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Liver Function Tests in Diabetic and Non-Diabetic Patients in Dhaka City of Bangladeshi Population

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Liver Function Tests in Diabetic and Non-Diabetic Patients in Dhaka City of Bangladeshi Population id3083609 pdfMachine by Broadgun Software - a great PDF writer! - a great PDF creator! - http://www.pdfmachine.com http://www.broadgun.com ISSN : 0974 - 7532 Volume 7 Issue 4 Research & Reviews in Trade Science Inc. BBiiooSScciieenncceess RRBS, 7(R4), e201v3 [i14e7-1w52] Liver function tests in diabetic and non-diabetic patients in dhaka city of bangladeshi population Md.Jahangir Alam1*, Most.Nur-E-Taj Mokarrama Mukti6, Md.Mominul Hoque2, Md.Rezaul Karim3, Md.Saiful Islam4, Sunil C.Mallik5, Subhagata Choudhury1 1Bangladesh Institute of Research & Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Department of Biochemistry, Shahbag, Dhaka-1000, (BANGLADESH) 2Department of Biochemistry and Molecular Biology, University of Rajshahi, Rajshahi, (BANGLADESH) 3Department of Applied Nutrition and Food Technology, Islamic University, Kushtia-7003, (BANGLADESH) 4Department of Physiology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka-1000, (BANGLADESH) 5Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka, (BANGLADESH) 6Department of Zoology, University of Rajshahi, Rajshahi, (BANGLADESH) E-mail : [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected] ABSTRACT KEYWORDS These studies evaluated the liver function test in diabetic and non dia- Diabetic; betic patients. The measuring parameters were fasting blood sugar, total Hyperglycemia; bilirubin, aspartate aminotransferase (AST), alanine aminotransferase Glycogen; (ALT), alkaline phosphatase (ALP), total protein, albumin and globulin. Liver function; The study was carried out in BIRDEM hospital (Bangladesh Institute of Metabolism; Research & Rehabilitation in Diabetes, Endocrine and Metabolic Disor- Metabolic disorders. ders). This study investigated a total of 459 diabetic patients and 193 non diabetic individuals to compare the level of liver function tests between diabetic and non-diabetic patients. Their ages ranged between 30 and 60 years. The biochemical parameters did not differ significantly between non-diabetic male and female patients. In this study, mean values of ALT (p<0.041), ALP (p<0.001) and total bilirubin (p<0.001) were significantly higher in diabetic patients than in the non diabetic patients. Total protein (p<0.001) and albumin (p<0.007) concentrations in patients were lower compared to non diabetic patients. The mean of serum fasting blood sugar in patients revealed significant difference (P<0.001) in comparison to the non diabetic patients. Overall BMI of diabetic patients were high. Al- though the differences were statistically significant, the means of ALT, AST, and ALP were falling within the abnormal range. Moreover, 27.66% (127) patients had increased one or more liver enzymes in diabetic pa- tients. 2013 Trade Science Inc. - INDIA INTRODUCTION bohydrate metabolism, as it uses glucose as a fuel, it has the capability to store glucose as glycogen and also The liver plays a major role in the regulation of car- synthesize glucose from non-carbohydrate sources. This 148 LiverC faunnncatbioisn ttoexsitcsi tiyn adniad bae.dtivce rasned b nioolno-gdiciabl eaticct ivpiatytients RRBS, 7(4) 2013 Review type of role makes the liver more susceptible to dis- effects of serum liver enzymes, i.e. AST, ALT and ALP, eases in subjects having metabolic disorder, especially on the development of diabetes in a prospective study for diabetes[17]. Elevated serum enzymes activity of the of a defined Bangladeshi population, taking into account aminotransferases, aspartate aminotransferase (AST) comprehensive risk factors, including fasting blood and alanine aminotransferase (ALT) is the most fre- sugar, total bilirubin, total protein, albumin, globulin and quently measured indicator of liver disease and occurs BMI. The present study was aimed to evaluate the liver in diabetics more frequently than in the healthy popula- function variables in diabetic patients compared to non- tion[11]. The endogenous substances such as drugs are diabetic patients. excreted through kidney or billiary channel after meta- bolic processes in liver[13]. In type-2 diabetes, exces- MATERIALS AND METHODS sive hepatic glucose output contributes to the fasting hyperglycemia. Maintaining glucose homeostasis is one Study design and subjects of the crucial roles of the liver and this may provide a This study was done including diabetic and non dia- clue to pathogenesis in glucose intolerance but it is not betic patients in Dhaka city of Bangladesh. This study known that liver disease is directly associated with dia- was carried out in BIRDEM hospital from January 2010 betes mellitus. Recent studies indicate that increased to December 2010. Patients those who had diabetes gluconeogenesis plays a predominant mechanism for registration number at BIRDEM were considered dia- the increased glucose output but glycogenolysis is not betic and the overnight fasting normal individuals were [8] to be involved in the type-2 diabetes patients . Exces- taken as non-diabetic subjects. Patients who had been sive deposition of glycogen in liver may cause hepatome- following interview, clinical examinations were done and galy and liver enzyme abnormalities; sometimes it may blood sample were collected for the assay of fasting also cause abdominal pain, even nausea and vomiting blood sugar, total bilirubin, AST, ALT, ALP, total pro- and rarely ascities for the patients having this feature. tein, albumin, and globulin. Proper control of glucose level may assure to over- come all these abnormalities[9]. Determination of liver function test (LFT) Usually in clinical practice, liver function tests (LFTs) Liver function test (LFT) was done by enzyme ki- are done to diagnose liver diseases but the tests are netic and end point assay through the determination of also done to follow up the progression of known dis- the activity of serum enzyme from blood samples. Blood ease, monitor the function of potentially hepatotoxic samples were collected by venepuncture after an asep- drugs etc. Serum billirubin, aminotransferases, alkaline tic measure. The samples were allowed to clot and the phosphatase, total protein and albumin are the most serum was separated by centrifugation at 10,000 rpm common tests in LFTs. Aminotransferase such as ala- for 15 minutes at room temperature. Serum samples nine aminotransferase (ALT) and aspartate aminotrans- were stored at 2-40C until tested. For enzyme kinetic ferase (AST), total protein (TP), albumin (Alb) and assay, commercially available kits (Bio-Rad Laborato- globulin (Glo) levels are sensitive indicators of liver-cell ries, Richmond, USA; Randox laboratories Ltd., injury and are helpful in recognizing hepatocellular dis- Antrim, UK; Merck, Germany; Sigma Chemicals Co, eases[4]. Chronic mild elevation of liver enzymes is fre- USA; Roche international Inc. USA; Jhonson & quently found in type 2 diabetic patients. However, Jhonson Inc. USA.) were used. Absorbance of reac- though all these reports suggests that the liver function tion mixture was measured after performing the assay is involved in the development of diabetes but no study according to the supplied instruction. Then absorbance so far have been known to show which of these en- was converted by plotting a standard curve to deter- zymes is the best markers for the development of dia- mine sample values. All tests were done at 370C. betes. Moreover, it is also not known whether these The glucose test method is an adaptation of the hex- liver enzymes parameters are indicators or predictors okinase-glucose-6-phosphate dehydrogenase method, of future diabetes than the well-known risk factors for presented as a general clinical laboratory method by[15]. diabetes, such as adiposity, inflammation, insulin resis- The absorbance due to NADH (and thus the glucose tance etc. The purpose of this study is to examine the concentration) is determined using a bichrimatic (340 149 RRBS, 7(4) 2013 Md.Jahangir Alam et al. Review and 383 nm) endpoint technique. The instrument auto- ported by[10,18]. The complex absorbs at 600 nm and is matically calculates and prints the activity of glucose in measured using a polychromatic (600, 540, 700 nm) mmol/L. endpoint technique. The instrument automatically cal- The total bilirubin test was determined by the modi- culates and prints the activity of Alb in gm/L. fication of the Doumas reference method, which was Diabetes was diagnosed based on drug treatment modification of the diazo method described by for diabetes (insulin or oral hypoglycemic agents) and/ Jendrassik and Grof[10]. The reaction forms a red chro- or criteria laid by the WHO Consultation Group report mophore representing the total bilirubin, which absorbs i.e. fasting plasma glucose (FPG) 126 mg/dl[1]. at 540 nm and was measured using a bichromatic The diagnosis is based on BIRDEM laboratory ref- (540,700 nm) end point technique. The instrument au- erence values as ALP >120 and 119 U/L for men and tomatically calculates and prints the activity of total bi- women, respectively; ALT >41 and 31 U/L for men lirubin in mg/dl. and women, respectively; AST >37 and 31 U/L for Serum AST test method is an adaptation of the men and women, respectively; Serum total bilirubin >1.2 methodology recommended by the International Fed- mg/ dl, total protein (63-82) mg/L, and albumin (35- eration of Clinical Chemistry (IFCC)[10]. The change in 57) mg/L for both male and female. absorbance with time due to the conversion
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