Acta Med Scand 201: 53-58, 1977

Amylase, Hepatic Enzymes and Bilirubin in Serum of Chronic Alcoholics G. Skude and J. Wadstein From the Department of Clinical Chemistry and the Alcohol Clinic, University of Lund, Malmo General Hospital, Malmo, Sweden

ABSTRACT. The serum concentration of bilirubin and the activities of aspartate aminotransferase (ASAT, GOT), alanine aminotransferase (ALAT, GPT), y-glutamyltransferase (GT), total amylase and pancreatic isoamylase have been determined in serum of 182 male chronic alcoholics. Twelve per cent had abnormally high levels of bilirubin, 73% increased activity of S-ASAT, 50% increased SALAT, and 69% increased S-GT. The highest values were often found after 5-20 years of well documented alcoholism. Some patients with alcoholism of more than 20 years’ duration displayed a slight tendency towards normalization of the activities. For all parameters the scatter around the mean was greater in the patients than in the controls. Patients who had had attacks of delirium showed slightly higher SASAT and S-ALAT than other alcoholics. Determination of S-ALAT and S-bilirubin did not add to the cases with abnormal laboratory tests demonstrated by the combination of S-ASAT and S-GT. In 14 patients the above mentioned parameters were within normal limits, even though severe alcoholism had lasted for many years. Isoamylase determination disclosed 20% to have decreased activity of pancreatic isoamylases in serum, whereas only 6% had low total serum amylase activity.

In non-alcoholic individuals, a single intake of 3 g ethanol/kg b.wt. had been found to increase the serum activity of aspartate aminotransferase (ASAT, GOT) on the following day, with a second peak 8 days after the intake (2). The same applies in alcohol addicts of varying severity (1, 16, 24). The elevation of S-ASAT activity is frequently more pronounced than that of alanine aminotransferase (ALAT, GPT). The serum activities of the aminotransferases may continue to increase for

some days after ethanol intake, especially in persons developing delirium tremens, a phenomenon known as delayed increase (19, 25). The elevation of S-ALAT has been found to be more pronounced in patients who have had several attacks of delirium tremens than in those without any such attacks (25). Increased serum activities of y-glutamyltransferase (GT) have also been reported in chronic alcoholics (13). Pancreatitis, chronic as well as acute, with disturbed exocrine pancreatic function, is often found in alcoholics (3, 26, 30). The present paper evaluates the serum concentrations of some commonly used laboratory parameters on hepatic cellular dysfunction, as well as total and pancreatic serum amylase activities, in an objectively defined series of persons with chronic alcoholism of varying duration. MATERIAL AND METHODS The total patient material consisted of 182 male inpatients, aged 25-72 years, a t the Alcohol Clinic. The patients had been hospitalized for detoxication, social or psychiatric rehabilitation because of acute ethanol intoxication. All fulfilled the criteria of y-alcoholism according to the classification of Jellinek (10, 11) and showed the three cardinal symptoms of alcoholism according to Kaij (14), i.e. uncontrolled drinking, blackouts, and restorer. All patients except 3 were registered with the Temperance Board; 48 had had one or more attacks of delirium tremens but not on the present admission. None had a diagnosis of liver cirrhosis, 17 had earlier had one or more attacks of acute pancreatitis. Blood samples were drawn almost exclusively on the day after admission and revealed the highest recorded values of S-bilirubin, S-ASAT, S-ALAT, and S-GT. The reference group for normal values comprised at least 97 male shipyard workers, aged 19-63 years. Blood samples were collected during the same period as from the ACIU Med ScondlOl

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patients. The samples were analysed within 20 hours after collection. Bilirubin was determined in a Technicon AutoAnalyzer with a modification of the method by Jendrassik and Grof (12). The serum activities of ASAT and ALAT were determined with an LKB Reaction Rate Analyzer 8600 at 35°C using reagents from Kabi, Stockholm, Sweden; the results, however, are given in U/l (37") and pkat/l (37"). G T activity was determined with y-glutamyl-p-nitroanilide as substrate according to Orlowski and Meister (21) and serum amylase activity with Phadebas" Amylase Test (Pharmacia, Uppsala, Sweden), essentially as recommended by the manufacturer. Agarose gel electrophoresis was used to separate and detect the salivary and pancreatic isoamylases of serum (28). The contribution from each of these two groups of isoamylases to the serum amylase activity was determined by densitometric scanning. The patients were divided into groups according to the duration of alcoholism: 0 - 5 , 5-10, 10-20 and more than 20 years, i.e. years after fulfillment of the criteria of chronic alcoholism and will be referred to below as groups 0-5,5-10, 10-20, and >20. As all the parameters of the various groups showed an approximately normal distribution when transferred to logarithmic values (Fig. I), the logarithms were used in the statistical analysis. The normal ranges were defined as the arithmetic mean f 2 S.D. of the reference group (calculated on the logarithms). Before comparing the means of the various groups with &analysis, the variances were tested for equality with variance analysis; when not equal, the performance of the r-test was modified accordingly.

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The bilirubin determinations in the reference group and the groups of chronic alcoholics gave identical arithmetic means (Fig. 1) but the S.D. was significantly higher in all groups of alcoholics than in the reference group (pG0.05). All groups of alcoholics had single pathologically elevated values, most frequently in groups 0-5 and 10-20. The overall frequency of pathologic values among the alcoholics was 12%. In ail groups of alcoholics, the mean values of S-ASAT and S-ALAT were significantly increased, p in all cases being