Plasma Cholinesterase Activity in Liver Disease: Its Value as a Diagnostic Test of Liver Function Compared With Flocculation Tests and Plasma Protein Determinations 1

Abstract

The physiological significance of plasma cholinesterase is not clearly understood, but attention has recently been focussed on its relation to protein metabolism. It has been identified in high concentration in the a2 globulin of Cohn's fraction IV-6-3 (1).The evidence which has accumulated suggests that the liver is the probable source of plasma cholinesterase; and low values of plasma cholinesterase activity have been reported in patients with liver disease (2-1 1). We have been investigating. acetylcholine and water metabolism in liver disease, and the present communication is an account of work undertaken to determine in which types of liver and biliary tract disease the plasma cholinesterase activity is deranged, and what diagnostic significance can be attached to these findings. Concurrent determinations of plasma proteins and flocculation tests were also made. MATERIAL AND METHODSThe observations were carried out on 43 patients with liver and biliary tract disease. Of these, 15 patients were suffering from acute, four from sub-acute, 14 from chronic liver disease, and ten from extra-hepatic biliary obstruction. The plasma cholinesterase activity of 144 normalsubjects was also studied; of these, 100 were healthy blood donors, and 44 were convalescent patients in hospital, who had no history or clinical evidence of liver disease; concurrent protein estimations were also made on the plasma of the latter patients.Specimens of venous blood were transferred immediately after collection to heparinized tubes and centrifuged. After separation of the plasma, the red cells were washed twice with normal saline, and then laked with an amount of distilled water equal to the original volume of the 1 The expenses of this work were defrayed partially by a grant from the Medical Research Council, from whom one of us (R. J. C.) is in receipt of a whole-time grant, and by financial assistance from the Ministry of Supply, from whom one of us (H. G.) receives a wholetime grant. Maizels (14).In assessing the value of plasma cholinesterase activity as a diagnostic test of liver and biliary tract disease a comparison has been made with the results obtained for plasma albumin and globulin and the serum flocculation tests. For the interpretation of the flocculation tests we have adopted as an index of abnormality the conventional standards used in this hospital (14), for the colloidal red and cephalin cholesterol tests, flocculation greater than one plus (+) at 24 hours, and for the thymol turbidity test a value greater than 4 units. RESULTSIt will be convenient to begin by comparing the total results of the 33 patients with liver disease with those of the normal subjects in respect of plasma cholinesterase activity, plasma albumin and globulin estimations. Our aim here is to determine the limits of normality for these tests. The results have been plotted and give the overlapping histograms seen in Figure 1. The best discrimination will be given by the point on the scale where the two distributions (A) normal and (B) diseased inte...

An Assessment of the Value of Serum Cholinesterase as a Liver Function Test and in the Diagnosis of Jaundice

“…He found low enzyme activity in jaundice of hepatic origin, and his observations have since been confirmed by others (Alcalde, 1950;Vorhaus, Scudamore, and Kark, 1950;Mann, Mandel, Eichman, Knowlton, and Sborov, 1952;Wilson, Calvert, and Geoghegan, 1952;Kaufman, 1954). Most workers have reported unimpaired ChE activity in post-hepatic jaundice.…”

Volumetric and functional recovery of the liver after right hepatectomy for living donation

“…Since its clinical introduction in 1989, living donor liver transplantation is now routinely performed in Asiatic countries without cadaveric organ donation16 and also in many centers in the western world 15. Many concerns have been raised regarding the immediate and short‐term risk of complications for the donor, particularly since right lobe living donor liver transplantation was introduced 17, 18.…”

Serum-cholinesterase activity in health and in liver disease

“…It has frequently been reported that abnormally low values of serum cholinesterase are found in the sera of patients suffering from liver disease. Although there is a considerable variation in the cholinesterase activity in normal sera (Callaway, Davies & Rutland, 1951), as assayed by the manometric method of Arnmon (1933), abnormally low activities have been found in liver disease which are statistically significant (McArdle, 1940;Wilson, Calvert & Geoghegan, 1952). McArdle (1940) used acetylcholine as the substrate for the enzyme estimation and Wilson et al (1952) used benzoylcholine.…”