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Serum lactate dehydrogenase activity ratios with different substrates.

D Barlow, F Naghizadeh, J King

Clinical Biochemistry

|October 1, 1975

Summary

Lactate dehydrogenase activity ratios can differentiate myocardial infarction from hepatocellular damage. Specific substrate ratios, particularly glyoxylate/hydroxypyruvate, show high diagnostic accuracy for these conditions.

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Area of Science:

Biochemistry
Clinical Chemistry
Enzymology

Background:

Lactate dehydrogenase (LDH) is an enzyme with multiple forms.
Distinguishing between myocardial infarction and hepatocellular damage is clinically important.
LDH isoenzyme analysis is a common diagnostic tool.

Purpose of the Study:

To evaluate the diagnostic utility of LDH activity ratios using various substrates.
To assess the effectiveness of different substrate combinations for differentiating myocardial infarction and hepatocellular damage.
To investigate potential alterations in LDH activity ratios in cases of poisoning.

Main Methods:

Assay of lactate dehydrogenase activity in sera from patients with myocardial infarction (n=89) and hepatocellular damage (n=55).
Enzyme activity measured using pyruvate, alpha-oxobutyrate, hydroxypyruvate, and glyoxylate as substrates under optimal conditions.
Activity also measured with lactate at varying pH values.
Calculation and analysis of activity ratios between different substrate assays.

Main Results:

Single ratio analysis showed varying differentiation accuracy, with glyoxylate/hydroxypyruvate and glyoxylate/alpha-oxobutyrate ratios exceeding 93% accuracy.
Hydroxypyruvate/alpha-oxobutyrate ratio demonstrated minimal diagnostic value.
Use of multiple ratios (up to seven assays) offered little improvement over single optimal ratios.
An inverted hydroxypyruvate to pyruvate activity ratio was observed in a case of morphine poisoning.

Conclusions:

Specific lactate dehydrogenase activity ratios, particularly those involving glyoxylate, are highly effective in differentiating myocardial infarction from hepatocellular damage.
The diagnostic utility of LDH assays can be enhanced by strategic substrate selection.
Alterations in LDH activity ratios may serve as indicators for specific toxicological conditions, such as morphine poisoning.

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