Research on the Historical Development of Diagnostic Enzymology
Summary
At the beginning of the 20th century, the enzymes in body fluids were measured clinically to diagnose diseases. For example, Wohlgemuth measured amylase (AMY) in urine as early as 1908 to diagnose acute pancreatitis. In the 1930s, alkaline phosphatase (ALP) was clinically tested for the diagnosis of skeletal diseases, and then it was found that many liver and gallbladder diseases, especially when obstructive jaundice occurred, this enzyme often increased significantly. These enzymes became routine test items in clinical laboratories at that time, and ALP was still the most frequently tested enzyme in the world until the 1960s.- Author Name: Iva Colter
At the beginning of the 20th century, the enzymes in body fluids were measured clinically to diagnose diseases. For example, Wohlgemuth measured amylase (AMY) in urine as early as 1908 to diagnose acute pancreatitis. In the 1930s, alkaline phosphatase (ALP) was clinically tested for the diagnosis of skeletal diseases, and then it was found that many liver and gallbladder diseases, especially when obstructive jaundice occurred, this enzyme often increased significantly. These enzymes became routine test items in clinical laboratories at that time, and ALP was still the most frequently tested enzyme in the world until the 1960s.
However, before the 1950s, enzyme determination only accounted for a small part of the routine work of the laboratory. The real development of diagnostic enzymology began with the establishment of a continuous monitoring enzyme activity concentration method by spectrophotometry in the 1950s. It can measure many enzymes that cannot be measured with the old "fixed time method" and used to diagnose diseases. The results found that lactate dehydrogenase (LD), aspartate aminotransferase (AST) and α-hydroxybutyrate dehydrogenase (HBDH) are far more sensitive than other diagnostic methods in diagnosing acute myocardial infarction (AMI).
In the early 1960s, it was confirmed that creatine kinase (CK) had an earlier increase in the diagnosis of AMI than the above enzymes, and the specificity was also high. At present, this enzyme has replaced ALP as the most frequently measured enzyme in the world. At the same time, it was found that alanine aminotransferase (ALT) and AST were not only sensitive to the diagnosis of hepatitis, but also increased significantly as early as the pre-jaundice of hepatitis. These achievements aroused widespread interest and attention of clinical and laboratory workers at that time. A large amount of clinical and experimental work has been carried out successively, and the clinical significance of hundreds of enzyme assays have been tried and evaluated. Among them, about ten enzymes have become important assay items commonly used in laboratory departments. Enzyme determination accounts for about 1/4 to 1/2 of the current total workload of clinical chemistry.
With extensive application and research, it has also been found that the specificity of total enzyme activity concentration determination for disease diagnosis is far less than what people initially expected. Beginning in the 1970s, scholars have gradually focused their attention on isoenzyme determination and found that CK-MB and LD1 have higher specificity for diagnosing AMI than the above-mentioned total enzymes. CK-MB has become a recognized "gold indicator" for diagnosing AMI. These two isozyme determinations have also become mandatory items in the laboratory of major hospitals.
Since the 1980s, it has been discovered that the isoenzymes in tissues may change after entering body fluids. For example, Ck-MM can be further divided into Ck-MM1, MM2 and MM3, and Ck-MB can be divided into MB1 and MB2. It is superior to CK total enzymes and isoenzymes in the diagnosis of AMI, and has become a research hotspot in clinical enzymology.
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