A biochemical study on liver disorders among Jau

　　　　 作者：M. Kiran Deedi， D.S.R.S. Prakash， V.S. Prabodh， R.L. Nayak and C. Satyanarayana

【摘要】 　　Objective:To detect types of liver disorders through biochemical studies in coastal Andhra Pradesh， India. Methods: Serum level of bilirubin (total and direct)， serum glutamate oxaloacetate transaminase (SGOT)， serum glutamate pyruvate transaminase (SGPT) and alkaline phosphatase (ALP) were measured among the adult men and women from a South Indian district. Standard methodologies were adopted during selection of study participants and collection and analysis of blood samples. Results: It is observed that there is no difference in the levels of bilirubin (total and direct) and ALP in male and female patients. It is observed that there are significant differences in the levels of SGOT and SGPT. Males recorded higher levels than females. Conclusion: A considerable number of patients showed increased levels of total and direct bilirubin， SGOT， SGPY and ALP. The higher levels of SGOT and SGPT among males might be due to their alcoholic habits and among men in this community. The overall liver function abnormalities may be due to dietary habits， malabsorption， nonalcoholic fatty liver， diabetes mellitus and contaminated drinking water.

【关键词】 Jaundice， Liver disorders， Biochemical， Andhra， India

　　INTRODUCTION
　　
　　Liver's central role is in carbohydrate， protein and fat metabolism. It is the site where waste products of metabolism are detoxified through processes such as amino acid deamination， which produces urea. It also participate in synthesis of certain blood coagulation factors， synthesis of other proteins， synthesis and secretion of bile salts and bile pigments， detoxification and storage. Many of these biosynthetic functions use the products of digestion. At the microscopic level， the primary functional unit of the liver is the liver acinus， which is defined by the territory supplied by each terminal branch of the hepatic artery and hepatic portal vein. The portal tract forms the central axis of the acinus; hepatocytes are arranged in plates that radiate out from the portal triad. Bile is secreted into a network of minute bile caniculi situated between adjacent hepatocytes ［1］. Liver disease is often reflected by biochemical abnormalities of different hepatic systems or of liver function. Although tests that measure the level of serum liver enzymes are commonly referred to as liver function tests， they usually reflect hepatocyte integrity or cholestasis rather than liver function［2］.
　　
　　In clinical manifestation of liver diseases， jaundice is an important condition. Jaundice is a physical sign characterized by yellow appearance of the patient that results form the deposition of bile pigment in the skin mucous membrane and sclera. It is apparent clinically when serum bilirubin concentration reaches 2 mg/dl. Generally parameters namely， total and direct bilirubin levels and levels of enzymes namely serum glutamate oxaloacetate transaminase (SGOT)， serum glutamate pyruvate transaminase (SGPT)， alkaline phosphatase (ALP) are estimated in the diagnosis of jaundice ［35］.　　SGPT concentration levels are richly present in liver and lesser extent in kidney， heart， skeletal muscle， pancreas， spleen and lungs. The levels are increased in generally a result of primary liver diseases such as cirrhosis， carcinoma， viral or toxic hepatitis and obstructive jaundice and decreased levels may be observed in renal dialysis patients and those with deficiency of vitamin B6. SGOT occurs in all human tissues and is present in large amount in liver， renal， cardiac and skeletal muscle tissues. Increased levels are associated with liver diseases， myocardial infarction， muscular dystrophy and cholecystitis and decreased levels may be observed in renal dialysis patients and those with vitamin B6 deficiency. ALP is present is high concentration in the liver， bone， placenta， intestine and certain tumors. Elevated serum ALP occurs in pregnant women and in growing children. Increased levels of enzyme occur in liver diseases， bone diseases (Rickets， Paget's disease) Hodgkin's disease or congestive heart failure and decreased levels occur in hypophosphatasia and malnourished patients ［312］. In this paper an attempt is made to detect types of liver disorders through biochemical studies in coastal Andhra Pradesh of India.

　　MATERIALS AND METHODS
　　
　　The liver disorders are studied through biochemical analysis in the laboratory of Department of Biochemistry， GSL Medical University， Rajahmundry. For this study， 100 outpatients with specific jaundice symptoms were recruited. After obtaining the consent from patients， 5 ml. of venous blood was collected. Each blood sample was taken without anticoagulant; the blood was allowed to clot; it was centrifuged at 1500 rpm for 5 min and the serum was taken in fresh vial for the study of liver disorders. Biochemical studies of liver disorders (bilirubin， SGOT， SGPT and ALP) levels were estimated. Standard methodology is adopted during these biochemical investigations ［4，1316］.

　　RESULLTS
　　
　　The biochemical studies of liver disorders (jaundice) in terms of levels of birulubin， SGOT， SGPT and ALP levels by sex are presented in tables 15. Out of 100 cases， total bilirubin levels are increased in 68% of patients， while these are normal among 31% of patients (Table 1). There is no remarkable difference between male and female patients. The details of direct bilirubin levels are presented in Table 2. Among 44% of patients， the direct bilirubin levels have increased and among 56% of patients， they are in normal ranges. With regard to these levels， the sexdifferences are not remarkable. Table 1 Distribution of levels of total bilirubin levels by sex（略）Table 2 Distribution of levels of direct bilirubin by on sex（略）

　　Out of 100 cases， SGOT levels increased in 55% males and 29% females; and the ranges are normal among 45% male and 71% female patients (Table 3). These differences are significant (p&<0.001). Out of 100 cases， SGPT levels increased among 55% male and 29% of female patients; and the levels are normal among 45% males and 25% females (Table 4). The sex difference is statistically significant (p&<0.01). Out of 100 cases， ALP levels increased among 31% of patients and ALP levels are in normal ranges among 69% of patients (Table 5). There is no difference between male and female patients. Age groupwise distribution of patients according to the increased or normal levels of the biochemical variables for males and females are presented in table 6 and 7， respectively. There are no remarkable variations in these biochemical indicators across the age groups. Table 3 Distribution of levels of serum glutamate oxaloacetate transaminase by sex（略）Table 4 Distribution of levels of serum glutamate pyruvate transaminase by sex（略）Table 5 Distribution of levels of alkaline phosphatase by sex（略）Table 6 Distribution of levels of biochemical variables by age groups among male patients（略）Table 7 Distribution of levels of biochemical variables by age groups among female patients （略）

　　CONCLUSION
　　
　　Bilirubin， SGOT， SGPT and ALP levels in liver disorders were analyzed to determine various levels of serum bilirubins. There is slight difference in the levels of total and direct birilubin between males and females. There are significant differences in the levels SGOT levels between two sexes. The levels are higher among males than among females. This might be due to their alcoholic habits and among men in this community. No significant variations occurred across the age groups. The overall liver function abnormalities may be due to dietary habits， malabsorption， nonalcoholic fatty liver， diabetes mellitus and contaminated drinking water.

　　ACKNOWLEDGEMENT
　　
　　Authors expressed their sincere gratitude to Prof. Ammanna Pantulu， Head of the Department of Biochemistry， GSL Medical University， Rajahumandry， East Godavari district， Andhra Pradesh， India for his support during study.

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