各種 疾患에 있어서 血淸 γ-glutamyl transpeptidase의 診斷的 有用性 = Diagnostic Usefulness of Serum T-Glutamyl Transpeptidase Activity in Various Diseases

다국어 초록 (Multilingual Abstract)

γ-Glutamyl transpeptidase (GGT) is an enzyme that acts a catalyst for transferring γ-glutamyl group from certain γ-glutamylpeptides to suitable acceptors. In the presence of L-amino acid or peptides, transpeptidation occurs. In 1950 Hanes et al. found this enzyme in the kidney, pancreas and mammary glands of the sheep. Since 1950, nearly all works in clinical application has been done in Poland. In the past 10 years considerable numbers of clinical observations have been reported from Scandinavia, Netherlands, Germany, Italy, England, Unites States of America, Canada, etc. Interest and studies in GGT have been focused on its value in the diagnosis of various hepatobiliary diseases. Recently, GGT has been studied for the diagnosis of myocardial infarction, epilepsy, alcoholics, etc. GGT test has not been yet put in practice in Korea. In this laboratory, values of serum GGT activity among Koreans were measured by Szasz's kinetic photometric method reported in 1969.
In a series of author's test on 24 disease groups with total patient number of 362, the serum values of ALP, GOT, GPT and GGT were measured from the period Sept. 1973 to Aug. 1974.
Comparative analysis of these enzyme values in relation with each disease group was made in order to evaluate the efficacy of GGT value, i. e. the elevated percentage and times the upper limit of normal value of each enzyme were compared with each other to evaluate the clinical applicability of serum GGT activity. Elevated GGT value was obtained in hepatitis,, liver cirrhosis, primary hepatoma, biliary system disease (including cholelithiasis, cholecystitis and cholangitis), myocardial infarction and pancreatitis groups. The elevation frequency of each of these diseases is more than 80%. In each disease group, percentage of frequency of abnormal elevation and times the upper limit of these 4 enzymes in the order of ALP, GOT, GPT and GGT are listed as follows:
In hepatitis group: 77 : 95 : 98 : 97, 1.4 : 7.4 : 12.0:5. 1; in cirrhosis group:57 : 74 : 60 : 88, 1.4 2.0 : 1.6 : 5.4; in hepatoma group:80 : 80 : 80 : 90, 2.6 : 3.1:1.9 : 9. 3; in biliary system disease group: 96 : 79 : 75 : 96, 2.4:3.3:3.9 : 7.8; in myocardial infarction group: 0 :75 :75 : 100, 0.6 :2.6 : 2.1 3.9; in pancreatitis group: 40:40 :60:80, 1.5:1.4 :2.7:2.6.
From these-results, the following conclusions are obtained:
In hepatitis group, GOT is most sensitive with 98 elevated percentage and 12 times the upper limit of normal, and GGT is also a sensitive test to the same extent as GOT with 97 elevated percentage and 5. 1 times -the -upper limit -of normal.
In cirrhosis group, GGT appears to be -most reliable with 88 elevated frequency.
In hepatoma group, GGT is markedly increased in both elevated percentage and times the upper limit of normal. Only hepatoma and cholelithiasis groups show more than 9 times the upper limit of normal among 24 disease groups.
In biliary system disease grtoup, GGT is most reliable and ALP is next to GGT in its sensitiveness. In a series of author's tests on myocardial infarction group elevated GGT values are observed, while GOT falls to low value.
In pancreatitis group, GGT test is very sensitive with 80 elevated percentage and 2.6 times the upper limit of normal, while GPT is less sensitive with 60 elevated percentage and 2.7 times the upper limit of norrgal,
Typhoid fever in Korea is one of -prevalent infectious diseases, and it is found that GGT seems to be a significant test.
On the other hand, GGT in nephrotic syndrome, malignant tumor, hypertension, diabetes mellitus, enteric 1etver sAd stomach carcinoma show more than 1.0 times the upper limit of norwal,and relatively high elevated percentage (36 to 56%). In each group, elevated percentage and times the upper limit of normal of ALP, GOT. GPT and GGT -areas follows:
In nephrotic syndrome group: 33 : 0 : 0 : 56, 0.-9 : 0.6 0.6 : 2. 1; in malignant tumor group: 27 : 27
9 54, i.' : 1.1 :0.8:1.8; in hypertension group: 0 : 9 : 14 : 45, 0.7 : 0.7:0.8: 1.3; in diabetes group: 1-5:0!0-C50. in enteric fever group: 22:13:13-:38, 0.9:0.9:1.0:1.6; in stomach earoinoma group: 38-:13:13:38. 1.2:0.8:0.8:1.1.
tlevert4idess, -the slight elevation of GGT in these disease groups draw the author's attention in iasterpretaUieoa of rte clinical significance. The elevation of GGT in both malignant neoplasm and stomach careisooa is highly suggestive of their metastasis to the liver if ALP is elevated simaltaneously. Gol4barg et-al. reported that 92% of malignant tumors without metastasis to the liver showed normal GGT aedvit r. Rutenberg et al. also reported that 86% of malignant tumors without liver
metastasis,exciudiag primary carcinoma of hepato-biliary system and pancreas showed normal GGT activity.
n eptgTig foot grolup inchl4ing so-called fever of unknown origin without definite evidence of typhai4 f#VAW, troth C.GT and GPT show increase in both elevated percentage and times the upped limit of gored? In nephrotic syndrome, hypertension and diabetes groups the elevation of GGT is difficult to j explain, but t is proably due -to the slight liver involvement.
In cerebral thrpmbosis, pulmonary tuberculosis, pneumonia, bronchitis, peptic ulcer, gastritis, CO
iptoxicatigzi, a an. ne？rosis groups, there is little clinical significance of GGT test.