SerumAmylaseActivityin Liver Disease

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					Serum AmylaseActivityin Liver Disease

                    Izharul Hasan Bhutta’ and M. Ataur Rahman

                    Serum amylase activity was measured in 15 normal persons and in 60 liver-
                    disease patients. Impairment of liver was assessed by serum bilirubin and
                    thymol turbidity values. Most of the patients had serum amylase values
                    that were well below the normal limits. Amylase activities were related to the
                    degree of liver dysfunction, and serum amylase decreased as the bilirubin
                    and turbidity values increased.

                    Additional Keyphrases            thymol     turbidity test #{149} serum bilirubin        #{149} type of dis-
                    ease vs. severity in effect on amylase        #{149} hepatic function  #{149} origin of serum amylase

    Despite the use of serum amylase determination                          old. The diagnosis was based on the clinical exami-
in clinical medicine, very little is known of the or-                       nation. The blood was collected by venipuncture
igin, function,       and regulation       of this enzyme in the            and serum was used for determination             of amylase,

body (1). Clinical observations              of abnormal     serum          bilirubin, and thymol turbidity.
                                                                                Amylase activity was determined           and expressed

activity of this enzyme in hepatic disease suggested
that serum amylase             originates     in the liver. High            in terms of the amount           of reducing   sugar formed
values were obtained
hepatobiliary        disorders
                                in some patients        with acute
                                  (2-4), low values in others
                                                                            after incubation
                                                                                          di      with starch at 38#{176}C described
                                                                                            i.e., milligrams
                                                                                                                 of glucose equivalent
with chronic liver diseases (5, 6). Dreiling et al. (7)                     released by 100 ml of serum in 30 mm (10). Biliru-

suggested       that     liver contributes         to the blood             bin and thymol turbidity           were determined    by the
amylase and is an important              extrapancreatic      site of       methods of Malloy and Evelyn (11) and Maclagan

its regulation.       Amylase isolated from human liver                      (12), respectively.

differs structurally         and immunologically          from the
salivary and pancreatic           amylases (8). However,          the        Results

experimental        observations        provide circumstantial
evidence for the synthesis             of amylase by the liver                  The patients suffering from various liver diseases

(9). Information         on the relationship        between liver            showed serum amylase values well below those for

diseases and variations            in serum amylase levels is                the normal individuals    (Table 1). This decrease in

still scarce. The present study deals with changes                           serum amylase    activity   in hepatic  disease, often
in serum amylase activity in patients                with various
hepatic     disorders,       and the correlation           of these             Table 1. Serum Amylase Activities in Normal
changes with liver dysfunction.                                                 Persons and in Patients with Liver Diseases
                                                                                                        BilirubIn,        Thymol       Amyias.,
                                                                                                        mg/100 ml        turbidIty,   unita/iQO ml
Materials and Methods                                                                                     serum          Mac. units      serum
    Fifteen  normal     human    subjects  and sixty pa-                     Normal persons           038005b           2.2±0.50      120.0±9.07
tients with liver diseases were studied.          Normal                       (15)
subjects of both sexes were chosen from among the                            Infective                 6.0 ± 0.54 10.8 ± 0.78 60.3 ± 4.75
staff and students     of Jinnah Postgraduate    Medical                       hepatitis (27)                                 P<0.05(s)
Centre, Karachi,      and had no history of liver disor-                     Cirrhosis (18)            7.6 ± 0.39 14.1 ± 1.24 51.3 ± 6.10
ders. The patients,       of both sexes, were selected                                                                        P<0.01(s)
from the hospital wards and were diagnosed           cases                   Jaundice(7)              10.2±0.67 16.5±1.36 48.0 ± 6.07
of liver dysfunction.     The age of the patients varied
                                                                             Heterogenous              5.9 ± 1.73 13.7 ± 2.12 52.5 ± 8.33
between 18 to 70 years; most were 30 to 55 years                                                                              P <0.01(s)
                                                                                group (8)
  From the Department     of Biochemistry,   Jinnah Postgraduate                 The
                                                                                #{149}amylase values given are the mean of the determina-
Medical Centre, Karachi, Pakistan.                                           tions in each case. Figures in parentheses indicate the number
  1 Present  address: Department    of Pathology,   Dow Medical              of cases in each group.
College, Karachi.                                                                Standard error of the mean.
  Received July 6, 1971; accepted Aug. 25, 1971.

                                                                              CLINICAL CHEMISTRY, Vol. 17, No. 12, 1971 1147
considerable,    could not be attributed         to the type of
the hepatic     disease. By contrast,          severity    of the
hepatic disease appeared         important      in the diminu-                    24

tion of serum amylase levels; patients                with more
severely     impaired      hepatic     function      had lesser
serum amylase activity.                                                           II.

   The thymol        turbidity     values were moderately
elevated in the group of patients with liver disease,
which indicates        that hepatocellular         damage     has
occurred. Figure 1 shows that the thymol turbidity                          I-

values increase with a simultaneous             decrease in the
serum amylase values. Liver impairment                   as mea-
sured by serum bilirubin             values shows that the
                                                                                   0    10   20    lU         40         50        60                  70               80            90       00         110   20
serum amylase         decreases     as serum bilirubin         in-
                                                                                                                                                             p8r        110 1
creases (Figure 2).                                                                                           S.rl.      #{149}1.88.           Unit.

                                                                            Fig. 1. Relationship          between                        serum                          amylase                     and thymol
                                                                            turbidity   in liver disease
                                                                            Individual values for serum amylase and thymol turbidity are
                                                                            shown.     Regression curve calculated from least squares. Cor-
    A number of diseases are reported                  to be associ-        relation coefficient, -0.317 for amylase with thymol turbidity
 ated with subnormal           amylase value (13). In 1941,
 Gray et al. (6) claimed that impaired hepatic func-
tion was associated         with subnormal         amylase levels.
 Cummins        and Bockus (2), on the other hand, ob-
served that 21% of patients with viral hepatitis                       or

liver cirrhosis         had supranormal           serum amylase

activity.     Gray et al. (6) also stated that in 287

postoperative        patients the amylase activity tended
to fall to subnormal         levels on the third and fourth
postoperative         days. Dreiling        et al. (14) demon-
strated decreased blood amylase activity in people
with no evidence           of pancreatic       disease, after the

administration         of substances      that increased carbo-                                         ThW               60             66                  Ii                  P0        0         00

 hydrate      metabolism.         These      results      also agree

                                                                                                        U.Ul4         .*7188           Unjt8           pe.        100        1

with those of Somogyi (5) and others, who reported

                                                                            Fig. 2. Relationship         between                       serum                        amylase                    and bilirubin
low values for serum amylase in cases of hepatitis                          in liver disease
and cirrhosis of the liver, and concluded that such

                                                                            Each point represents the serum amylase and serum bilirubin
values for serum amylase were to be found only in                           values for a sinIe patient. Regression curve calculated from

those chronic cases of liver diseases that had some                         least squares. Correlation coefficient, -0.759 for amylase and
form of liver damage and impairment                         of hepatic      bilirubin

function.     Chapman        and Karl (15) needle-biopsied

25 patients       with fatty infiltration        of the liver and
found serum amylase              activities    to be less by 50             and Rutter (9), in their perfusion experiments,            that
units in 14 patients.                                                       liver is capable of synthesizing          amylase.    In addi-
    Alterations       of serum        amylase        activity       seen    tion, McGeachin       et al. demonstrated       the ability of
clinically in some patients with chronic liver disease                      puromycin,     a specific inhibitor of protein synthesis,
have also been observed             in experimental           animals.      to block amylase production             by rat liver, both in
Winawer et al. (16) found a decreased serum amy-                            vitro (20) and in vivo (21). The latter studies have
lase activity in rats with chronic liver injury, i.e.,                      further    shown that the 50% decrease in hepatic
fatty liver, fibrosis, and cirrhosis. McGeachin                      and    amylase activity under the influence of puromycin
Potter      (17) observed        50% decrease            in amylase         was associated     with a corresponding         change in the
level of liver and serum after hepatic damage. The                          serum amylase activity.
mechanism         of the decreased          serum amylase             ac-       Liver is known to synthesize            albumin     and x-
tivity in hepatic diseases is apparently                little under-       and j3-globulins of the serum proteins. The amylase
stood; it may be related to impaired synthesis                         of   activity of the serum is associated with the globulin
serum proteins, a view that agrees with the studies                         fraction in man (10) and though the globulins are
of Mukerjee       and Werner (18), who found a correla-                     increased in the liver diseases, amylase production
tion between         serum albumin          concentrations           and    is decreased.    It is possible that the decreased           ac-
the amylase activity          of the blood in patients             with     tivity of serum amylase is a direct consequence               of
malnutrition        and edema.         Experimentally,           it has     inhibition    of amylase      synthesis.   Berk et al. (22)
been observed by McGeachin                et al. (19) and Arnold            have in fact indicated       that although      a majority    of

1148 CLINICAL CHEMISTRY, Vol. 17, No. 12, 1971
serum amylase often occupies the gamma globulin                                      9. Arnold,  M., and Rutter,  W. J., Liver amylase:     Ill.            Synthesis
                                                                                     by the perfused   liver and secretion  into the perfusion               medium.
position in the electrophoretic       pattern,     the enzyme                        J. Blot. Chem. 238, 2760 (1963).
is not necessarily        associated     with this protein                           10. Rahman,    M. A., 1)istribution       pattern of amylase          activity      in
fraction.                                                                            serum protems.   Nature (London)         205, 973 (1963).
    Another possibility,    as suggested by Comfort and                              11. Malloy,    Fl. T., and Evelyn,     K. A., 1)eterniination of hilirubin
Osterberg     (23), is that hepatic         disease may be                           with photoelectric     colorimeter.   J. J3iol. Chem. 119, 481 (1937).
associated     with an accompanying               pancreatitis.                      12. Maclagan,      N. F., Thymol       turbidity  test; new indicator               of
                                                                                     liver dysfunction.    Brit. J. Exp.    Pathol. 25, 234 (1944).
In support     of this possibility,     the coincidence         of
                                                                                     13. Sullivan,   J. F., and Knight,     W. A., Jr.,   Serial   serum      diastase
pancreatic    disease, as evidenced      by the pressure of
                                                                                     studies:   Normal    controls.   Amer. J. Dig. Dis. 5, 246 (1960).
inflammation      and necrosis in this organ, was re-                                14. I)reiling,    I). A., Janowitz,        H. I)., and Josephherg,    L. J.,
ported by Steigman         and Chung (24) in cirrhotic                               Serum iso-enzymes.        An electrophoretic     study of the blood amylase
patients   with jaundice.       However,       disease of the                        and the patterns        observed     in pancreatic    disease.  Ann. Intern.
                                                                                     Mcd. 58, 233 (1963).
pancreas    is invariably     accompanied        by increased
                                                                                     15. Chapman,       J. A., and    Karl, M. M., The serum   amylase    in
rather than decreased serum amylase activity.                                        experimental    liver damage.     Amer. J. Mcd. Sd. 244, 344 (1962).
                                                                                     16. Winawer,    S. J., Broitman,     S. A., Gottlieb,  L. S., and Zam-
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                                                                                      CLINICAL CHEMISTRY, Vol. 17, No. 12, 1971 1149

Description: liver biopsy, Non-alcoholic fatty liver disease, liver enzymes, alcoholic liver disease, liver damage, Non-alcoholic Steatohepatitis, Liver Cirrhosis, liver transplantation, five patients, liver cancer, liver transplant, Liver transplantation, portal vein, liver disease, bile ducts, cancer cells, Liver Diseases,