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    Analizat e Mëlçisë

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    I. C. Straussman
    1. ALT and AST are liver enzymes that help metabolize proteins and indicate liver cell damage. 2. When the liver is damaged, these enzymes leak into the blood in large amounts due to cell membrane rupture. 3. The assays for ALT and AST require vitamin B6, so alcoholics who are often B6 deficient can show normal or low levels of these enzymes despite liver damage. A case study is described where a patient showed normal enzyme levels until given B6 supplements and the levels increased, resolving the diagnostic dilemma.

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    Analizat e Mëlçisë

    Uploaded by

    I. C. Straussman
    416 views2 pages
    1. ALT and AST are liver enzymes that help metabolize proteins and indicate liver cell damage. 2. When the liver is damaged, these enzymes leak into the blood in large amounts due to cell membrane rupture. 3. The assays for ALT and AST require vitamin B6, so alcoholics who are often B6 deficient can show normal or low levels of these enzymes despite liver damage. A case study is described where a patient showed normal enzyme levels until given B6 supplements and the levels increased, resolving the diagnostic dilemma.

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    Melcia

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    1. ALT and AST are liver enzymes that help metabolize proteins and indicate liver cell damage. 2. When the liver is damaged, these enzymes leak into the blood in large amounts due to cell membrane rupture. 3. The assays for ALT and AST require vitamin B6, so alcoholics who are often B6 deficient can show normal or low levels of these enzymes despite liver damage. A case study is described where a patient showed normal enzyme levels until given B6 supplements and the levels increased, resolving the diagnostic dilemma.

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    416 views2 pages

    Analizat e Mëlçisë

    Uploaded by

    I. C. Straussman
    1. ALT and AST are liver enzymes that help metabolize proteins and indicate liver cell damage. 2. When the liver is damaged, these enzymes leak into the blood in large amounts due to cell membrane rupture. 3. The assays for ALT and AST require vitamin B6, so alcoholics who are often B6 deficient can show normal or low levels of these enzymes despite liver damage. A case study is described where a patient showed normal enzyme levels until given B6 supplements and the levels increased, resolving the diagnostic dilemma.

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    ANALIZAT E MËLÇISË

    [bilanci hepatik]
    TREGUESIT E DËMTIMIT TË QELIZËS HEPATIKE
    Transaminazat: enzima të melçisë që ndihmojnë në metabolizmin e
    proteinave.
    - AST [sGOT]
    - ALT [sGPT]
    Të dyja janë enzima citoplazmatike të hepatocitit. Kur hepatociti
    dëmtohet, derdhen në gjak në sasi të mëdha si pasojë e çarjes së
    membranës qelizore.
    Kanë si kofaktor vit. B6 [piroksidal fosfatin/ pirodoksinë] që
    d.m.th., kur ka mungesë të vit. B6, kanë aktivitet të ulët. Një
    pacjentët që ka probleme me melçinë por që ka mungesë të vit. B6,
    sGOT dhe sGPT janë të ulura ose/dhe normale. Nëse bëhet dozimi i
    aminotransferazave pas vitaminoterapisë apo terapisë specifike
    për patologjinë, ato do të paraqiten të rritura.
    CLINICAL CASE:
    In many of the serum assays for ALT and AST, it is assumed that the
    patient’s serum provides a sufficient complement of pyridoxal
    phosphate, a circumstance that does not always apply. In a most
    poignant case illustrating this point, a patient, a known alcoholic,
    was admitted to a hospital with a presumptive diagnosis of alcoholic
    hepatitis, a condition described at length later. His admission
    clinical chemistry profile showed normal to low serum levels of ALT
    and AST. This finding is unusual in alcoholic hepatitis because, as
    we discuss later, both enzymes become significantly elevated such
    that AST levels are higher than those for ALT. During the course of
    the next 24 hours, he was treated for his condition, with apparent
    clinical improvement. However, a repeat liver function profile showed
    marked elevations of both enzymes to levels greater than 200 IU/L.
    This presented a diagnostic dilemma, which was resolved when it was
    realized that, as part of the protocol for treatment of alcoholic
    hepatitis, the patient had received vitamin supplements, including
    vitamins B6 and B12. Because the serum assays for both ALT and AST
    required vitamin B6 supplied by the patient’s serum, and the patient,
    an alcoholic, was vitamin B6 deficient (common in alcoholics), the
    assays for both enzymes showed normal to low levels caused by the
    absence of vitamin B6. Upon therapeutic intervention, when vitamins
    were administered, sufficient serum levels of vitamin B6 were present
    to allow full enzyme activities. This clinical history illustrates
    the central role of pyridoxal phosphate in enzyme catalysis by AST
    and ALT, and the importance of understanding the chemical basis for
    enzyme assays.

    Gjysmë-jeta në gjak: AST [ 17 orë] ALT [47 orë].


    Shpërndarja në organizëm: ALT gjendet më tepër në mëlçi por dhe
    në veshka, kurse AST është e shpërdnarë dhe në muskul skeletik
    dhe miokard në sasi thuajsë të barabarta.
    AST brenda-qelizore është ~7000 herë më e lartë se AST serike.
    ALT brenda-qelizore është ~3000 herë më e lartë se ALT serike. Si
    pasojë e kësaj: në dëmtim akut të heparit, AST do të jetë më e
    lartë se ALT, por brenda 24-48 orësh, vlera e ALT do të jetë më e
    lartë, sepse gjysmë-jeta e sGOT është më e shkurtër.
    Rriten edhe nw kolestaza, por analitwt e kolestazws [ ALP;
    bilirubina] janw shumw mw tw larta nw krahasim me transamainzat.
    Kur vwrehen rritje dhe e transaminazave dhe analitwve tw
    kolestazws, atwhere dyshohet pwr ndonjw rast ku dwmtimi
    hepatocellular ka ndikuar nw sekretimin e bilws nw nivelin e
    hepatocitit [kolestazw intrahepatike (dmth problemi qwndron tek
    hepari, jo tek sistemi biliar)]

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