Serum Cholinesterase Values Research Articles

An Assessment of the Value of Serum Cholinesterase as a Liver Function Test and in the Diagnosis of Jaundice

This report assesses the value of cholinesterase (ChE) activity as an indicator of liver function and analyses its usefulness in the diagnosis of jaundice. A rapid method of determination has been used, and alterations in ChE activity in conditions other than liver disease have been studied to permit a fuller and more accurate survey of its value as a liver function test. The level of serum cholinesterase activity remains constant under normal circumstances, and follows the pattern of protein metabolism, falling in catabolism and rising in anabolism.In hepatocellular disease cholinesterase activity is lowered. Very low levels in cirrhosis with jaundice indicate a grave prognosis. Normal levels are usual in post-hepatic jaundice unless complicating factors are present, such as cholangitis or liver metastases. Serum cholinesterase is useful both as a liver function test and in the diagnosis of jaundice provided consideration is given to the other factors which affect the level of activity of the enzyme.

Further studies on relationship between human serum cholinesterase and serum albumin.

The previously observed (1,2) correlation of serum albumin and serum cholinesterase values is prlobably due to the simultaneous production of these two proteins by related synthesizing mechanisms in the liver. Albumin does not act as a precursor of serum cholinesterase. Changes in the level of this enzyme reflect the changing ability of the liver to produce both serum cholinesterase and serum albumin. It is suggested that serum cholinesterase determinations are of prognostic value in liver disease and that cholinesterase determinations may be used as an indication of albumin synthesis, particularly in the presence of administered albumin.

Diagnostic value of serum cholinesterase determinations in jaundice and in cirrhosis of the liver

1. In cases of uncomplicated common duct stone with jaundice, serum Cholinesterase values varied from 41 to 112; 21 of 25 observations were above 50; a value below 40 speaks strongly against this diagnosis. 2. In cases of neoplastic obstruction of biliary passages with jaundice but without Cholangitis or metastases, Cholinesterase values varied from 40 to 74; a value below 40 throws considerable doubt on this diagnosis. 3. In cases of obstructive jaundice with Cholangitis or metastases, Cholinesterase values varied from 6 to 58 with 13 of 17 observations below 40; a value above 60 points to the absence of these complications. 4. In the jaundice of “catarrhal icterus” or toxic hepatitis values for Cholinesterase ranged from 28 to 100, 13 of 30 observations were below 50; 17 of 30 observations were above 50. Milder cases appeared to have higher values, and clinical improvement was accompanied by rise in the Cholinesterase level. 5. In the most important clinical problem, the differential diagnosis between biliary tract obstruction and toxic hepatitis (including catarrhal jaundice) a high value is of no aid; a value below 40 speaks against obstruction provided metastases or Cholangitis can be excluded. 6. Cases of cirrhosis of the liver, with or without jaundice, show low Cholinesterase values, the range being 9 to 69; 36 observations were below 50, 32 of 38 below 40. A value above 40 speaks against cirrhosis; a value above 50 practically excludes cirrhosis.