Plasma glutathione S-transferase and F protein are more sensitive than alanine aminotransferase as markers of paracetamol (acetaminophen)-induced liver damage.
Concentrations of glutathione S-transferase (GST; glutathione transferase; EC 2.5.1.18) B1 subunits, F protein, and the activity of alanine aminotransferase (ALT; EC 2.6.1.2) were measured in sequential plasma samples taken from nine patients with self-administered paracetamol (acetaminophen) poisoning. GST exceeded the reference interval in all patients at the time of admission, and F protein was increased in seven. In contrast, abnormal activities of ALT in plasma were found in only one of the nine on admission, a patient admitted 12 h after poisoning. Subsequent to admission nine, eight, and five patients, respectively, had abnormal concentrations of GST, F protein, and ALT. When expressed as multiples of the upper reference limit, the highest values for GST measured in each patient always far exceeded the greatest abnormalities in ALT; this was true for F protein in only five patients. Patients in whom the concentration of GST exceeded 10 micrograms/L on admission subsequently went on to develop moderate or severe liver damage, despite treatment with N-acetylcysteine. F protein and ALT measurements on admission were not as efficient as GST at predicting the clinical outcome of the patients. We conclude that GST and F protein offer clear advantages over ALT for detecting minor degrees of acute liver dysfunction, particularly when only centrilobular damage may be involved.
Beckett
G J
GJ
University Department of Clinical Chemistry, Royal Infirmary, Edinburgh, U.K.
Foster
G R
GR
Hussey
A J
AJ
Oliveira
D B
DB
Donovan
J W
JW
Prescott
L F
LF
Proudfoot
A T
AT
D000082:Acetaminophen / Q000506:poisoning*; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D056486:Chemical and Drug Induced Liver Injury; D005982:Glutathione Transferase / Q000097:blood*; D006801:Humans; D008107:Liver Diseases / Q000201:enzymology; D009124:Muscle Proteins / Q000097:blood*; D025203:Phosphofructokinase-1, Muscle Type; D025221:Phosphofructokinases; D011506:Proteins
D009124:Muscle Proteins; D011506:Proteins; D000082:Acetaminophen; D005982:Glutathione Transferase; D000410:Alanine Transaminase; D025221:Phosphofructokinases; D025203:Phosphofructokinase-1, Muscle Type; C026043:PFKM protein, human