجام آزمایش اسیدفسفاتاز اسیدی کردن سرم می باشد

27. Angiotensine converting enzyme (ACE)