peranan enzim

8/13/2019 peranan enzim

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PERAN ENZIM DALAMKLINIK

Yulia Suciati



Peran enzim dalam klinik

Enzim sebagai alat diagnosis

Enzim dan pengobatan



Enzim sebagai alat diagnosis

Terbagi menjadi tiga kelompok:Penggunaan enzim sebagai marker (Petanda)dari kerusakan suatu jaringan atau organ akibatpenyakit tertentuEnzim sebagai suatu reagensia untuk mengukurkonsentrasi suatu senyawa yang mempunyai nilaidiagnostik dalam cairan tubuh atau ekstrak

jaringanEnzim yang digunakan untuk melacak danmengukur konsentrasi senyawa tertentu.



Enzim sebagai suatu marker

Sebagian besar enzim berada dan bekerja didalam sel

Scr teori, seharusnya enzim intra sel tidakterlacak di dalam cairan ekstraselKenyataannya

?




Selalu terdapat enzim intra sel di dalamcairan ekstra sel ( darah dan cairan tubuhlain)

?




Antara lain disebabkan oleh adanya sel-selyang mati dan pecah, shg isinya tercurah kedalam cairan ekstra sel.

Dlm keadaan sehat, jumlah sel mati tersebut tidakbanyak dan tetap.

Aktifitas enzim intra sel di dalam darah selalu

rendah dan memiliki nilai maksimum.



Enzim sebagai suatu marker,…

Tiap keadaan yang menyebabkan hilang ataurusaknya keutuhan membran sel, akanmenyebabkan hilangnya fungsi membran sel

dalam mempertahankan gradien denganlingkungan luar

keracunan bhn kimia Adanya radikal bebasInfeksiTimbulnya sifat non-self membran sel




Juga oleh Turnover rate suatu enzim, Jumlahenzim yg disintesis dan jumlah enzim ygdipecah, pada kondisi fisiologis tertentu

c/ Fosfatase alkali anak-anak dan pdpenyembuhan tulang yg patah



Jenis enzim dalam plasma

Enzim yang bekerja atau fungsional di dalamplasma ( c/ enzim untuk penggumpalandarah, fibrinolisis, enzim pd sistem

komplemen, lipase lipoprotein, sistem renin-angiotensin)Enzim yang tidak bekerja didalam plasma,namun ada di tempat tersebut

Enzim sal cerna ( tripsin, pepsin, amilase)Enzim intrasel



Kebanyakan enzim intra sel yang digunakanuntuk tujuan diagnosis adalah enzimmetabolisme antara, baik metabolismekarbohidrat, lipid, maupun protein.Sehingga enzim yg sering digunakan berasaldari berbagai jaringan




Bagaimana memilih enzim yang terdapatdalam beberapa jaringan untuk tujuandiagnosis?

Dengan melihat nilai aktifitas spesifik tertinggienzim tersebut di berbagai jaringan

( c/ ALT untuk hati, AST untuk jantung)

Dengan mengukur aktifitas isozim khas jaringan( c/ CK 1, CK 2, LDH 1, LDH 2)



Transaminase

GPT ( Glutamat Piruvat Transaminase)/ALTGOT (Glutamat Oksaloasetat Transaminase)/

AST



GPT/ALT

Enzim ini tersebar luas di berbagai jaringan

Glutamic-Pyruvic Transaminase (GPT) isfound in significant quantities in liver, kidney,and skeletal muscle, in decreasing order.



GPT/ ALT

When liver cells are damaged, GOT and GPTlevels rise especially early in the disease.

The enzyme levels are especially useful inassessing subtle and early changes in biliaryobstruction and active cirrhosis.



GOT / ASTGlutamic-Oxaloacetic Transaminase (GOT)occurs in large concentrations in the heartand liver with moderate amounts in skeletal

muscle, kidneys, and pancreas. Aktifitas spesifik tertinggi GOT ditemukan di jantung.GOT levels can be used to diagnosemyocardial infarction within 10-48 hoursOther conditions with elevated GOT includearrhythmias and severe angina of the heart,and liver damage.



CS Mui et al,” Enzyme estimation as an aid to diagnosis”.

Singapore Medical Journal, 1962: 3 (1)



Lipase

Lipase is an enzyme secreted by thepancreas into the duodenum.Enzim hidrolase yg mengurai ikatan esterantara gliserol dan asam lemakDamage to the pancreas as in acutepancreatitis results in lipase in the blood fromthe secretory cells.



Amilase

Enzim ekstrasel yg bekerja di sal. CernaBerf/ memecah pati menjadi molekul-molekullbh kecilDihasilkan oleh sejumlah organ spt: kel liur,kel pankreas, kel air mata, kel prostat, tetapimemiliki aktifitas tertinggi di kel pankreasTerjadi peningkatan di serum padapankreatitis akut



Gamma-glutamyl Transpeptidase(GGT):

GGT catalyzes the transfer of the glutamylgroups among different polypeptides andamino acids.

Clinically significant GGT found in the bloodcomes from cells that line the biliary tract .GGT levels rise dramatically with obstructivediseases of the biliary tract and liver cancers.GGT is especially useful in assessing liverfunction associated with alcohol - inducedliver disease.



Aldolase:

Aldolase is present most significantly inskeletal and heart muscle.Damage to skeletal muscle produces highserum levels of aldolase, particularly in thecase of progressive muscular dystrophy .

Aldolase may also be slightly increased inearly stages of viral hepatitis and advancedcancer of the prostate.



Creatine Phosphokinase (CPK orCK)

CPK catalyzes the reversible transfer ofphosphate groups between creatine andphosphocreatine as well as between ATP

and ADP.Most of the CPK resides in skeletal muscle,heart muscle, and in the gastrointestinal tract.CPK enters the blood rapidly followingdamage to muscle cells.



CK

CK adalah protein dengan 2 subunit, yaitusubunit B ( Brain) dan M (Muscle)Terdapat 3 macam isozim, CK 1, CK 2, CK 3.

Aktifitas spesifik CK tertinggi ialah dalam ototrangkaPada seluruh penyakit distrofia otot, terjadikenaikan aktifitas



Lactic Dehydrogenase (LDH):

LDH is present in nearly all types ofmetabolizing cells, but different cells havedifferent forms of the enzyme which can bedistinguished.LDH catalized pyruvat to lactatThe enzyme is especially concentrated in theheart, liver, red blood cells, kidneys, muscles,brain, and lungs.



LDHThe total LDH can be further separated intofive components or fractions labeled bynumber: LDH-1, LDH-2, LDH-3, LDH-4, andLDH-5.Each of these fractions, called isoenzymes, isused mainly by a different set of cells ortissues in the body.



LDH-1 is found mainly in the heart.LDH-2 is primarily associated with the systemin the body that defends against infection.LDH-3 is found in the lungs and other tissues,LDH-4 in the kidney, placenta, and pancreas,and

LDH-5 in liver and skeletal muscle. Normally,levels of LDH-2 are higher than those of theother isoenzymes.



Certain diseases have classic patterns ofelevated LDH isoenzyme levels.For example, an LDH-1 level higher than thatof LDH-2 is indicative of a heart attack orinjury;

elevations of LDH-2 and LDH-3 indicate lunginjury or disease;elevations of LDH-4 and LDH-5 indicate liver

or muscle disease or both. A rise of all LDH isoenzymes at the sametime is diagnostic of injury to multiple organs.



One of the most important diagnostic uses forthe LDH isoenzymes test is in the differentialdiagnosis of myocardial infarction or heart

attack.The total LDH level rises within 24-48 hoursafter a heart attack, peaks in two to threedays, and returns to normal in approximatelyfive to ten days.This pattern is a useful tool for a delayeddiagnosis of heart attack.



The LDH-1 isoenzyme level, however, ismore sensitive and specific than the totalLDH.Normally, the level of LDH-2 is higher thanthe level of LDH-1.

An LDH-1 level higher than that of LDH-2, aphenomenon known as "flipped LDH," isstrongly indicative of a heart attack.



Enzim sbg obat

Berbagai penyakit saluran cerna yangdisebabkan oleh berbagai hal , seringkalidigunakan enzim pencernaan penggantiYang biasa digunakan adalah pepsin, tripsin,amilase, lipase.Juga pada kekurangan enzim yang menetapkarena kelainan genetik.c/ hemofilia



Enzim sbg obat

Pada kelainan G6PD (Glukosa 6 Phosfatdehidrogenase), yg dapat menimbulkankelainan berat pada eritrosit, shg tjdhemolisisKelainan fenilalanin hidroksilase, ygsebabkan sel tidak mampu mengubah

fenilalanin menjadi tirosin.Masih belum dapat dilakukan penggantianenzim intrasel ini krn beberapa sebab



Enzim sbd target pengobatan

Enzim sel individu sbg sasaranc/ asetazolamid yg menghambat keja anhidrasekarbonat, shg pertukaran kation di tubulus ginjaltdk terjadi

ACE Inhibitor pd hipertensiSenyawa penghambat COX I dan COX II, pdinflamasiMAO Inhibitor pd psn depresi



Enzim sbd target pengobatan

Enzim mikroorganisme patogen sbg sasaran

c/ antibiotika



TERIMA KASIH

Rabbi Zidna ‘ilma war zuqna fahma,

amiiin…

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