Pyridoxal-5′-Phosphate 시약이 아미노전이효소 측정에 미치는 영향
Effects of Pyridoxal-5′-Phosphate on Aminotransferase Activity Assay
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배경: Pyridoxal-5’-phosphate (P5P)는 AST와 ALT의 보조인자로, IFCC에서는 아미노전이효소 활성도 측정에 P5P 시약의 첨가를 권장하고 있다(IFCC법). 하지만 현재 국내 대부분의 임상검사실에서는 P5P 시약을 첨가하지 않는 modified IFCC법을 사용하고 있다. 본 연구에서는 아미노전이효소 활성도 측정에 있어서 IFCC법과 modified IFCC법의 검사 결과를 비교 분석하고자 하였다. 방법: 총 2,318개의 잔여 검체를 대상으로 하였고, Beckman Coulter사의 AU5800 chemistry analyzer 기기를 이용하여 아미노전이효소 활성도를 측정한 후, 두 검사법 간의 결과값 차이를 비교하였다. 또한 RCPA에서 제시한 오차허용기준을 벗어나는 결과 값들의 빈도를 처방의 종류, 처방 발행처, 환자들의 각 임상 양상 별로 나누어 분석하였다. 결과: IFCC법을 사용하였을 때, modified IFCC법을 사용하였을 때보다 높은 AST와 ALT 결과값을 확인하였고, 통계학적 유의한차이가 확인되었다(AST, 5.8±14.2 IU/L; ALT, 2.8±6.9 IU/L). 오차허용기준을 벗어나는 값의 빈도는 응급처방 검체(AST, 65.8%; ALT, 14.4%), 병동 검체(AST, 70.4%; ALT, 18.5%)의 경우 각각 정규처방 검체(AST, 3.2%; ALT, 9.6%), 외래 검체(AST, 56.6%; ALT, 10.0%)보다 유의하게 높게 관찰되었다. 환자들의 각 임상 양상 별로 나누어 분석하였을 때, 급성 심근경색증 환자군에서만 오차허용기준을 벗어나는 값이 유의하게 높은 빈도로 관찰되었다. 결론: P5P 시약을 첨가하지 않는 검사법의 경우 아미노전이효소 활성도가 낮게 측정되었다. 특히 P5P 시약의 영향은 임상적으로 혈장 P5P 농도가 떨어져 있을 것이라 예측되는 급성 심근경색증 환자군에서 더욱 뚜렷하였다. 따라서 AST, ALT 활성도를 측정하는데 있어서, P5P 시약을 첨가하는 표준 IFCC 검사법을 임상검사실에 도입하는 것이 필요할 것으로 사료된다.
Abstract
Background: Pyridoxal-5′-phosphate (P5P), a coenzyme of the aspartate aminotransferase (AST) and alanine aminotransferase (ALT) reactions, is required to measure aminotransferase levels (IFCC method). However, a modified IFCC method that uses a reagent devoid of P5P is commonly used in laboratories in Korea. To determine the differences between the two methods, we compared aminotransferase levels measured by using the IFCC method and modified IFCC method. Methods: Serum levels of AST and ALT, with and without P5P, were measured in 2,318 patients. Based on the allowable limits of performance set by the Royal College of Pathologists of Australasia (RCPA), differences between the two methods were analyzed under various conditions. Results: Higher AST and ALT values were obtained by the IFCC method compared to modified IFCC method, showing significant differences between the two methods (AST, 5.8±14.2 IU/L; ALT, 2.8±6.9 IU/L) (P<0.001). Values exceeding RCPA criteria were more frequently observed in emergency orders (AST, 65.8%; ALT, 14.4%) than in routine orders (AST, 3.2%; ALT, 9.6%), as well as in inpatient wards (AST, 70.4%; ALT, 18.5%) compared to outpatient clinics (AST, 56.6%; ALT, 10.0%). However, the differences between the two methods were not significant among the disease groups, except for the acute myocardial infarction group. Conclusions: The method using reagents without P5P underestimated aminotransferase activity. The effect of P5P was more significant in patients with acute myocardial infarction, considered as P5P-deficient. In conclusion, the IFCC method with P5P should be applied for measuring AST and ALT serum levels.
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