Alkaline phosphatase increased in the blood. What does this mean in the child, women, women in the analysis

The enzyme phosphatase is present in virtually all human tissues. Distinguish 2 of its varieties, depending on the acidity of the medium in which it is activated - alkaline and acid.

If the increased blood concentration of the first type of enzyme, it may indicate the presence of bone disease and hepatobiliary systems. Certain physiological conditions also accompanied by changes in its level (pregnancy, a period of rapid growth in children, menopausal women and others).

enzyme

Alkaline phosphatase protein refers to enzymes which are involved in metabolism in the liver and in the process of bone formation. This biologically active compound activates decomposition of phosphoric esters which serve as structural components of cell membranes and the nucleic acids.

Increased alkaline phosphatase often in diseases of bone and liver, since they are the source of 95% of this enzyme, abundant in the circulating blood. Determination of its level is the standard diagnostic criteria for detecting diseases of the musculoskeletal and hepatobiliary systems.

The highest concentration of alkaline phosphatase observed in the following human tissues:

• mucous membrane of the small intestine;
• wall biliary and renal tubules;
• placenta;
• liver;
• young cells of bone tissue;
• breast cancer in women during lactation.

Determining the level of this enzyme is produced within the biochemical analysis of blood. This method provides a diagnostic laboratory general idea of ​​the liver, kidney and other internal organs, as well as the metabolic processes in the human body.

Classification

Alkaline phosphatase in the blood contained in several isoforms that are not yet fully understood.

Currently in medicine are the following types of the enzyme:

• digestive, produced by the intestinal epithelial cells and plays a key role in his defense;
• nonspecific (concentrated in the liver, bone and kidney);
• placental;
• the embryo, which is located in the small intestine of the fetus up to 30 weeks of pregnancy.

Isoenzymes can be separated by electrophoresis, which allows you to determine exactly what kind of increases. The difference between them lies in the fact that their output encoded by different genes; they have different properties, but activate the same biochemical processes.

In human blood, is dominated by the bone (especially in children), and hepatic isoforms. Their ratio is normally 50%. In childhood, bone phosphatase content may reach 90% of the total population of this group of isoenzymes. Quantitative content of a particular species of enzyme can be seen on the corresponding organ lesions.

Norm

Normal values ​​of alkaline phosphatase in the blood depend on the method of determining (at Bessey-Lowry by King-Armstrong, IFCC standard 37 ° C and others), as well as on the apparatus used.

Therefore, tests should always be interpreted in view of the reference range in the laboratory where the test was performed. On the medical form issued to the patient should be given not only to the values ​​obtained, but the norm. The units of measurement are enzyme U / L or mmkat / l in the SI system. The ratio between them as follows: 1 mmkat / L = 60 U / L.

In adults, men and women

In domestic medicine most commonly used method for measuring kinetic alkaline phosphatase. It consists in determining the degradation of p-nitrophenylphosphate enzymes speed contained in the serum of the patient's blood.

Normal values ​​in this case are 35-123 U / L (with a reaction temperature of 37 ° C) for women, and 40-130 U / l for men.

During pregnancy

Pregnant increased alkaline phosphatase is a physiological and does not require treatment, if not revealed other changes. by the above procedure rate is 30-130 U / l.

Increasing the concentration of the enzyme is most often from 16 weeks of pregnancy when the placenta begins to actively grow. After birth, blood alkaline phosphatase returns to normal.

children

Normal values ​​of the enzyme in U / L for children according to the age and sex are shown in the table below.

Age, years	Girls	Boys
Up to 1 month of age	75-316	48-406
1-12 months.	82-383	124-341
4-6	93-309	96-297
7-9	86-315	69-325
10-12	42-362	51-332
13-15	74-390	50-162
16-18	52-171	47-119
over 18	35-123	40-130

As seen from the table, the upper limit of normal values ​​of alkaline phosphatase activity in the neonatal period 3 times higher than in adults.

Reasons for increasing performance

Alkaline phosphatase increased, when violated the metabolic processes in the human body. Excessive intake of enzyme protein occurs if the damaged tissue biliary system (the liver and gall bladder), pancreas and other organs.

In doubtful cases where it is unclear why increased levels of phosphatase, the doctor may prescribe isozyme additional studies to identify its species (liver, bone and others). Increasing the enzyme activity may be also caused by physiological factors (listed below) and receiving the following medications:

• sulfa antibiotics group (Etazol, Sulfazin, Urosulfan and others), erythromycin, tetracycline, lincomycin;

  

• nonsteroidal antiinflammatory drugs (Phenylbutazone and analogs thereof);
• antiarrhythmics (procainamide);
• oral contraceptives containing estrogen and progesterone.

Pathology of the liver and biliary tract

Level hepatic isomer phosphatase increases in the following diseases:

• bile stasis in liver or gallbladder hepatitis, cirrhosis, tuberculosis, biliary obstruction in cholelithiasis, solderings, compressing tumors; at an acute cholecystitis (inflammation of the gallbladder);
• Alcoholic liver disease in which there is a toxic lesion tissues;
• malignant tumors in the liver or other sites, giving metastasis in the body;
• Medicinal liver lesions during chronic administration of NSAIDs or overdose, tetracycline and other drugs.

Especially the enzyme concentration increases strongly with obstructive jaundice and drug intoxication. The reason for this is to increase production of phosphatase in liver tissues under the influence of bile acids.

Analyzes of blood serum can be interpreted as follows:

• enzyme concentration is increased to 10 times or more - cholelithiasis (blockage of bile ducts is liver tissue);
• level does not exceed 2-3-times magnification - intrahepatic biliary tract overlap with hepatitis and other liver pathologies.

bone disease

Alkaline phosphatase is actively involved in the formation of bone. It promotes mineralization (formation of crystalline structures) of bones and teeth, thereby providing them with the necessary durability and hardness.

Enhancing its performance due to the increase in the number of young "immature" bone cells and observed the following pathologies:

• osteomalacia - violation bone mineralization process the shortage or deterioration of the exchange of vitamin D, hereditary metabolic disorders (syndrome hypophosphatasia), osteoporosis, with a deficit of microelements in the body due to their increased excretion in renal disease when suction or reduced intestinal diseases;
• tumor or bone metastasis;
• sarcoidosis - autoimmune disease in which the pathological formation of granulomas (nodules) in various tissues and organs;
• Paget's disease (presumably hereditary character), which deteriorates when the process of bone formation;
• lymphoma or Hodgkin's disease, - a malignant pathology lymphoid tissue;
• fractures on the stage of healing;
• osteoarthritis - cartilage damage of the joints;
• tuberculosis of bones.

Other diseases

Alkaline phosphatase may be elevated in several other diseases:

• hyperparathyroidism, or excess production of hormones in the parathyroid glands;
• kidney cancer;
• infectious mononucleosis (the first week of illness);
• celiac - congenital protein intolerance cereals;
• blood cancer;
• leukemoid reaction - abnormal increase in the total number of leukocytes in polycythemia, essential thrombocythemia, and other blood diseases;
• failure of the lymphatic system;
• Hyperthyroidism - increased thyroid activity;
• myocardial infarction, lung, or kidney;
• gastrointestinal disease - ulcerative colitis, Crohn's disease, intestinal infections, and malignancies.

This symptom is also observed in patients in the diet which lacks calcium and phosphate as well as vitamin C overdose

If the child has improved

The normal level of alkaline phosphatase is highly dependent on the patient's age. In children, there is an active growth and formation of the musculoskeletal system, so the blood concentration of the enzyme is much greater than in adults.

However, the increase in enzyme activity may indicate the presence and the pathologies listed above. There are also a number of "childhood" diseases, which are characterized by this feature.

Rickets

Determination of alkaline phosphatase level in rickets in children is a standard set of studies for the diagnosis of disorders of calcium-phosphorus metabolism. Particularly the disease is often diagnosed in premature infants (up to 80% of patients).

Rickets is dangerous because there is bone deformity, affecting the nervous system (hydrocephalus, neurodevelopmental lag), and increased risk of fractures with minimal load.

Development of the disease contribute to such factors as:

• inadequate maternal nutrition during pregnancy or after the birth of the child;
• pathology of the liver, kidney, gastrointestinal tract;
• endocrine disorders;
• rapid weight gain;
• frequent infections;
• insufficient insolation (sunlight irradiation), which leads to lack of vitamin D.

Limfoblastoz

Limfoblastoz, or infectious mononucleosis is an acute viral disease in which there is not only a change in biochemical the composition of the blood, but also marked the other distinctive signs - fever, oropharyngeal loss, enlargement of the liver and lymph nodes, jaundice.

The causative agent - Epstein-Barr virus, which is a source of ill people and virus carriers.

The prevalence of this disease is very high. The virus is present in 90% of people over 40 years oldAnd half of them carries the disease is in childhood. In young children, for pathology often asymptomatic.

Mild forms limfoblastoza treated on an outpatient basis by means of immunomodulators and immunostimulants, and in severe cases, a child's hospitalization.

other causes

Also the diseases listed above, increased levels of alkaline phosphatase in children may be associated with CMV infection. The causative agent of the disease belongs to the family of herpes viruses. Infection occurs by human patient in one form or another (latent or active). Newborn babies can become infected in the womb sick mother.

Playback of the virus occurs in the blood cells, thus changing its performance and, in particular, increases the concentration of phosphatase. In the first 2-3 weeks of the onset of the disease in children may also develop jaundice, indicating liver damage.

In some cases, the increase is normal?

Alkaline phosphatase increased for physiological reasons in the following cases:

• During pregnancy (even at its normal flow). Normal levels occur in a few weeks or months after birth. However, the high enzyme concentration in preeclampsia (complication consists in raising blood pressure in a pregnant woman) may indicate damage to the placenta. Low activity of phosphatases in some cases is a sign of lack of development of the placenta.
• In children with active bone growth.
• Upon resumption of motor activity after prolonged bed rest.
• In menopausal women, due to hormonal changes in the body.

Symptoms and signs

Symptoms of high levels of alkaline phosphatase depends on the type of disease. Listed below are the characteristic features of the most common pathologies.

liver diseases:

• yellow coloring of the skin, sclera eyes and mucous membranes;
• nausea, vomiting;
• dark urine;
• itching;
• fever, chills;
• spider veins on the skin;
• general weakness, and weight loss;
• pain in the right upper quadrant.

Symptoms of osteomalacia:

• bone pain;
• decreased muscle tone;
• frequent fractures with minimal trauma, evidence of the development of osteoporosis;
• loss of muscle mass;
• skeleton deformation.

Last sign during pregnancy manifested as a change in the structure of the lumbar spine, pelvis and upper thigh sections.

Rickets in children:

• increased fearfulness;
• increased sweating;
• retraction of the sternum ( "chicken breast");
• bone deformation;
• increase in frontal and parietal hillocks;
• changing the shape of the skull;
• limb jerking;
• later teething and overgrowing fontanels;
• decreased muscle tone, retarded physical development.

Infectious mononucleosis:

• temperature rise;
• inflammation of the pharynx;
• swollen lymph nodes and liver;
• shortness of nasal breathing, snoring in his sleep;
• jaundice;
• pruritus, rash.

Cytomegalovirus infection in children:

• jaundice;
• hyperexcitability syndrome (abnormal motor activity, tremor of the lower lip and chin limbs);
• convulsions;
• incoordination;
• hindered nasal breathing;
• marble figure of the skin;
• fatigue;
• a sore throat;
• periodic rises in body temperature.

Dangers and Consequences

The above diseases are accompanied by increased levels of alkaline phosphatase can result in the following complications:

• hepatobiliary diseases: hepatic and renal failure, acute cholecystitis, perforation gall bladder, abscess, peritonitis, hydrocephalus, biliary fistula, cancer, massive bleeding, coma lethal Exodus;
• Mononucleosis: splenic rupture, asphyxia (suffocation), pneumonia, inflammation of the heart muscle, encephalitis, paralysis, hemolytic anemia, hepatitis;
• rickets: bone deformity, neurological disorders, mental and physical retardation, loss of internal organs;
• cytomegalovirus infection: delayed development in children, impaired hearing and vision, meningoencephalitis, convulsions, loss heart and liver, bronchitis, pneumonitis, colitis and enteritis, enterocolitis, nephritis, endocrine disorders, liver cirrhosis, early death.

Preparation for Analysis and its holding

Preparation for passing a blood test to determine the level of alkaline phosphatase is as follows:

• Last food intake should not be less than 12 hours before the intake of biomaterial. Failure to do this leads to incorrect results, since the food raises the blood levels of the enzyme, particularly in people with I and III blood group. Dinner should be light (no meat, fried, spicy, fatty foods). It is not recommended to drink strong tea and coffee. Non-carbonated water use possible.
• It is also necessary to give up alcohol (at least 1 day) and smoking for 2 hours.
• Avoid heavy physical exertion and stress, you can not go to the bath or sauna the day before.
• Since the results may affect the reception of certain medications (listed above), you are kindly requested to inform the doctor and agree with them the necessary period of their cancellation.
• Blood must be collected prior to other medical procedures, appointed on the same day.

The procedure for biomaterial sampling is conducted by the following procedure:

1. The patient sits on a chair in front of a nurse, put his hand on the table.
2. On humerus zone superimposed harness.
3. Puncture site - area cubital vein - rubbed with a cotton swab, pre-moistened with rubbing alcohol, or special cloth.
4. The patient is asked "to work" hand clenching and unclenching his fist for blood flow.
5. The vein needle is introduced into a disposable blood sampling and produce a tube. Its required amount is 5-8 ml.
6. To puncture site cotton swab is applied for 10-15 min. until it stops bleeding.

What to do when a pathological level of alkaline phosphatase?

Alkaline phosphatase is elevated in a variety of pathologies, so this symptom is not only important in clinical diagnostics. If detected that the level of the enzyme is high, it is necessary to conduct additional tests to determine the primary cause.

Thus, in diseases of the hepatobiliary system main diagnostic methods include ultrasound and radiography, bone pathologies - anthropometric, radiographic, tomographic and densometricheskie methods. If the increase in enzyme level is associated with a physiological condition, the treatment is not required.

Numerous medical studies have confirmed the importance of alkaline phosphatase as a marker for various diseases.

If it is in the blood serum level is elevated, it may indicate liver pathologies, gall bladder, bone, the presence of infectious diseases, inherited diseases and cancer processes. Some of them are asymptomatic and require clarification and differential diagnosis.

Registration of the article: Vladimir the Great

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