膀胱癌における酵素学的研究 第2編: 膀胱癌患者の糖負荷による血清cholinesteraseおよびtransaminaseの変動について

Abstract

In spite of many enzymo-chemical studies on cancer-bearing individuals, no cancer-specific enzyme has been found. In this second report of enzymological studies in tumor of the bladder, cholinesterase and transaminase levels of the patients were investigated particularly under sugar loading condition. The subjects included pretreatment bladder tumors 46 (34), post-treatment 14(14), and controls 36 (12). The number in the parenthesis indicates those jn which changes of the enzyme levels after the sugar loading could be followed. The method of sugar loading and of sampling the blood were as same as in the previous study (Part I). Cholinesterase level was measured by phenol red indicator colorimetry (Shibata's method) and transaminase level (GOT and GPT) by Reitman-Frankel's method. 1) Resting level of cholinesterase was significantly low in the pre-treatment bladder tumor group compared with the control group. Percentage of cases with abnormally low level, however, remained 19.5%. In the high stage group it was significantly low compared with the low stage group (p<0.05). In the high grade group, it was slightly lower than in the low grade group. 2) As to transaminase level (GOT and GPT), there was no significant difference between the pre-treatment bladder tumor group and the control group. Percentage of the cases showing abnormally high or low transamninase level did not differ between two groups. Stage or malignancy also had no relation with transaminase level. 3) Sugar loading test did not produce obvious changes both in the pre-treatment bladder tumor as well as in the control group. Percentage of cases showing the changes over 20% range did not differ between two groups. This was same as to stages and grades of the tumors. 4) No obvious changes of GOT and GPT level were noted on sugar loading both in the pretreatment bladder tumor and the control group. Percentage of cases showing wide range changes did not differ between two groups. The high stage or high grade group showed slight elevation of GOT and GPT after sugar loading, but the low stage or low grade group showed no remarkable changes. 5) The post-treatment bladder tumor group showed the higher cholinesterase level close to the control group level. No changes were observed after sugar loading. 6) Transaminnase level (GOT and GPT) of the post-treatment group showed the same pattern as that of the pre-treatment group. Cholinesterase is known as one of the few enzymes whose blood level decrease in the cancer-bearing individuals. It also decreases in hepatocellular damage and some of researchers point out the secondary hepatic damage in the cancer-bearing individuals as a cause of cholinesterase depression, and some others advocate tumor itself as a cause. In this study, all the cases had normal liver function. This suggest that significantly low cholinesterase level in the bladder tumor group might be the result of presence of cancer. The lower cholesterol level was seen along with progression of malignancy or stage of cancer. This was a same finding with previous report by other investigators. It was, however, impossible to observe the significant drop of cholinesterase on sugar loading test as Mustea did. Transaminase level in cancer-bearing individuals without metastases to the liver has been said to be within normal range by Shinsky et al and West and Zimmerman. In this study, GOT and GPT were mostly within normal limits in bladder tumors with few occurrence of abnormal value. Transaminase level was thought to be of little significance in diagnosis of bladder tumor not only in the static state but in the dynamic test under sugar loading.