Karaciğer İşlev Testleri

Abstract

Karaciğer protein, karbonhidrat ve yağ metabolizmasında önemli rolü olan kompleks bir organdır. Safra yapımı ve salınımından sorumludur. Aynı zamanda lipoproteinleri ve plazma proteinlerini sentezler. Glikojenez, glikojenoliz ve glikoneojenez ile normal kan glukoz düzeyini sağlar. Metabolizmanın artık ürünleri yine karaciğer tarafından zehirsizleştirilir. Anormal karaciğer enzim düzeyleri karaciğer hasarını gösterebilir. Karaciğer enzim düzeylerindeki değişiklikler klinikte en sık karşılaşılan problemlerden biridir. Karaciğer enzimlerinin patofizyolojisini bilmek değişikliklerini anlamak için önemlidir. Liver Function Tests The liver is a complex organ that has crucial role in protein, carbonhydrate and fat metabolism. It is responsible for synthesizing and secreting bile. It also synthesizes lipoproteins and plasma proteins. By glycogenesis, glycogenolysis and gluconeogenesis it maintains normal blood glucose level. Waste products of metabolism are also detoxified by liver. Abnormal liver enzyme levels may signal liver damage. Alterations in liver enzyme levels are one of the most common problems in clinical practice. Knowledge of the pathophysiology of liver enzymes is an essential guide to understanding their alteration.

Keywords

• -

References

1. Alpers DH, Kaplowitz N, Laine L. Digestive and liver disease. In: Tadaka Yamada (ed.) Textbook of Gastroenterology. Lippincott Williams and Wilkins, Philadelphia, USA, 2003; 3309–422.
2. Gülten M. Sarılık (ikter) ayırıcı tanı ve tedavisi, Memik F (ed.) Klinik Gastroenteroloji. 1.baskı, Bursa, Nobel ve Günefl yayınları, 2005; 551–558.
3. Berk PD, Martin JF, Blaschke TF, et al. Unconjugated hyperbilirubinemia: physiologic evaluation and e x p e r i m e n t a l approaches to therapy. Ann Intern Med 1975; 82: 552–570.
4. Bloomer JR, Berk PD, Vergalla J,et al. Influence of albümin on the extravascular distribution of u n c o n j u g a t e d bilirubin. Clin Sci Mol Med 1973; 45: 517–521.
5. McDonagh AF, Palma AA, Lauff JJ, et al. Origin of mammalian biliprotein and rearrangement of b i l i r u b i n glucuronides in vivo in the rat. J Clin Invest 1984; 74: 763–770.
6. Fevery J, Blanckaert N. What can we learn from analysis of serum bilirubin. J Hepatol 1986; 2: 113–121.
7. J.H. Grendell. Pancreatitis. In William N. Kelley. Textbook of Internal Medicine. Third Edition. Lippincott-Raven Publishers. Philadelphia. 1997. Pp.: 793–807.
8. Frank BB. Clinical Evaluation of Jaundice, JAMA 1989; 262: 3031–3034.

9. Ihara H, Aoki Y, Aoki T, et al. Light has a greater effect on direct bilirubin measured by the bilirubin oxidase method than by the diazo method. Clin Chem 1990; 36: 895–897.
10. Abbas AK, Lichtman AH, Pober JS. Antigen processing and presentation to T lymphocytes. In: Cellular and Molecular Immunology, WB Saunders Comp. USA, second ed. 1994; 115–135.
11. Akan E. Genel Mikrobiyoloji ve Immunoloji. Çukurova ÜniversitesiTıp Fakültesi Yayınları, No: 16, Adana, 1992; 56–89.
12. Doumas BT, Peters T. Serum and urine albümin: a progress report on their measurement and clinical significance. Clin Chim Act 1997; 258: 320.
13. Dufour DR. Gender related differences in liver f u n c t i o n and integrity tests Clin Chem 1998; 44(Suppl 6): A137.
14. Günflar F. Karaciğer enzim profilindeki değiflikliklerde yaklaflımlar. Güncel Gastroenteroloji. Eylül 2003; 192–203.
15. Miyaji H, Ito S, Azuma T, et al. Effects of Helicobacter pylori eradication therapy on hyperammonemia in patients with liver cirrhosis. Gut 1997; 40: 726–730. 16. Zullo A, Rinaldi V, Hassan C, et al. Helicobacter pylori and plasma ammonia levels in cirrhotics: role of u r e a s e inhibition by acetohydroxamic acid. Ital J Gastroenterol Hepatol 1998; 30: 405–409.
16. Heubi JE, Daugherty CC, Partin JS, et al. Grade 1 Reye’s syndrome–outcome and predictors of progression to deeper coma grades. N Engl J Med 1984; 311: 1539–1542.
17. Butterworth RF, Giguere JF, Michaud J, et al. Ammonia: key factor in the pathogenesis of hepatic encephalopathy. Neurochem Pathol 1987; 6: 1–12.
18. McClain CJ, Zieve L, Doizaki WM, et al. Blood methanetriol in alcoholic liver disease with and without hepatic encephalopathy. Gut 1980; 21: 318–323.
19. Huizenga JR, Tangerman A, Gips CH. Determination of blood ammonia in biological fluids. Ann Clin Biochem 1994; 31: 529–543.
20. Usta Y, Yüce A. Wilson hastalığı: Tanı ve Tedavide Güncel Yaklaflımlar. Pediatrik Gastroenteroloji, Hepatoloji ve Beslenme Dergisi 2004; 1: 227–239.
21. Giannini E, Testa R, Savarino V. Liver enzyme alteration: a guide for clinicians. Canadian Medical Association or its licensors. 2005; 367–378.
22. fientürk H, Canbakan B, Hatemi İ. Karaciğer Enzim Yüksekliklerine Klinik Yaklaflım. Gastroenterolojide Klinik Yaklaflım Sempozyum Dizisi. Mart 2004; 9–13. 24. Maggiore G, Caprai S. Liver involvement in celiac dis- ease. Indian J Pediatr. 2006 ; 73: 809–811.
23. Kaplan M. Alanin aminotransferase levels: What’ s normal? Ann Intern Med. 2002 Jul 2; 137: 49–51.
24. Prati D, Tailoli E, Zanella A, et al. Updated definitions of healthy ranges for serum alanine aminotransferase levels. Ann Intern Med. 2002; 137: 1–9.
25. Crofton PM. Biochemistry of alkaline phosphatase isoenzymes. Crit Rev Clin Lab Sci 1982; 16: 161–194. 28. Posen S. Alkaline phosphatase. Ann Intern Med 1967; 67: 183–194.
26. Fishman WH. Alkaline phosphatase isoenzymes: recent progress. Clin Biochem 1990; 23: 99–104.
27. Moss DW. Multiple forms of acid and alkaline p h o s p h a t a s e s : genetics, expression and tissue m o d i f i c a t i o n . Clin Chim Acta 1986; 161: 123–135.
28. Weiss MJ, Ray K, Henthorn PS, et al. Structure of the human liver /bone/kidney alkaline phosphatase gene. J Biol Chem1988; 263: 12002–12010.
29. Clubb JS, Neale FC, Posen S. The behavior of infused placental alkaline phosphatase in human subjects. J Lab Clin Med 1965; 66: 493–507.
30. Kleerekoper M, Horne M, Cornish CJ, et al. Serum alkaline phosphatase after fat ingestion: an i m m u n o l o g i c a l study. Clin Sci 1970; 38: 339–345.
31. Posen S, Grundstein HS. Turnover of skeletal alkaline phosphatase in humans. Clin Chem 1982; 28: 153–154.
32. Anciaux ML, Pelletier AG, Attali P, et al. Prospective study of clinical and biochemical features of s y m p t o m a t i c choledocholithiasis. Dig Dis Sci 1986; 31: 449–453.
33. Kress BC, Mizrahi IA, Armour KW,et al. Use of bone alkaline phosphatase to monitor alendronate therapy in individual postmenopausal osteoporotic women. Clin Chem 1999; 45: 1009–1017.
34. Miura T, Matsuda Y, Tsuji A, et al. Immunological cross-reactivity of -glutamyl transpeptidase from human and rat kidney. J Biochem 1981; 89: 217–222.
35. Hedworth-Whitty RB, Whitfield JB, Richardson RW. Serum-glutamyl transpeptidase activity in myocardial ischaemia. Br Heart J 1967; 29: 432–438.
36. Ratanasavanh D, Tazi A, Gaspart E. Hepatic -glutamyl transferase release: effect of bile salt and membrane structure modification. Adv Biochem Pharamacol 1982; 3: 93–103.
37. Zhang H, Forman HJ, Choi J. Gamma-glutamyl transpeptidase in glutathione biosynthesis. Methods Enzymol. 2005; 401: 468–83.
38. Hozawa A, Okamura T, Kadowaki T, et al. Gamma- Glutamyltransferase predicts cariovascular death among Japanese women. Atherosclerosis. 2007; 194: 498–504.