• 1
    Oct
  • The Utility of Lactate Dehydrogenase Isoenzyme Pattern: RESULTS

LDH levels and isoenzyme activities were studied in the ascitic fluid in malignant ascites and non-malignant ascites. Data regarding LDH and its isoenzymes of malignant and nonmalignant ascites were summarized in Table 1. LDH level and LDH isoenzyme activities of subgroups were shown in Table 2.

Table 1. Ascitic Fluid LDH Levels and Its Isoenzyme Activities in Malignant and Nonmalignant Ascites

Malignant Ascites (n=21) Nonmatignant Ascites (n=55)

P Value

Ascites LDH (U/l)

439.1 ±169.1

261.2 ± 135.7

<0.001
Ascites LDH-1 (%)

21.2 ±4.0

43.9 ± 5.2

<0.01
Ascites LDH-2 (%)

29.5 ± 3.6

23.8 ± 2.5

0.076
Ascites LDH-3 (%)

22.6 ± 1.4

18.8 ± 1.1

0.095
Ascites LDH-4 (%)

15.6 ±2.8

5.9 ± 1.3

O.001
Ascites LDH-5 (%)

11.4 ±2.5

5.1 ± 1.2

<0.001

Table 2. Ascitic Fluid LDH Level and Its Isoenzyme Activities in All Groups

Group 1 Group 2a Group 2b Group 2c Group 2d
(n=21) (n=15) (n=13) (n=13) (n=14)
Ascites LDH (U/l)

439.1 ±169.1

93.5 ± 35.7

62.8 ± 7.8

740.5 ± 270.4

185.4 ± 66.6

Ascites LDH-1 (%)

21.2 ±4.0

32.7 ± 3.2

78.7 ± 4.8

16.9 ±5.9

42.4 ± 6.2

Ascites LDH-2 (%)

29.5 ± 3.6

36.7 ± 1.5

14.0 ± 1.2

20.1 ± 1.5

26.2 ± 2.4

Ascites LDH-3 (%)

22.6 ± 1.4

28.9 ±3.1

7.1 ±3.6

32.3 ± 1.1

10.4 ± 1.8

Ascites LDH-4 (%)

15.6 ±2.8

0.3 ± 0.3

0

18.5 ±4.5

5.6 ±2.1

Ascites LDH-5 (%)

11.4 ± 2.5

0

0

12.1 ±3.1

8.6 ± 2.3

LDH Levels
In all groups, the highest and lowest ascitic fluid LDH levels were detected in group 2c and group 2b, respectively. Ascitic fluid LDH was found to be significantly higher in malignant ascites when compared with nonmalignant ascites (pO.OOl). Ascitic fluid LDH levels were found to be significantly higher in group 2c when compared with group 2a (p<0.01) and group 2b (p<0.01), in group 1 (p<0.01) and group 2d (pO.Ol) when compared with group 2b.
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LDH-1 Activity
The highest and lowest ascitic fluid LDH-1 activities were detected in group 2b and group 2c, respectively. Ascitic fluid LDH-1 activity was found to be significantly lower in malignant ascites when compared with nonmalignant ascites (pO.Ol). Ascitic fluid LDH-1 activity was found to be higher in group 2a when compared with group 1 (p<0.01) and group 2c (pO.Ol); in group 2b when compared with group 1 (pO.OOl), group 2a (pO.OOl), group 2c (pO.OOl) and group 2d (pO.OOl); in group 2d when compared with groups 1 (pO.Ol) and 2c (pO.Ol).

LDH-2 Activity
There was no statistically significant difference between malignant and nonmalignant ascites groups (p=0.076). Ascitic fluid LDH-2 was found to be higher in group 2a when compared with groups 1 (pO.OOl), 2b (pO.OOl), 2c (pO.OOl) and 2d (pO.OOl); in group 1 (pO.Ol), group 2c (pO.Ol) and group 2d (pO.Ol) when compared with group 2b.
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LDH-3 Activity
There was no statistically significant difference between malignant and nonmalignant ascites groups (p=0.095). Ascitic fluid LDH-3 activity was found to be higher in group 2a when compared with group 2b (pO.OOl) and group 2d (pO.OOl); in group 1 when compared with group 2b (pO.Ol) and group 2d (pO.Ol); in group 2c when compared with group 2b (pO.OOl) and group 2d (pO.OOl).

LDH-4 Activity
Ascitic fluid LDH-4 activity was not detected in patients with sterile cirrhotic ascites. Ascitic fluid LDH-4 activity was found to be significantly higher in malignant ascites when compared with the nonmalignant ascites group (pO.OOl). Ascitic fluidLDH-4 activity was found to be higher in group 1 (pO.OOl) and group 2c (pO.OOl) when compared with group 2a; in group 1 (p<0.01), group 2c (p<0.01) and group 2d (p<0.01) when compared with group 2b; in group 1 (p<0.01) and group 2c (p<0.01) when compared with group 2d.
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LDH-5 Activity
Ascitic fluid LDH-5 activity was not detected in patients with spontaneous bacterial peritonitis and sterile cirrhotic ascites. Ascitic fluid LDH-5 activity was found to be significantly higher in malignant ascites when compared with nonmalignant ascites (pO.OOl). Ascitic fluid LDH-5 activity was detected to be higher in group 1 (p<0.01), group 2c (pO.Ol) and group 2d (pO.Ol) when compared with group 2a; in group 1 (pO.Ol), group 2c (pO.Ol) and group 2d (p<0.01) when compared with group 2b. There were positive correlations between ascitic fluid LDH level, LDH-2, LDH-3, LDH-4 and LDH-5 activities with ascitic fluid albumin, globulin and protein levels. There was a negative correlation between ascitic fluid LDH-1 activity with ascitic fluid albumin, globulin and protein levels (Table 3). In the diagnosis of malignant ascites, the sensitivity and specificity were 96% and 76% for ascitic fluid LDH level (cut-off value >200 U/L), 90% and 70% for ascitic fluid LDH-1 activity (cut-off value <30%), 94% and 62% for ascitic fluid LDH-4 activity (cutoff value >60%), 100% and 56% for ascitic fluid LDH-5 activity (cut-off value >5%), respectively.
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Table 3. The Correlation between Ascitic Fluid LDH Isoenzymes with Ascitic Fluid Albumin, Globulin and Protein Levels

Ascitic fluid albumin Level (g/l)

Ascitic fluid globulin Level (g/l)

Ascitic fluid protein Level (g/l)

r value p value r value p value r value

p value

Ascitic fluid LDH level (U/l)

0.650

0.025

0.620

0.001

0.755

0.002
Ascitic fluid LDH-1 activity (%)

-0.700

0.035

-0.565

0.005

-0.645

0.015
Ascitic fluid LDH-2 activity (%)

0.450

0.047

0.585

0.042

0.495

0.025
Ascitic fluid LDH-3 activity (%)

0.550

0.037

0.750

0.035

0.640

0.035
Ascitic fluid LDH-4 activity (%)

0.400

0.045

0.440

0.040

0.485

0.030
Ascitic fluid LDH-5 activity (%)

0.600

0.025

0.450

0.030

0.555

0.038

The coefficient of variations for within-day repeatability and day-to-day reproducibility were 6.6% and 9.7%, respectively, for LDH.

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