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| Year : 1980 | Volume
: 26
| Issue : 2 | Page : 108-11 |
LDH-isoenzymes and HBsAg.
Bharucha ZS, Mehta SH, Purandare SM
How to cite this article:
Bharucha Z S, Mehta S H, Purandare S M. LDH-isoenzymes and HBsAg. J Postgrad Med 1980;26:108 |
Etiology and diagnosis of hepatitis is still one of the burning problems of medicine. The significant progress in the field has now revealed besides the two A and B viruses, a third variety viz., the non A non B type. In 1976, Baxi et al[1] showed a possible relationship of HBs Ag to LDH isoenzyme appearing as an anamalous band between LDH4 and LDH5 Vyas et al[6] felt that LDH5 ex was associated with HBe Ag.
This work was carried out to find out to what extend there is a correlation, as the LDH isoenzyme study by polyacrylamide gel disc electrophoresis would be an ideal alternative screening test in the absence of ready supply of HBs antibody and more so for HBe antibody.
One hundred and twenty serum samples from acute hepatitis cases and 50 serum samples from healthy voluntary blood donors acting as control were studied. Anti HBs anti sera was obtained from Behringwerke. HBs Ag control was obtained from the Blood Group Reference Centre-Bombay. Counter immunoelectrophoresis method of Posendorfer et al[5], and acrylamide gel disc electrophoresis method of Dietz et al[2] were used to study the Australia antigen and LDH isoenzymes respectively.
All 50 donors taken as control were negative for HBs Ag by C.E.P. method and showed presence of only three distinct visible bands in acrylamide gel disc electrophoresis. On the other hand all 120 cases of acute hepatitis showed 4 or 5 bands with or without the presence of LDH5 ex (Fig. I on page 109). The results of HBs Ag and LDH5 ex are tabulated in [Table 1]. [Table 2] shows the total serum bilirubin and SGPT levels of cases which were positive for both LDH5 ex and HBs Ag or either. The findings are compared with other two workers in [Table 3].
No correlation of LDH5 ex was found with the duration of icterus.
The present study is done to review the method of polyacrylamide gel disc electrophoresis for LDH isoenzymes wherein the presence of LDH5 ex is associated with HBs Ag positivity. Baxi et al[1] have thought of a complex formed between LDH5 and HBs Ag which forms LDH5 ex. Vyas et at[6], feel that it is the HBe Ag which forms the complex. Thus all sera that are positive for HBs Ag may not be positive for LDH5 ex as has been observed in our series.
In our series, out of 18 HBs Ag positive acute hepatitis cases, 16 showed LDH5 ex and 2 failed to do so. Eeleftheriou et al[3] in a study of 99 cases of acute hepatitis for HBe Ag/anti HBe system found 14 cases having only anti HBe Vyas et al[6], observed that the 14 asymptomatic carriers of HBs Ag with anti HBe did not show LDH5 ex. Our 2 cases may be HBe Ag negative or may be containing anti HBe. It has been observed that patients who are HBs Ag positive and HBe Ag negative show lower level of SGPT and serum bilirubin. These 2 cases also showed similar findings.
Out of 102 non B hepatitis cases 6 showed LDH5 ex band [Table 1]. Similar findings were obtained by Baxi et all who have reported 6 LDH5 ex bands in 75 non B hepatitis cases. These 6 samples were positive for HBs Ag by RIA on rechecking. No such observations were made by Vyas et al[6], in the 20 non B hepatitis cases studied by them. In our study the sera after LDH isoenzyme studies were stored at -20°C for a maximum period of three months to get unbiased CEP results. The 6 sera which were negative for HBs Ag may have lost their potency to the extent of being detectable by CEP. In absence of more sensitive methods, this possibility cannot be ruled out. These sera when rechecked by disc electrophoretic method showed persistence of LDH5 ex.
Krentzer et al[4] have suggested that bilirubin or bile salts in higher concentration alter the LDH isoenzyme giving a band with anomalous electrophoretic properties. In our 6 cases of LDH5 ex positive and HBs Ag negative the serum bilirubin level was higher as compared to the other cases.
A definite relation exists between HBs ag and LDH5 ex. The LDH isoenzyme study cannot replace CEP method, as the visual interpretations of LDH5 ex is difficult and the process is laborious. A follow up study of hepatitis cases is indicated to know the extent of the relationship with HBe Ag as in absence of HBe Ag reagents this method would be of use as an indicator of prognosis and chronicity of liver disease.
This study was supported by a grant from Research Society-B. Y. L. Nair Ch. Hospital and T.N. Medical College. We are grateful to the Superintendent, Kasturba Hospital for allowing us to collect blood samples from their hepatitis cases. Our thanks are also due to Dean, Nair Ch. Hospital for allowing us to publish this data, to Dr. A. J. Baxi for his advice and Miss S. Gore and Mr. E. D'Souza for their technical assistance.
| 1. | Baxi, A. J., Bapat, J. P., Damle, S. R., Talavdekar, R. V., Rajpal, R. M. and Dave, J. K.: New laboratory method to detect Hepatitis B ag based on 'Anomalous' Lactate Dehydrogenase Isoenzyme. Vox Sang, 31: 70-73, 1976.  |
| 2. | Dietz, A. A., Lubrano, T. and Robinstein, H. M.: Disc electrophoresis of LDH isoenzymes. Clinica Chemica Acta, 27: 225-232, 1970. |
| 3. | Eleftheriou, N., Thomas, H. C., Heathcote, J. and Sherlock, S.: Incidence and clinical significance of e antigen and antibody in acute and chronic liver disease. Lancet, 2: 1171-1173, 1975. |
| 4. | Kreutzer, H. H., Jacobs, P. and Francke, C.: Lactate dehydrogenase isoenzymes: Irregularities in electrophoretic mobilities. Clinica Chemica Acta, 11: 159-169, 1965. |
| 5. | Posendorfer, F., Kranitsky, O. and Welwalka, F. G.: Immunoelectrophoretic methods in viral hepatitis and tests for the Australia (hepatitis associated) antigen and antibody. Bull. Wld. Hlth. Org., 42: 974-975, 1970. |
| 6. | Vyas, G. N., Peterson, D. L., Townsend, R. M., Damle, S. R. and Magnius, L. O.: Hepatitis B `e' antigen: an apparent association with lactate dehydrogenase isozyme 5. Science 198 (4321): 1068-1070, 1977. |
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