Laboratory analysis of enzymes is important of clinical diagnosis of diseases.

1. Medical Enzymology
‫الطبية‬ ‫األنزيمات‬

3. Enzymes
 Biological catalysts
 Very efficient – can increase reaction rates at the order of x 10
 All enzymes are proteins- so liable to denaturation
 Enzymes are specific to substrates
 Partly specific to tissues
 Assay by the measure of the rate of specific reaction catalyzed by that
enzyme
 Enzyme activity is affected by the temperature and pH of the medium

‫البيولوجية‬ ‫ات‬‫ز‬‫المحف‬

‫للغاية‬ ‫فعال‬
-
‫تيب‬ ‫ر‬
‫بت‬ ‫التفاعل‬ ‫معدالت‬ ‫زيادة‬ ‫يمكنه‬
×
10

‫بروتينات‬ ‫عن‬ ‫عبارة‬ ‫اإلنزيمات‬ ‫جميع‬
-
‫للتمسخ‬ ‫عرضة‬ ‫ي‬
‫فه‬ ‫لذا‬

‫كائز‬
‫بالر‬ ‫خاصة‬ ‫اإلنزيمات‬

‫جزئيا‬ ‫باألنسجة‬ ‫خاص‬

‫اإلنزيم‬ ‫هذا‬ ‫يحفزه‬ ‫الذي‬ ‫المحدد‬ ‫التفاعل‬ ‫معدل‬ ‫قياس‬ ‫طريق‬ ‫عن‬ ‫المقايسة‬

‫حموضته‬ ‫ودرجة‬ ‫الوسط‬ ‫ارة‬‫ر‬‫ح‬ ‫بدرجة‬ ‫اإلنزيم‬ ‫نشاط‬ ‫يتأثر‬

4. Properties of enzymes…
• All enzymes are proteins or protein in nature (except a small group of
catalytic molecules)
• Enzymes have a molecular weight ranging from 20,000 - 1 million
• Some enzymes require no chemical group other than their amino acid
residue for activity.
• Some enzymes may require an additional chemical compound called
cofactors (Zn2+, Mg2+, Fe2+, Mn2+etc.)
• Some enzymes may require a complex organic or metallorganic molecule
called coenzymes
• Sometimes, they need both cofactors and coenzymes
•
‫الطبيعة‬ ‫ي‬
‫ف‬ ‫بروتينات‬ ‫أو‬ ‫بروتينات‬ ‫عن‬ ‫عبارة‬ ‫اإلنزيمات‬ ‫جميع‬
(
‫من‬ ‫ة‬ ‫ر‬
‫صغت‬ ‫مجموعة‬ ‫باستثناء‬
‫الجزيئات‬
‫المحفزة‬
)
•
‫من‬ ‫اوح‬ ‫ر‬
‫يت‬ ‫ي‬
‫جزيئ‬ ‫وزن‬ ‫لها‬ ‫اإلنزيمات‬
20000
‫إىل‬
1
‫مليون‬
•
‫لل‬ ‫بها‬ ‫الخاصة‬ ‫األمينية‬ ‫األحماض‬ ‫بقايا‬ ‫بخالف‬ ‫كيميائية‬‫مجموعة‬ ‫أي‬ ‫اإلنزيمات‬ ‫بعض‬ ‫تتطلب‬ ‫ال‬
‫نشاط‬
.
•
‫المساعدة‬ ‫العوامل‬ ‫يسىم‬ ‫ا‬ً‫إضافي‬ ‫ا‬ً‫كيميائي‬‫ا‬ً‫كب‬
‫مر‬ ‫اإلنزيمات‬ ‫بعض‬ ‫تتطلب‬ ‫قد‬
(
Zn2 +
،
Mg2 +
،
Fe2 +
،
Mn2 +
).
•
‫جزيء‬ ‫اإلنزيمات‬ ‫بعض‬ ‫تتطلب‬ ‫قد‬
orgainc
‫أو‬
metalloorganic
‫المساعدة‬ ‫اإلنزيمات‬ ‫يسىم‬ ‫معقد‬

5. Properties of enzymes
• A coenzyme or metal ion that is covalently bound to the enzyme protein is
called a prosthetic group
• A complete catalytically active enzyme, together with its coenzymes and or
metal ions, is called a holoenzyme
• The protein part of such an enzyme is called the apoenzyme or apoprotein
• Enzymes are classified by the reactions they catalyze. Many enzymes have been
named by adding the suffix “-ase” to the name of their substrate or a word or
phrase describing their activities. Thus, urease catalyzes the hydrolysis of urea.
•
‫االصطناعية‬ ‫بالمجموعة‬ ‫اإلنزيم‬ ‫ر‬
‫وتي‬ ‫ر‬
‫بت‬ ‫ا‬ً‫تساهمي‬ ‫المرتبط‬ ‫المعدن‬ ‫أيون‬‫أو‬ ‫اإلنزيم‬ ‫يسىم‬
•
‫و‬ ‫المساعدة‬ ‫اإلنزيمات‬ ‫مع‬ ‫ا‬
ً
‫ي‬ ‫ر‬
‫تحفت‬ ‫النشط‬ ‫الكامل‬ ‫اإلنزيم‬ ‫يسىم‬
/
‫ـ‬‫ب‬ ‫المعادن‬ ‫أيونات‬ ‫أو‬
holoenzyme
•
‫ـ‬‫ب‬ ‫اإلنزيم‬ ‫هذا‬ ‫من‬ ‫ر‬
‫وتي‬ ‫ر‬
‫الت‬ ‫جزء‬ ‫يسىم‬
apoenzyme
‫أو‬
apoprotein

7. How do enzymes work ?
• An enzyme circumvents many problems by providing a specific
environment within which a given reaction is energetically more
favorable.
• An enzyme-catalyzed reaction occurs within the confinement of a pocket
on the enzymes called the active site
• The molecule that is bound by the active site and acted upon by the
enzyme is called the substrate
• The enzyme-substrate complex is central to the action of enzymes.
•
‫ف‬ ‫رد‬ ‫فيها‬ ‫يكون‬ ‫محددة‬ ‫بيئة‬ ‫ر‬
‫توفت‬ ‫خالل‬ ‫من‬ ‫المشكالت‬ ‫من‬ ‫العديد‬ ‫عىل‬ ‫اإلنزيم‬ ‫يتغلب‬
‫ر‬
‫معي‬ ‫عل‬
‫النشطة‬ ‫الناحية‬ ‫من‬ ‫مالءمة‬ ‫ر‬
‫أكت‬
.
•
‫النشط‬ ‫الموقع‬ ‫يسىم‬ ‫اإلنزيمات‬ ‫عىل‬ ‫جيب‬ ‫داخل‬ ‫باإلنزيم‬‫محفز‬ ‫تفاعل‬ ‫يحدث‬
•
‫ة‬ ‫ر‬
‫كت‬
‫الر‬ ‫اإلنزيم‬ ‫عليه‬ ‫يعمل‬ ‫والذي‬ ‫النشط‬ ‫بالموقع‬ ‫المرتبط‬ ‫الجزيء‬ ‫يسىم‬
•
‫اإلنزيمات‬ ‫لعمل‬ ‫ا‬
ً
‫كزي‬
‫مر‬ ‫ي‬
‫اإلنزيىم‬ ‫ة‬ ‫ر‬
‫كت‬
‫الر‬ ‫كب‬
‫مر‬ ‫ر‬
‫يعتت‬
.

9. Enzyme classification
Class of Enzyme Type of reaction catalyzed
1. Oxidoreductases Oxidation-reduction reactions
2. Transferases Transfer of functional groups
3. Hydrolases Hydrolysis reactions
4. Lyases Group elimination to form double bond
5. Isomerases Isomerization reactions
6. Ligases Bond formation couples with ATP hydrolysis

10. SOME IMPORTANT TERMS:
Reactant -----> Substrate [S]
Catalyst -----> Enzyme [E]
Product -----> Product [P]
Enzyme-substrate complex [ES]
Maximum velocity Vmax
Machaelis constant Km

11. Measurement of serum enzymes
 Enzymes are used for diagnostic purposes
 Enzymes are normally intracellular and have a LOW
concentration in blood
 Enzyme release (leakage) in the blood indicates cell damage (cell
death, hypoxia, intracellular toxicity)
 Enzyme levels are a Quantitative measure of cell/tissue damage
 Enzyme tests are Fairly noninvasive; it is possible to do repeated
tests
 Enzymes are Organ-specific – but not absolute specificity despite
the same gene content.
 Most enzymes are present in most cells in differing amounts

12. Measurement of serum enzymes
‫المصل‬ ‫إنزيمات‬ ‫قياس‬

‫التشخيص‬ ‫اض‬‫ر‬‫ألغ‬ ‫اإلنزيمات‬ ‫تستخدم‬

‫الدم‬ ‫ي‬
‫ف‬ ‫منخفض‬ ‫ر‬
‫كت‬
‫تر‬ ‫ولها‬ ‫الخاليا‬ ‫داخل‬ ‫اإلنزيمات‬ ‫تكون‬ ‫ما‬ ‫عادة‬

‫اإلنزيم‬ ‫إطالق‬ ‫ر‬
‫يشت‬
(
‫الترسب‬
)
‫الخاليا‬ ‫تلف‬ ‫إىل‬ ‫الدم‬ ‫ي‬
‫ف‬
(
‫ن‬ ، ‫الخاليا‬ ‫موت‬
‫قص‬
‫الخاليا‬ ‫داخل‬ ‫السمية‬ ، ‫األكسجة‬
)

‫الخاليا‬ ‫لتلف‬ ‫ي‬
‫كىم‬‫مقياس‬ ‫ي‬
‫ه‬ ‫اإلنزيم‬ ‫مستويات‬
/
‫األنسجة‬

‫متكرر‬ ‫ات‬‫ر‬‫اختبا‬ ‫اء‬‫ر‬‫إج‬ ‫الممكن‬ ‫من‬ ‫؛‬ ‫ما‬ ‫حد‬ ‫إىل‬ ‫باضعة‬ ‫ر‬
‫غت‬ ‫اإلنزيم‬ ‫ات‬‫ر‬‫اختبا‬
‫ة‬

‫باألعضاء‬ ‫خاصة‬ ‫اإلنزيمات‬
-
‫من‬ ‫الرغم‬ ‫عىل‬ ‫مطلقة‬ ‫خصوصية‬ ‫ليست‬ ‫ولكنها‬
‫نفس‬
‫ي‬
‫الجيئ‬ ‫المحتوى‬
.

‫مختلفة‬ ‫بكميات‬ ‫الخاليا‬ ‫معظم‬ ‫ي‬
‫ف‬ ‫اإلنزيمات‬ ‫معظم‬ ‫توجد‬

13. Information from enzyme measurements in serum
‫الدم‬ ‫مصل‬ ‫ي‬
‫ف‬ ‫االنزيمات‬ ‫قياسات‬ ‫من‬ ‫معلومات‬
 Information about the Presence of disease
 Information about the Organs involved in the disease
 Etiology /nature of disease: differential diagnosis
 Extent of disease - more damaged cells will cause more leaked
enzymes in blood
 Time course of disease

‫المرض‬ ‫وجود‬ ‫عن‬ ‫معلومات‬

‫المرض‬ ‫ي‬
‫ف‬ ‫المتورطة‬ ‫األعضاء‬ ‫عن‬ ‫معلومات‬

‫المسببات‬
/
‫المرض‬ ‫طبيعة‬
:
‫ي‬
‫ر‬
‫التفريق‬ ‫التشخيص‬

‫المرض‬ ‫مدى‬
-
‫ا‬ ‫من‬ ‫المزيد‬ ‫ترسب‬ ‫ي‬
‫ف‬ ‫التالفة‬ ‫الخاليا‬ ‫من‬ ‫المزيد‬ ‫يتسبب‬
‫ي‬
‫ف‬ ‫إلنزيمات‬
‫الدم‬

‫للمرض‬ ‫الزمنية‬ ‫الدورة‬

14. Tissue damage or necrosis resulting from injury or disease is generally
accompanied by increases in the levels of several nonfunctional plasma enzymes.
‫يصاحب‬
‫تلف‬
‫األنسجة‬
‫أو‬
‫النخر‬
‫الناتج‬
‫عن‬
‫اإلصابة‬
‫أو‬
‫المرض‬
‫بشكل‬
‫عام‬
‫زيادة‬
‫ي‬
‫ف‬
‫مستويات‬
‫ال‬
‫عديد‬
‫من‬
‫إنزيمات‬
‫البالزما‬
‫ر‬
‫غت‬
‫الوظيفية‬
.
DIAGNOSTIC ENZYMES :-

15. EARLY
DETECTION OF
DISEASE
• EASIER
TREATMENT
• LOW MEDICAL
COSTS
HELPS IN
ASCERTAINING
THE RESPONSE
OF DRUGS
• BETTER DRUGS
• BETTER
TREATMENT
HELPS IN
ASCERTAINING
TIME COURSE
OF DISEASE
• LOW
• MILD
• SEVERE
CLINICAL SIGNIFICANCE

16. ENZYME
CONCENTRATIONS
BONE
DISEASES
LIVER
DISORDERS
BRAIN CELL
DAMAGE
GASTRIC
DISORDERS

17. Enzymes routinely measured
NAME OF THE ENZYME PRESENT IN
Aspartate Amino transferase (AST)
Serum glutamate-oxaloacetate
transaminase (SGOT)
Heart and Liver
Alanine Amino transferase (ALT)
Serum glutamate-pyruvate transaminase
(SGPT)
Heart and Liver
Alkaline Phosphatase (ALP) Bone, intestine and other tissues
Acid Phosphatase (ACP) Prostate
 glutamyl Transferase ( GT) Liver
Creatine kinase (CK) Muscle Including cardiac muscle
Lactate Dehydrogenase (LDH) Heart, liver, muscle, RBC
 Amylase Pancreas

18. Isoenzymes
• Catalyze same reactions but are formed from structurally different
polypeptides.
• They perform the same catalytic function.
• Different isoenzymes may arise from different tissues and their specific
detection may give clues to the site of pathology.
• Various isoenzymes of an enzyme can differ in three major ways:
Enzymatic properties
Physical properties (e.g. heat stability)
Biochemical properties such as amino acid composition and immunological
reactivities
‫تحفز‬
‫التفاعالت‬
‫نفسها‬
‫ولكنها‬
‫تتشكل‬
‫من‬
‫عديد‬
‫ببتيدات‬
‫مختلفة‬
‫ا‬ً‫هيكلي‬
.
‫يؤدون‬
‫نفس‬
‫الوظيفة‬
‫ية‬ ‫ر‬
‫التحفت‬
.
‫قد‬
‫تنشأ‬
‫أنزيمات‬
‫مختلفة‬
‫من‬
‫أنسجة‬
‫مختلفة‬
‫وقد‬
‫ي‬
‫يعط‬
‫اكتشافها‬
‫المحدد‬
‫أدلة‬
‫عىل‬
‫موقع‬
‫ع‬
‫لم‬
‫اض‬‫ر‬‫األم‬
.
‫يمكن‬
‫أن‬
‫تختلف‬
‫إنزيمات‬
‫اإلنزيم‬
‫المختلفة‬
‫بثالث‬
‫طرق‬
‫رئيسية‬
:

‫الخصائص‬
‫األنزيمية‬

‫الخصائص‬
‫يائية‬ ‫ر‬
‫الفت‬
(
‫مثل‬
‫ار‬‫ر‬‫استق‬
‫ارة‬‫ر‬‫الح‬
)

‫الخصائص‬
‫البيوكيميائية‬
‫مثل‬
‫تكوين‬
‫األحماض‬
‫األمينية‬
‫والتفاعالت‬
‫المناعية‬

21. Measurement of enzyme activity
• Enzyme activity is expressed in International unit
(IU)
It corresponds to the amount of enzymes that catalyzes the
conversion of one micromole (mol) of substrate to product per
minute
‫يتم‬
‫التعبي‬
‫عن‬
‫نشاط‬
‫اإلنزيم‬
‫بالوحدة‬
‫الدولية‬
(
(IU
‫يتوافق‬
‫مع‬
‫كمية‬
‫اإلنزيمات‬
‫الت‬
‫تحفز‬
‫تحويل‬
‫ميكرومول‬
‫واحد‬
‫من‬
‫كي‬
‫الر‬
‫ة‬
‫إىل‬
‫منتج‬
‫ف‬
‫الدقيقة‬

22. LACTATE DEHYDROGENASE (LDH)
Pyruvate Lactate (anaerobic glycolysis)
 LDH is elevated in myocardial infarction, blood disorders,
tissue injury
 It is a tetrameric protein and made of two types of subunits
namely H = Heart, M = skeletal muscle
 It exists as 5 different isoenzymes with various combinations
of H and M subunits

23. Separation of LDH Isoenzymes by gel electrophoresis

24. Isoenzyme
name
Composition Composition Present in Elevated in
LDH1 ( H4) HHHH Myocardium,
RBC
myocardial
infarction
LDH2 (H3M1) HHHM Myocardium,
RBC
LDH3 (H2M2) HHMM Kidney,
Skeletal
muscle
LDH4 (H1M3) HMMM Kidney,
Skeletal
muscle
LDH5 (M4) MMMM Skeletal
muscle, Liver
Skeletal muscle
and liver
diseases

25. AMI = Acute Myocardial Infarction
ULN = Upper Limit of Normal values (‫العادية‬ ‫للقيم‬ ‫األعىل‬ ‫)الحد‬
Pernicious anemia =
a deficiency in the production of red blood cells through a lack of vitamin B12

26. Creatine + ATP phosphocreatine + ADP
(Phosphocreatine – serves as energy reserve during muscle contraction)
 Creatine kinase is a dimer made of 2 monomers
occurs in the tissues
 Skeletal muscle contains M subunit, Brain contains B
subunits
 Three different isoenzymes are formed
CREATINE KINASE (CK)

27. Isoenzyme
name
Composition Present in Elevated in
CK-1 BB Brain CNS diseases
CK-2 MB
Myocardium
/ Heart
Acute
myocardial
infarction
CK-3 MM
Skeletal
muscle,
Myocardium

28. ALANINE TRANSAMINASE (ALT) &
ASPARTATE TRANSAMINASE( AST)
 Alanine transaminase (ALT) and Aspartate transaminase (AST) enzymes are the most
abundantly present in the liver and are elevated in blood as a result of leakage from
damaged cells
 Measurement of these transaminases is useful for the diagnosis of liver diseases
 In viral hepatitis the enzyme levels are increased 20-50 times above the upper limit of
the normal range
 Alanine transaminase (ALT) increase is specific for liver damage involving hepatocellular
damage
 Aspartate transaminase (AST) is moderately increased in Muscular dystrophy and acute
myocardial infarction

‫إنزيمات‬
Alanine Transaminase (ALT)
‫و‬
Aspartate Transaminase (AST)
‫ف‬ ‫ة‬ ‫ر‬
‫بكي‬ ‫ا‬
ً
‫تواجد‬ ‫ر‬
‫األكي‬ ‫ه‬
‫التالفة‬ ‫الخاليا‬ ‫من‬ ‫للترسب‬ ‫نتيجة‬ ‫الدم‬ ‫ف‬ ‫وترتفع‬ ‫الكبد‬

‫الكبد‬ ‫اض‬‫ر‬‫أم‬ ‫تشخيص‬ ‫ف‬ ‫مفيد‬ ‫انساميناسات‬‫الي‬ ‫هذه‬ ‫قياس‬

‫اإلنزيم‬ ‫مستويات‬ ‫تزداد‬ ‫وس‬‫الفي‬ ‫الكبد‬ ‫التهاب‬ ‫ف‬
20
-
50
‫الطبيع‬ ‫للنطاق‬ ‫األعىل‬ ‫الحد‬ ‫فوق‬ ‫مرة‬

‫األالني‬ ‫أمي‬ ‫ناقلة‬ ‫زيادة‬ ‫إن‬
(
ALT)
‫الكبد‬ ‫خاليا‬ ‫تلف‬ ‫يشمل‬ ‫الذي‬ ‫الكبد‬ ‫بتلف‬ ‫خاصة‬

‫األسبارتات‬ ‫أمي‬ ‫ناقلة‬ ‫يزداد‬
(
AST)
‫الحاد‬ ‫القلب‬ ‫عضلة‬ ‫واحتشاء‬ ‫العضىل‬ ‫الحثل‬ ‫ف‬ ‫معتدل‬ ‫بشكل‬

29. LEVELS OF ENZYMES IN DISEASES
INVOLVING LIVER DAMAGE
In viral hepatitis
Rapid rise in
transaminases (AST & ALT)
in serum occurs even
before bilirubin rise is
seen
‫ف‬
‫التهاب‬
‫الكبد‬
‫وس‬‫الفي‬
‫يحدث‬
‫االرتفاع‬
‫ع‬ ‫ي‬‫رس‬‫ال‬
‫ف‬
‫ن‬
‫اقالت‬
‫األمي‬
AST & ALT
‫ف‬
‫المصل‬
‫حت‬
‫قبل‬
‫مالحظة‬
‫ارتفاع‬
‫وبي‬‫البيلي‬

34.  Alkaline Phosphatase is a group of enzymes that have maximal activity at a high
pH between 9.0 - 10.5
 Widely distributed throughout the body
 High levels are seen is liver, bone, placenta and intestine and useful to assess
hepatobiliary and bone diseases
 In hepatobiliary obstruction, hepatocytes lining the biliary ducts induces the
synthesis of ALP.
 High levels of ALP is indicative of extrahepatic obstruction rather than
intrahepatic obstruction

‫الفوسفاتاز‬
‫القلوي‬
‫عبارة‬
‫عن‬
‫مجموعة‬
‫من‬
‫اإلنزيمات‬
‫ي‬
‫ر‬
‫الئ‬
‫لها‬
‫أقىص‬
‫نشاط‬
‫عند‬
‫درجة‬
‫حموضة‬
‫عالية‬
9.0
-
10.5

‫موزعة‬
‫عىل‬
‫نطاق‬
‫واسع‬
‫ي‬
‫ف‬
‫جميع‬
‫أنحاء‬
‫الجسم‬

‫لوحظ‬
‫وجود‬
‫مستويات‬
‫عالية‬
‫منها‬
‫ي‬
‫ف‬
‫الكبد‬
‫والعظام‬
‫والمشيمة‬
‫واألمعاء‬
‫ي‬
‫وه‬
‫مفيدة‬
‫ي‬
‫ف‬
‫تقييم‬
‫اض‬‫ر‬‫أم‬
‫ا‬
‫لكبد‬
‫والقناة‬
‫اوية‬‫ر‬‫الصف‬
‫والعظام‬

‫ي‬
‫ف‬
‫انسداد‬
‫القنوات‬
‫اوية‬‫ر‬‫الصف‬
،
‫تحفز‬
‫الخاليا‬
‫الكبدية‬
‫المبطنة‬
‫للقنوات‬
‫اوية‬‫ر‬‫الصف‬
‫عىل‬
‫تخليق‬
ALP.

‫تدل‬
‫المستويات‬
‫العالية‬
‫من‬
ALP
‫عىل‬
‫انسداد‬
‫خارج‬
‫الكبد‬
‫ا‬
‫بدل‬
‫من‬
‫االنسداد‬
‫داخل‬
‫الكبد‬
ALKALINE PHOSPHATASE (ALP)

35.  In bones, the enzyme ALP is derived from osteoblasts. Hence, there are
increased levels of ALP in bone diseases like rickets, osteomalacia, neoplastic
diseases with bone metastases, and healing fractures
 The activity of the bone isoenzyme can be estimated by heat-treating a serum
sample at 56oC. The bone ALP is heat liable and is destroyed or heat-inactivated
at this temperature.
 Measurement of ALP before and after heat treatment gives a measure of bone
ALP

‫ي‬
‫ف‬
‫العظام‬
،
‫شتق‬
ُ
‫ي‬
‫إنزيم‬
ALP
‫من‬
‫بانيات‬
‫العظم‬
.
‫ي‬
‫وبالتاىل‬
،
‫هناك‬
‫مستويات‬
‫ايدة‬ ‫ر‬
‫مت‬
‫من‬
ALP
‫ي‬
‫ف‬
‫اض‬‫ر‬‫أم‬
‫العظام‬
‫مثل‬
‫الكساح‬
‫ر‬
‫وتلي‬
‫العظام‬
‫اض‬‫ر‬‫وأم‬
‫ام‬‫ر‬‫األو‬
‫مع‬
‫النقائل‬
‫العظمية‬
‫والكسور‬
‫ي‬
‫ر‬
‫الئ‬
‫تلت‬
‫ئم‬
.

‫يمكن‬
‫تقدير‬
‫نشاط‬
‫إنزيم‬
‫العظام‬
‫عن‬
‫طريق‬
‫المعالجة‬
‫ارية‬‫ر‬‫الح‬
‫لعينة‬
‫مصل‬
‫عند‬
56
‫درجة‬
‫مئوية‬
.
‫يكون‬
‫العظم‬
ALP
‫عرضة‬
‫ارة‬‫ر‬‫للح‬
‫ويتم‬
‫ه‬ ‫ر‬
‫تدمت‬
‫أو‬
‫تعطيل‬
‫ارة‬‫ر‬‫الح‬
‫عند‬
‫درجة‬
‫ارة‬‫ر‬‫الح‬
‫هذه‬
.

‫ي‬
‫يعط‬
‫قياس‬
ALP
‫قبل‬
‫وبعد‬
‫المعالجة‬
‫ارية‬‫ر‬‫الح‬
‫ا‬ ً
‫مقياس‬
‫ـ‬‫ل‬
ALP
‫ي‬
‫ف‬
‫العظام‬
ALKALINE PHOSPHATASE (ALP) (continued)

36. ALKALINE PHOSPHATASE
RISES IN RICKETS
OSTEOMALACIA
PAGET’S DISEASE
HYPERPARATHYROIDISM
PRIMARY AND
SECONDARY
MALIGNANCIES OF BONE

37. ACID PHOSPHATASE (ACP)
 Acid Phosphatase is a group of enzymes that have maximal activity at pH
5.0-6.0
 It is present in the prostate gland, liver, spleen, and RBCs
 The primary source of ACP is the prostate gland, and so it can be used as a
marker for prostate diseases
 Abnormally high serum levels of acid phosphatase may indicate infection,
injury, or cancer of the prostate.

‫الحموضة‬ ‫درجة‬ ‫عند‬ ‫نشاط‬ ‫أقىص‬ ‫لها‬ ‫ي‬
‫ر‬
‫الئ‬ ‫اإلنزيمات‬ ‫من‬ ‫مجموعة‬ ‫هو‬ ‫ر‬
‫الفوسفاتت‬ ‫حمض‬
5.0
-
6.0

‫اء‬‫ر‬‫الحم‬ ‫الدم‬ ‫ات‬‫ر‬‫وك‬ ‫والطحال‬ ‫والكبد‬ ‫وستاتا‬ ‫ر‬
‫الت‬ ‫غدة‬ ‫ي‬
‫ف‬ ‫يوجد‬

‫ـ‬‫ل‬ ‫ي‬
‫الرئيس‬‫المصدر‬
ACP
‫وست‬ ‫ر‬
‫الت‬ ‫اض‬‫ر‬‫ألم‬ ‫كعالمة‬‫استخدامه‬ ‫يمكن‬ ‫ي‬
‫وبالتاىل‬ ‫وستات‬ ‫ر‬
‫الت‬ ‫غدة‬ ‫هو‬
‫اتا‬

‫إىل‬ ‫الدم‬ ‫ي‬
‫ف‬ ‫ي‬
‫الحمىص‬‫الفوسفاتاز‬ ‫من‬ ‫ي‬
‫طبيع‬ ‫ر‬
‫غت‬ ‫بشكل‬ ‫المرتفعة‬ ‫المستويات‬ ‫ر‬
‫تشت‬ ‫قد‬
‫أو‬ ‫عدوى‬ ‫وجود‬
‫وستاتا‬ ‫ر‬
‫الت‬ ‫رسطان‬ ‫أو‬ ‫إصابة‬
.

38. AMYLASE
 Amylase is the digestive enzyme produced from the pancreas and salivary glands
to digest complex carbohydrates
 Although salivary and pancreatic amylases are similar, they are encoded by
different genes (AMY1 and AMY2, respectively) and show different levels of activity
against starches of various origins
 Pancreatic amylase is elevated in acute pancreatitis. It is used as a marker to
detect acute pancreatitis

‫المعق‬ ‫ات‬‫ر‬‫الكربوهيد‬ ‫لهضم‬ ‫اللعابية‬ ‫والغدد‬ ‫البنكرياس‬ ‫من‬ ‫ينتج‬ ‫ي‬
‫هضىم‬ ‫إنزيم‬ ‫هو‬ ‫ر‬
‫األميلت‬
‫دة‬

‫مخت‬ ‫جينات‬ ‫بواسطة‬ ‫مشفرة‬ ‫أنها‬ ‫إال‬ ، ‫والبنكرياس‬ ‫اللعابية‬ ‫ات‬‫ز‬‫األميال‬ ‫تشابه‬ ‫من‬ ‫الرغم‬ ‫عىل‬
‫لفة‬
(
AMY1
‫و‬
AMY2
،
‫ي‬
‫التواىل‬ ‫عىل‬
)
‫مختلفة‬ ‫أصول‬ ‫من‬ ‫النشا‬ ‫ضد‬ ‫النشاط‬ ‫من‬ ‫مختلفة‬ ‫مستويات‬‫وتظهر‬

‫الحاد‬ ‫البنكرياس‬ ‫التهاب‬ ‫ي‬
‫ف‬ ‫البنكرياس‬ ‫ر‬
‫أميلت‬ ‫يرتفع‬
.
‫ع‬ ‫للكشف‬ ‫كعالمة‬‫استخدامه‬ ‫يتم‬
‫التهاب‬ ‫ن‬
‫الحاد‬ ‫البنكرياس‬

40. Amino acid + Glutathione  -glutamyl amino acid +
Cysteinylglycine
 -glutamyltransferase is involved in amino acid transport across the membranes.
 Found mainly in biliary ducts of the liver, kidney and pancreas.
 Enzyme activity is induced by a number of drugs and in particular alcohol.
 -GT levels are increased in liver diseases especially in obstructive jaundice.
 -GT levels are used as a marker of alcohol induced liver disease and in liver
cirrhosis.

‫يشارك‬

-
glutamyltransferase
‫األغشية‬ ‫ر‬
‫عت‬ ‫األمينية‬ ‫األحماض‬ ‫نقل‬ ‫ي‬
‫ف‬
.

‫والبنكرياس‬ ‫والكىل‬ ‫للكبد‬ ‫اوية‬‫ر‬‫الصف‬ ‫القنوات‬ ‫ي‬
‫ف‬ ‫ي‬
‫رئيس‬ ‫بشكل‬ ‫توجد‬
.

‫الكحول‬ ‫وخاصة‬ ‫األدوية‬ ‫من‬ ‫عدد‬ ‫طريق‬ ‫عن‬ ‫اإلنزيم‬ ‫نشاط‬ ‫ر‬
‫تحفت‬ ‫يتم‬
.

‫بيتا‬ ‫مستويات‬ ‫تزداد‬
-
‫االنسدادي‬ ‫قان‬ ‫ر‬
‫الت‬
‫ا‬
‫خاصة‬ ‫الكبد‬ ‫اض‬‫ر‬‫أم‬ ‫ي‬
‫ف‬ ‫ي‬
‫ر‬
‫ت‬ ‫ي‬ ‫ر‬
‫ج‬
.

‫مستويات‬ ‫تستخدم‬

-
GT
‫الكبد‬ ‫وتليف‬ ‫الكحول‬ ‫يسببها‬ ‫ي‬
‫ر‬
‫الئ‬ ‫الكبد‬ ‫اض‬‫ر‬‫ألم‬ ‫كعالمة‬
.
( GT)
 glutamyltransferase ( GT)

41. NAME OF THE ENZYME
Conditions in which level of activity in serum
is elevated
Aspartate Amino transferase (AST)
Serum glutamate-oxaloacetate
transaminase (SGOT)
Myocardial infarction, Liver disease especially
with liver cell damage
Alanine Amino transferase (ALT)
Serum glutamate-pyruvate
transaminase (SGPT)
Liver disease especially with liver cell damage
Alkaline Phosphatase (ALP) Liver disease- biliary obstruction
Osteoblastic bone disease-rickets
Acid Phosphatase (ACP) Prostatic carcinoma
 glutamyl Transferase ( GT) Liver disorder like liver cirrhosis
Creatine kinase (CK) Myocardial infarction and skeletal muscle disease
(muscular dystrophy)
Lactate Dehydrogenase (LDH) Myocardial infarction, other diseases like liver
disease.some blood diseases
 Amylase Acute pancreatitis
Lipase Acute pancreatitis
Troponin I or Troponin T Myocardial infarction

43. ‫الرسيري‬‫السيناريو‬
1
:
‫العمر‬ ‫من‬ ‫يبلغ‬ ‫رجل‬
69
‫عيادتك‬ ‫ي‬
‫ف‬ ‫البطن‬ ‫ي‬
‫ف‬ ‫آالم‬ ‫من‬ ‫ي‬
‫يعات‬ ‫ا‬ ً‫عام‬
.
‫الن‬ ‫عىل‬ ‫ي‬
‫ه‬ ‫ه‬ ‫ر‬
‫مختت‬ ‫نتائج‬
‫ي‬
‫التاىل‬‫حو‬
.
‫اللون‬ ‫داكن‬ ‫وبول‬ ‫شاحب‬ ‫از‬‫ر‬‫وب‬ ‫اء‬‫ر‬‫صف‬ ‫جسده‬ ‫صلبة‬ ‫كانت‬
.
‫منه؟‬ ‫ي‬
‫يعات‬ ‫الذي‬ ‫قان‬ ‫ر‬
‫الت‬ ‫نوع‬ ‫ما‬

44. ‫الرسيري‬‫السيناريو‬
2
:
‫العمر‬ ‫من‬ ‫يبلغ‬ ‫رجل‬ ‫قدم‬
35
‫عام‬ ‫وضعف‬ ‫وزن‬ ‫ونقص‬ ‫ا‬
ً
‫توعك‬ ‫عيادتك‬ ‫ي‬
‫ف‬ ‫ا‬ ً‫عام‬
.
‫ال‬ ‫داكن‬ ‫بول‬ ‫الحظ‬
‫لون‬
‫ر‬
‫الماضيي‬ ‫ر‬
‫اليومي‬ ‫خالل‬
.
‫منه؟‬ ‫ي‬
‫يعات‬ ‫الذي‬ ‫المرض‬ ‫نوع‬ ‫ما‬

45. ‫الرسيري‬‫السيناريو‬
3
:
‫العمر‬ ‫من‬ ‫يبلغ‬ ‫رجل‬ ‫قدم‬
50
‫ا‬ ‫ي‬
‫ف‬ ‫ر‬
‫ينترس‬ ‫الصدر‬ ‫ي‬
‫ف‬ ‫شديد‬ ‫ألم‬ ‫من‬ ‫ي‬
‫يعات‬ ‫الطوارئ‬ ‫قسم‬ ‫إىل‬ ‫ا‬ ً‫عام‬
‫اع‬‫ر‬‫لذ‬
‫اليرسى‬
.
‫لديه؟‬ ‫المرض‬ ‫حالة‬ ‫ما‬ ، ‫المعملية‬ ‫تحاليله‬ ‫عىل‬ ‫ا‬‫بناء‬