Apa maksud dari sgpt alt antara 0 41

April 29, 2022Chemical pathologyLab Tests

1. This is done on the serum of the patient.
2. The Blood sample can be taken at any time.
3. The fasting sample is not necessary.
4. Analyze the enzyme on the same day because the enzyme activity is lost at room temperature.
5. This enzyme is stable in whole blood for up to 12 to 24 hours; after that time, there is a gradual increase due to release from the RBCs.
6. The sample can be stored at 4 °C for 1 to 3 days (ALT is stable when refrigerated).
   1. ALT, when freezed, shows deterioration.

1. Avoid hemolysis because RBC contains increased ALT (SGPT) and AST (SGOT).
2. Drugs that may increase the SGPT value are acetaminophen, aminosalicylic acid, ampicillin, allopurinol, cephalosporin, chlorpropamide, clofibrate, cloxacillin, codeine, indomethacin, INH, Methyldopa, methotrexate, nalidixic acid, quinidine, phenylbutazone, phenytoin, salicylates, tetracycline, and propanol.
3. Ideally, perform the test as soon as possible or on the same day because the sample’s storage may not be satisfactory.
4. Previous I/M injection may increase the level.

1. Diagnose liver diseases.
2. Monitor liver diseases after the treatment.
3. It differentiates jaundice from liver disease or hemolytic anemia.

1. This enzyme catalyzes the reversible transfer of amino groups between an amino acid, and α-keto acids are called aminotransferase or transaminases.
2. One of the aminotransferases is Alanine aminotransferase (ALT), or the old name was glutamate-pyruvate transaminase (SGPT) which will catalyze the reversible transfer of the amino group between an amino acid and α-keto acid where vitamin B6 (pyridoxal phosphate) is the co-factor.
   

   SGPT (ALT) biochemical reaction

1. ALT is an enzyme found predominantly in the liver.
2. It is distributed in many tissues, with a moderate amount in:
   1. Kidneys.
   2. A small amount in:
   3.  Heart, skeletal muscles.
3. A minimal amount may be found in the pancreas, spleen, lungs, and RBCs.

1. The day-to-day variation of the ALT is 10% to 30%, and there is diurnal variation.
2. ALT is 45% higher in the afternoon than in the early morning.
3. Until the age of 15, ALT is higher than the AST; after that, AST is higher than the ALT.
4. In a few people, this pattern may reverse after the age of 60.
5. Exercise is the major determinant for AST but less for ALT in men.
   1. Strenuous exercise or bodybuilding increases AST 3-fold and a 50% increase in ALT.
   2. The effect of the exercise is minimal in the women.

1. This enzyme is present in cytosolic forms in the liver. The majority of the SGPT is present in the cytoplasm of liver cells.
2. There is always a low level of this enzyme in the blood.
3. This is a liver-specific enzyme of the transferases.
4. The liver hepatocytes contain 3 to 4 times more AST (SGOT) than the ALT (SGPT).
5. This is also normally found in bile, CSF, and saliva.
6. It is not found in the urine unless there is a kidney lesion.

SGPT distribution in the liver cell

Liver cell injury:

1. Any damage to the liver cells, SGPT enzyme, is released, specifically from liver cell necrosis.
2. First cytosolic SGPT is released, and in the case of necrosis, then mitochondria SGPT is released into circulation.
   

   SGPT level depends upon the number of liver cells injured

   

   SGPT level depends upon the number of cells injured

1. SGPT activity persists longer than the SGOT.
2. This enzyme is raised before there are clinical findings of jaundice.
3. In viral hepatitis, the SGPT/SGOT ratio is greater than 1.
4. Other than the viral cause, the SGPT/SGOT ratio is less than 1.

SGPT (ALT) biochemical reaction and variations in different conditions:

1. ALT catalyzes the reaction, and it is reversible.
2. Pyridoxal-5‘- phosphate  (P-5-P) functions as coenzymes in the amino-transfer reaction.
   1. The P-5-P is bound to the apoenzyme and serves as a true prosthetic group.
   2. The P-5-P bound to the apoenzyme accepts the amino group from the first substrate, alanine, to form enzyme-bound pyridoxine-5- phosphate, and the first reaction product is pyruvate.
   3. This coenzyme increases the ALT activity by 20% in the normal serum.
   4. Hemolysis increases both AST and ALT because of this enzyme activity in the RBCs compared to serum. This effect is more significant for AST than ALT.

SGPT (ALT) reaction principle

SGPT 1.5 to 8 times (mild or nor elevation) more than the normal level seen in:

1. Early, late and subclinical hepatitis.
2. Chronic hepatitis.
3. Alcoholic hepatitis.
4. Alcoholic fatty liver.
5. Laennec’s cirrhosis.
6. Chemical hepatitis.
7. Passive congestion with centrilobular necrosis.
8. Rye’s syndrome.
9. Cholangitis.
10. Hemochromatosis.
11. Pancreatitis.
12. Granulomatous infections.
13. Neoplasia infiltration.

SGPT >8 to 10 times (3 to 10 times than the normal ) more than the normal value seen in:

1. Mostly in acute viral hepatitis.
2. Chronic active hepatitis.
3. Infectious mononucleosis.

SGPT >30 times (20 or more) more than the normal value is seen in:

1. Drug toxicity like acetaminophen in alcoholics and malnourished people.
2. Viral hepatitis.

SGPT level in various tissue as compared to serum:

• Compared to serum (1 unit) in the heart is 450 times; the liver is 2850 times, the kidney is 1200 times, skeletal muscle is 300 times, the pancreas is 130, the spleen is 80 times, the lung is 45, and RBCs 7 times.

SGPT (ALT) levels in various tissues as compared to the serum (one unit)  are:

AST/ALT ratio:

1. The ALT is the cytoplasmic enzyme in the liver, while AST is both a cytoplasmic and mitochondrial enzyme with a wide distribution in various other tissues.
   1. AST/ALT ratio is typically <1, but infectious hepatitis becomes greater in the liver.
2. AST/ALT ratio is usually greater than 1 is seen in:
   1. The patient with alcoholic liver disease (cirrhosis). AST is more sensitive to alcoholic liver disease.
   2. Liver congestion.
   3. Metastatic tumor of the liver.
3. AST/ALT ratio of less than 1 is seen in:
   1. Acute hepatitis.
   2. Viral hepatitis.
   3. Infectious mononucleosis.
   4. The ratio will be less accurate if the AST level is more than 10 times the normal.

Diagnostic application of the SGPT (ALT):

1. The best indicator for liver cell injury is when both SGPT and SGOT are raised.
   1. Higher-level are found in hepatocellular disorders than the extrahepatic or intrahepatic obstructive lesions.
   2. Levels of both enzymes may reach as high as 100 times. 20 to 50 times, the elevated level is frequently found.
2. Measuring aminotransferases weekly is useful in hepatitis or other hepatic injuries.
3. Because of the accurate measuring techniques, it can detect liver cell injury due to alcohol.
4. It is used as a screening test for diagnosing hepatitis due to hepatotropic viruses, especially the hepatitis C virus in blood donors.
5. 5 to 10 times the elevation of ALT and AST occurs in the liver’s metastatic carcinoma. AST (SGOT) level is higher than the ALT (SGPT). In the early stages of malignant infiltration of the liver, these enzymes are normal.
6. ALT (SGPT) may be raised after intake of alcohol, delirium tremors, and after the administration of the drugs like opiates, salicylates, and ampicillin.

NORMAL SGPT (ALT) level

Source 4

Source 2

• Adult / child = 4 to 36 unit/L at 37 °C
• Elderly = slightly higher than the adult
• Infants = Maybe twice high as the adult

Another source

• Men = 10 to 30 units /L (some labs normal is 10 to 40 U/L).
• Women = 9 to 25 units /L (Some labs normal is 10 to 28 U/L).
• Children are two times of adult’s value.
  • In children, it is raised because of bone activity, which is normal for children.
  • The adult level is achieved by 6 months of age.
  • Males are slightly higher than females.

The increased SGPT (ALT) level is seen in:

1. Viral hepatitis. There is a markedly increased level.
2. Drug-induced hepatitis.
3. Chronic hepatitis.
4. Infectious mononucleosis.
5. Intrahepatic cholestasis.
6. Cholecystitis.
7. Active cirrhosis.
8. Metastatic tumors of the liver.
9. Obstructive jaundice.
10. Alcoholic cirrhosis.
11. The mild increase is seen in :
    1. Myosotis.
    2. Pancreatitis.
    3. Myocardial infarction.
    4. Shock.
    5. Infectious mononucleosis.
12. Alcohol-acetaminophen syndrome.
13. A significant increase in level has been in acute liver diseases.
    1. A moderately increased level is seen in chronic liver diseases and muscle trauma.
    2. A mildly increased level is seen in myositis, Myocardial infarction, and infectious mononucleosis.

Acute Viral hepatitis SGPT (ALT) Pattern:

1. This rises before the appearance of jaundice.
2. The peak level occurs between 7 to 12 days of jaundice.
3. Then there is a gradual decrease in the level.
4. Normal level after 3 to 4 weeks of the onset of jaundice.
5. AST/ALT ratio, which is normally <1, becomes greater > than 1.

SGPT level in Viral hepatitis

Critical value:

•  >9000 U/L  seen in Alcohol-acetaminophen syndrome.
  This level can distinguish it from alcoholic or viral hepatitis.

Comparison of AST/ALT

1. AST (SGOT) is always raised in acute myocardial infarction, where ALT (SGPT) will be normal unless there is damage to the liver.
2. ALT  (SGPT) is more raised in acute hepatobiliary obstruction than AST (SGOT).
3. ALT (SGPT) is more specific than AST (SGOT) for liver cell injury.
4. The AST/ALT ratio is higher in alcoholic liver diseases.
5. AST (SGOT) is more sensitive to alcoholic liver cell injury.

The main feature of  SGPT (ALT) and SGOT (AST):

Question 1: What is the half-life of SGPT?

It is 3 to 5 days (35 to 57 hours)

Question 2: What is the best indicator of liver cell injury, SGOT or SGPT?

SGPT is more specific for the liver cell injury.

Question 3: Is there any role of RBCs hemolysis in the level of SGPT.

Yes, RBCs hemolysis will increase the SGPT level because of the presence in the RBCs.