Retrospective Analysis Of Changes in Pseudocholinesterase (Butyrylcholinesterase) Values Based On Gender And Year
Yıl 2025,
Cilt: 8 Sayı: 4, 475 - 480, 31.12.2025
Alev Duygu Kuzzu
,
Kadir Bahadır Kuzzu
,
Ebru Afşar
,
Serkan Uslu
,
Deniz Kantar Gül
Öz
Aim: Pseudocholinesterase (PChE) serum PChE levels increase over time in different populations, leading to faster metabolism of anesthetic agents, shortening the duration of paralysis and requiring additional doses. This makes the assessment of serum PChE levels an important issue for anesthesia safety.
Methods: In this retrospective cross-sectional study, preoperative serum PChE levels of 8.951 patients were examined over a seven-year period. Differences by year, the years between which the differences occurred, gender-related changes, and year-gender interactions were analyzed.
Results: The mean serum PChE level in all patients was 10.621 ± 0.24 U/L. Linear regression analysis revealed a mean annual increase of 233.66 U/L across years. Male PChE levels were significantly higher than female PChE levels. The Year × Gender interaction was also found to be significant. Consequently, the rate of increase was found to be faster in males than in females. Furthermore, serum PChE levels were higher in females among individuals over 65 years of age. The highest serum PChE levels were observed in individuals under 15 years of age.
Conclusions: Conclusions: Differences between men and women may be due to biological differences related to sex, while the overall increase over time may be due to metabolic changes or environmental factors within the population. Therefore, our results suggest that individual sex and hormonal variations, as well as trends in serum PChE levels across populations, may be critical for anesthesia safety.
Etik Beyan
The study received approval from the Akdeniz University Medical Scientific Research Ethics Committee, dated May 28, 2025, with number 775.
Kaynakça
-
1.Wichmann S, Faerk G, Bundgaard JR, Gatke MR. Patients with prolonged effect of succinylcholine or mivacurium had novel mutations in the butyrylcholinesterase gene. Pharmacogenet Genomics. 2016;26(7):351-6. [Crossref]
-
2.Andersson ML, Moller AM, Wildgaard K. Butyrylcholinesterase deficiency and its clinical importance in anaesthesia: a systematic review. Anaesthesia. 2019;74(4):518-28. [Crossref]
-
3.Lockridge O. Review of human butyrylcholinesterase structure, function, genetic variants, history of use in the clinic, and potential therapeutic uses. Pharmacol Ther. 2015;148:34-46. [Crossref]
-
4.Andersson ML, Møller AM, Wildgaard K. Butyrylcholinesterase deficiency and its clinical importance in anaesthesia: a systematic review. Anaesthesia. 2019;74(4):518-28. [Crossref]
-
5.Ammundsen HB, Sørensen MK, Gätke MR. Succinylcholine resistance. BJA: British Journal of Anaesthesia. 2015;115(6):818-21. [Crossref]
-
6.Yao FS, Savarese JJ. Pseudocholinesterase hyperactivity with succinylcholine resistance: an unusual cause of difficult intubation. J Clin Anesth. 1997;9(4):328-30. [Crossref]
-
7.Neitlich HW. Increased plasma cholinesterase activity and succinylcholine resistance: a genetic variant. J Clin Invest. 1966;45(3):380-7. [Crossref]
-
8.Pope CN, Brimijoin S. Cholinesterases and the fine line between poison and remedy. Biochem Pharmacol. 2018;153:205-16. [Crossref]
-
9.Kurnutala LN, Rugnath N. Pseudocholinesterase Deficiency - Is Succinylcholine Still Needed to Facilitate Endotracheal Intubation? Cureus. 2020;12(9):e10721. [Crossref]
-
10.Robles A, Michael M, McCallum R. Pseudocholinesterase Deficiency: What the Proceduralist Needs to Know. Am J Med Sci. 2019;357(3):263-7. [Crossref]
-
11.Vallianou NG, Evangelopoulos AA, Bountziouka V, Bonou MS, Katsagoni C, Vogiatzakis ED, et al. Association of butyrylcholinesterase with cardiometabolic risk factors among apparently healthy adults. J Cardiovasc Med (Hagerstown). 2014;15(5):377-83. [Crossref]
-
12.Abdullayev R, Küçükebe Ö B, Kaya R, Çelik B, Kuşderci H, Duran M, et al. Pseudocholinesterase Enzyme Deficiency in Adıyaman City Area. Turk J Anaesthesiol Reanim. 2015;43(6):381-6. [Crossref]
-
13.Rhim JW, Go EJ, Lee KY, Youn YS, Kim MS, Park SH, et al. Pandemic 2009 H1N1 virus infection in children and adults: A cohort study at a single hospital throughout the epidemic. Int Arch Med. 2012;5(1):13. [Crossref]
-
14.Biau DJ, Kernéis S, Porcher R. Statistics in brief: the importance of sample size in the planning and interpretation of medical research. Clin Orthop Relat Res. 2008;466(9):2282-8. [Crossref]
-
15.Dell RB, Holleran S, Ramakrishnan R. Sample size determination. Ilar j. 2002;43(4):207-13. [Crossref]
-
16.Santarpia L, Grandone I, Contaldo F, Pasanisi F. Butyrylcholinesterase as a prognostic marker: a review of the literature. J Cachexia Sarcopenia Muscle. 2013;4(1):31-9. [Crossref]
-
17.Schmidt E, Henkel E, Klauke R, Lorentz K, Sonntag O, Stein W, et al. Proposal for standard methods for the determination of enzyme catalytic concentrations in serum and plasma at 37 degrees C. J Clin Chem Clin Biochem. 1990;28(10):805-8.
-
18.Hosseini J, Firuzian F, Feely J. Ethnic differences in the frequency distribution of serum cholinesterase activity. Ir J Med Sci. 1997;166(1):10-2. [Crossref]
-
19.Thomsen JL, Gätke MR. Plasma cholinesterase deficiency in Turkish patients - a reply. Anaesthesia. 2016;71(8):982-3. [Crossref]
-
20.da Conceição Filho JN, Dos Santos IC, Gonçalves DPJ, Ferreira JRD, Godoy A. Black and non-black population: investigation of the difference in butyrylcholinesterase activity in a healthy population in Salvador, Bahia. Ir J Med Sci. 2023;192(3):1311-9. [Crossref]
-
21.Flegar-Mestrić Z, Surina B, Siftar Z. Biological variations of human serum butyrylcholinesterase activity in a population from Zagreb, Croatia. Chem Biol Interact. 1999;119-120:193-9. [Crossref]
-
22.Lapauw B, Goemaere S, Zmierczak H, Van Pottelbergh I, Mahmoud A, Taes Y, et al. The decline of serum testosterone levels in community-dwelling men over 70 years of age: descriptive data and predictors of longitudinal changes. Eur J Endocrinol. 2008;159(4):459-68. [Crossref]
-
23.Ho-Pham LT, Nguyen ND, Nguyen TV. Quantification of the relative contribution of estrogen to bone mineral density in men and women. BMC Musculoskelet Disord. 2013;14:366. [Crossref]
-
24.den Blaauwen DH, Poppe WA, Tritschler W. [Cholinesterase (EC 3.1.1.8) with butyrylthiocholine-iodide as substrate: references depending on age and sex with special reference to hormonal effects and pregnancy]. J Clin Chem Clin Biochem. 1983;21(6):381-6. [Crossref]
-
25.Chadid S, Barber JR, Rohrmann S, Nelson WG, Yager JD, Kanarek NF, et al. Age-Specific Serum Total and Free Estradiol Concentrations in Healthy Men in US Nationally Representative Samples. J Endocr Soc. 2019;3(10):1825-36. [Crossref]
-
26.Frederiksen H, Johannsen TH, Andersen SE, Albrethsen J, Landersoe SK, Petersen JH, et al. Sex-specific Estrogen Levels and Reference Intervals from Infancy to Late Adulthood Determined by LC-MS/MS. J Clin Endocrinol Metab. 2020;105(3):754-68. [Crossref]
-
27.Alves-Amaral G, Pires-Oliveira M, Andrade-Lopes AL, Chiavegatti T, Godinho RO. Gender-related differences in circadian rhythm of rat plasma acetyl- and butyrylcholinesterase: effects of sex hormone withdrawal. Chem Biol Interact. 2010;186(1):9-15. [Crossref]
-
28.Alcântara VM, Oliveira LC, Réa RR, Suplicy HL, Chautard-Freire-Maia EA. Butyrylcholinesterase activity and metabolic syndrome in obese patients. Clin Chem Lab Med. 2005;43(3):285-8. [Crossref]
-
29.Heni M, Hummel J, Fritsche L, Wagner R, Relker L, Machann J, et al. Elevated Cholinesterase Activity and the Metabolic Syndrome-Dissecting Fatty Liver, Insulin Resistance and Dysglycaemia. Liver Int. 2025;45(5):e70046. [Crossref]
-
30.Oliveira-Silva JJ, Alves SR, Meyer A, Perez F, Sarcinelli PN, da Costa Mattos RC, et al. [Influence of socioeconomic factors on the pesticides poisoning, Brazil]. Rev Saude Publica. 2001;35(2):130-5. [Crossref]
-
31.Manfo FPT, Suh CF, Nantia EA, Moundipa PF, Cho-Ngwa F. Occupational use of agrochemicals results in inhibited cholinesterase activity and altered reproductive hormone levels in male farmers from Buea, Cameroon. Toxicol Res (Camb). 2021;10(2):232-48. [Crossref]
Cinsiyet ve Yıla Göre Psödokolinesteraz (Butirilkolinesteraz) Değerlerindeki Değişikliklerin Retrospektif Analizi
Yıl 2025,
Cilt: 8 Sayı: 4, 475 - 480, 31.12.2025
Alev Duygu Kuzzu
,
Kadir Bahadır Kuzzu
,
Ebru Afşar
,
Serkan Uslu
,
Deniz Kantar Gül
Öz
Amaç: Psödokolinesteraz (PChE), farklı popülasyonlarda serum PChE düzeylerinin zamanla artması, anestezik ajanların metabolizmasının daha hızlı olmasına ve bunun sonucunda paralizi süresinin kısalmasına ve ek dozlara ihtiyaç duyulmasına neden olur. Bu durum, serum PChE düzeylerinin değerlendirilmesini anestezi güvenliği açısından önemli bir konu haline getirmektedir.
Yöntemler: Bu retrospektif kesitsel çalışmada, 8.951 hastanın ameliyat öncesi serumunda ölçülen PChE düzeyleri yedi yıllım süreçte incelendi. Yıllara göre farklılıklar, farklılıkların hangi yıllar arasında olduğu, cinsiyete bağlı değişimler ve yıl-cinsiyet etkileşimleri analiz edildi.
Bulgular: Tüm hastalarda serum PChE düzeyi ortalaması 10,621 ± 0,24 U/L olarak bulundu. Doğrusal regresyon analizi, yıllar arasında ortalama yıllık 233,66 U/L'lik bir artış olduğunu ortaya koydu. Erkek PChE düzeyleri kadın PChE düzeylerinden anlamlı olarak yüksekti. Yıl × Cinsiyet etkileşiminin de anlamlı olduğu bulundu. Sonuç olarak, artış hızının erkeklerde kadınlardan daha hızlı olduğu sonucuna varıldı. Ayrıca, 65 yaş üstü bireylerde serum PChE düzeyleri kadınlarda daha yüksekti. En yüksek serum PChE düzeyleri 15 yaşın altındaki bireylerde gözlendi.
Sonuçlar: Erkekler ve kadınlar arasındaki farklılıkların cinsiyete bağlı biyolojik farklılıklardan kaynaklanabileceği, yıllar içindeki genel artışın ise popülasyondaki metabolik değişikliklerden veya çevresel faktörlerden kaynaklanabileceği düşünülmektedir. Bu nedenle, sonuçlarımız bireysel cinsiyet ve hormonal değişikliklerin yanı sıra popülasyonlar arasındaki serum PChE düzeyleri eğiliminin anestezi güvenliği açısından kritik olabileceğini göstermektedir.
Etik Beyan
Çalışma Akdeniz Üniversitesi Tıbbi Bilimsel Araştırmalar Etik Kurulu’ndan 28 Mayıs 2025 tarih ve 775 sayılı onay ile onay aldı.
Kaynakça
-
1.Wichmann S, Faerk G, Bundgaard JR, Gatke MR. Patients with prolonged effect of succinylcholine or mivacurium had novel mutations in the butyrylcholinesterase gene. Pharmacogenet Genomics. 2016;26(7):351-6. [Crossref]
-
2.Andersson ML, Moller AM, Wildgaard K. Butyrylcholinesterase deficiency and its clinical importance in anaesthesia: a systematic review. Anaesthesia. 2019;74(4):518-28. [Crossref]
-
3.Lockridge O. Review of human butyrylcholinesterase structure, function, genetic variants, history of use in the clinic, and potential therapeutic uses. Pharmacol Ther. 2015;148:34-46. [Crossref]
-
4.Andersson ML, Møller AM, Wildgaard K. Butyrylcholinesterase deficiency and its clinical importance in anaesthesia: a systematic review. Anaesthesia. 2019;74(4):518-28. [Crossref]
-
5.Ammundsen HB, Sørensen MK, Gätke MR. Succinylcholine resistance. BJA: British Journal of Anaesthesia. 2015;115(6):818-21. [Crossref]
-
6.Yao FS, Savarese JJ. Pseudocholinesterase hyperactivity with succinylcholine resistance: an unusual cause of difficult intubation. J Clin Anesth. 1997;9(4):328-30. [Crossref]
-
7.Neitlich HW. Increased plasma cholinesterase activity and succinylcholine resistance: a genetic variant. J Clin Invest. 1966;45(3):380-7. [Crossref]
-
8.Pope CN, Brimijoin S. Cholinesterases and the fine line between poison and remedy. Biochem Pharmacol. 2018;153:205-16. [Crossref]
-
9.Kurnutala LN, Rugnath N. Pseudocholinesterase Deficiency - Is Succinylcholine Still Needed to Facilitate Endotracheal Intubation? Cureus. 2020;12(9):e10721. [Crossref]
-
10.Robles A, Michael M, McCallum R. Pseudocholinesterase Deficiency: What the Proceduralist Needs to Know. Am J Med Sci. 2019;357(3):263-7. [Crossref]
-
11.Vallianou NG, Evangelopoulos AA, Bountziouka V, Bonou MS, Katsagoni C, Vogiatzakis ED, et al. Association of butyrylcholinesterase with cardiometabolic risk factors among apparently healthy adults. J Cardiovasc Med (Hagerstown). 2014;15(5):377-83. [Crossref]
-
12.Abdullayev R, Küçükebe Ö B, Kaya R, Çelik B, Kuşderci H, Duran M, et al. Pseudocholinesterase Enzyme Deficiency in Adıyaman City Area. Turk J Anaesthesiol Reanim. 2015;43(6):381-6. [Crossref]
-
13.Rhim JW, Go EJ, Lee KY, Youn YS, Kim MS, Park SH, et al. Pandemic 2009 H1N1 virus infection in children and adults: A cohort study at a single hospital throughout the epidemic. Int Arch Med. 2012;5(1):13. [Crossref]
-
14.Biau DJ, Kernéis S, Porcher R. Statistics in brief: the importance of sample size in the planning and interpretation of medical research. Clin Orthop Relat Res. 2008;466(9):2282-8. [Crossref]
-
15.Dell RB, Holleran S, Ramakrishnan R. Sample size determination. Ilar j. 2002;43(4):207-13. [Crossref]
-
16.Santarpia L, Grandone I, Contaldo F, Pasanisi F. Butyrylcholinesterase as a prognostic marker: a review of the literature. J Cachexia Sarcopenia Muscle. 2013;4(1):31-9. [Crossref]
-
17.Schmidt E, Henkel E, Klauke R, Lorentz K, Sonntag O, Stein W, et al. Proposal for standard methods for the determination of enzyme catalytic concentrations in serum and plasma at 37 degrees C. J Clin Chem Clin Biochem. 1990;28(10):805-8.
-
18.Hosseini J, Firuzian F, Feely J. Ethnic differences in the frequency distribution of serum cholinesterase activity. Ir J Med Sci. 1997;166(1):10-2. [Crossref]
-
19.Thomsen JL, Gätke MR. Plasma cholinesterase deficiency in Turkish patients - a reply. Anaesthesia. 2016;71(8):982-3. [Crossref]
-
20.da Conceição Filho JN, Dos Santos IC, Gonçalves DPJ, Ferreira JRD, Godoy A. Black and non-black population: investigation of the difference in butyrylcholinesterase activity in a healthy population in Salvador, Bahia. Ir J Med Sci. 2023;192(3):1311-9. [Crossref]
-
21.Flegar-Mestrić Z, Surina B, Siftar Z. Biological variations of human serum butyrylcholinesterase activity in a population from Zagreb, Croatia. Chem Biol Interact. 1999;119-120:193-9. [Crossref]
-
22.Lapauw B, Goemaere S, Zmierczak H, Van Pottelbergh I, Mahmoud A, Taes Y, et al. The decline of serum testosterone levels in community-dwelling men over 70 years of age: descriptive data and predictors of longitudinal changes. Eur J Endocrinol. 2008;159(4):459-68. [Crossref]
-
23.Ho-Pham LT, Nguyen ND, Nguyen TV. Quantification of the relative contribution of estrogen to bone mineral density in men and women. BMC Musculoskelet Disord. 2013;14:366. [Crossref]
-
24.den Blaauwen DH, Poppe WA, Tritschler W. [Cholinesterase (EC 3.1.1.8) with butyrylthiocholine-iodide as substrate: references depending on age and sex with special reference to hormonal effects and pregnancy]. J Clin Chem Clin Biochem. 1983;21(6):381-6. [Crossref]
-
25.Chadid S, Barber JR, Rohrmann S, Nelson WG, Yager JD, Kanarek NF, et al. Age-Specific Serum Total and Free Estradiol Concentrations in Healthy Men in US Nationally Representative Samples. J Endocr Soc. 2019;3(10):1825-36. [Crossref]
-
26.Frederiksen H, Johannsen TH, Andersen SE, Albrethsen J, Landersoe SK, Petersen JH, et al. Sex-specific Estrogen Levels and Reference Intervals from Infancy to Late Adulthood Determined by LC-MS/MS. J Clin Endocrinol Metab. 2020;105(3):754-68. [Crossref]
-
27.Alves-Amaral G, Pires-Oliveira M, Andrade-Lopes AL, Chiavegatti T, Godinho RO. Gender-related differences in circadian rhythm of rat plasma acetyl- and butyrylcholinesterase: effects of sex hormone withdrawal. Chem Biol Interact. 2010;186(1):9-15. [Crossref]
-
28.Alcântara VM, Oliveira LC, Réa RR, Suplicy HL, Chautard-Freire-Maia EA. Butyrylcholinesterase activity and metabolic syndrome in obese patients. Clin Chem Lab Med. 2005;43(3):285-8. [Crossref]
-
29.Heni M, Hummel J, Fritsche L, Wagner R, Relker L, Machann J, et al. Elevated Cholinesterase Activity and the Metabolic Syndrome-Dissecting Fatty Liver, Insulin Resistance and Dysglycaemia. Liver Int. 2025;45(5):e70046. [Crossref]
-
30.Oliveira-Silva JJ, Alves SR, Meyer A, Perez F, Sarcinelli PN, da Costa Mattos RC, et al. [Influence of socioeconomic factors on the pesticides poisoning, Brazil]. Rev Saude Publica. 2001;35(2):130-5. [Crossref]
-
31.Manfo FPT, Suh CF, Nantia EA, Moundipa PF, Cho-Ngwa F. Occupational use of agrochemicals results in inhibited cholinesterase activity and altered reproductive hormone levels in male farmers from Buea, Cameroon. Toxicol Res (Camb). 2021;10(2):232-48. [Crossref]