血清Glutamate Dehydrogenase活性測定による肝胆道疾患の診断

抄録

Determinations were made together with GLDH, aldolase (ALD), lactic dehydrogenase (LDH), GOT, GPT, isocitric dehydrogenase (ICD), alkaline phosphatase (ALP) and leucine aminopeptidase(LAP) activities in the sera of human cases of hepatobiliary diseases, rats with acute CCl₄ hepatic disturbances, with a common bile duct ligation or tumor bearing rats. Thus, a diagnostic value of GLDH activity was 'estimated as to hepatobiliary diseases with special reference to differentiation between benign and malignant hepatic duct obstruction. The results obtained of GLDH activity were as follows
1) On Schmidt's determination method the activity in normal subject's sera proved to be 0.55±0.237mu.
2) The average in acute hepatitis was 1.86mu, showing many cases of a slight increase. Abnormalities accounted for 68%. Its activity returned to normal earlier tha n other enzyme activities. Its pre-fatal value in fulminant hepatitis was considerably as high as 2.30mu.
3) The average in chronic hepatitis (active type) was 3. Omu,57% of which showed only a slight increase. Chronic hepatitis (inactive type) cases showed 1.54mu. Abnormalities were found in 71% and 46% in active and inactive type respectively.
4) The activity was slightly as high as 1.24mu in compensated ci@rrhosis of the liver and a normal range of 0.84mu in decompensated cirrhosis of the liver. Abnormalities of 47% were shared by both.
5) The activity increased to 2.66mu and 2.48mu in primary cancer of the liver and metastatic cancer of the liver respectively. Abnormalities accounted for 56% in the former and 83% in the latter.
6) Cholelithiasis directly after onset showed 5.82mu, being increased to 6.5 times the normal. But it showed a normal range of O.56mu, when improved.
7) No significant difference was found in the activity betw@een benign and malignant biliary duct obstruction.
8) Apparently the first attempt was made to study ICD/GLDH and LDH/GLDH in addition to GOT/GLDH and GPT/GLDH. Acute and chronic hepatitis (active type)showed high GOT/GLDH, GPT/GLDH and ICD/GLDH but low LDH/GLDH, w h i l e chronic hepatitis (inactive type) and cirrhosis of the liver showed a considerably low GPT/GLDH. Primary cancer of the liver show GPT/GLDH of 36.1, but metastatic cancer of the liver showed a markedly low GPT/GLDH of 7.6 with its hi gh LDH/GLDH of 884.8. Thus, GPT/GLDH and LDH/GLDH proved to be a useful aid to the diagnosis of metastatic cancer of the liver. The ratios in cholelithiasis directly afte r onset were all below normal and found increased when the disease was improved.
9) The activity was the highest reaching 3.9 times the normal, on the thi@rd day after intervention in acute CCl₄ hepatic disturbance rats. It showed a peak 25.8 times the normal on the fifth day in common bile duct ligation rats. Both rats showed wer e increase in GLDH than in ALP and LAP. Neither ascites type Yoshida sarcoma nor DAB hepatoma rats showed any increase in the activity. Yoshida ascites hepatoma A H 130 and AH601 showed an increase 1.7 times and 2.8 times the normal on the thi rd day after intervention. It was considered that an marked increase of the activity in common bile duct ligation rats afforded experimental evidence to an increase of GLDH clinically encountered in cases of cholelithiasis directly after onset.