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KMID : 0367419690100010018
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Journal of Korean Pediatric Society
1969 Volume.10 No. 1 p.18 ~ p.31
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Studies of Serum Alkaline Phosphatase Activity and Serum Calcium, Inorganic Phosphorus, Calcium-Inorganic Phosphorus Product and Serum Proteins in Healthy Individuals from Birth to Maturity, Nutritional Deficiency and Mother-New born Pair among Korean Peo
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李晶燮/Lee, Johng Sup
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Abstract
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Following the discovery of enzyme as organic catalyst which was the active cause of the fermentation, came the first clue that the phosphate combining and splitting enzymes might be involved with processes of the fermentation in the animal body as well as in the yeast cells during the later ninteenth century. Then Robison proposed his well known "osteoblastic(alkaline) phosphatase" theory of bone formation based onthe determination of a high concentration of a glucose-phosphate splitting enzyme in young growing vones. Kay found that the high levels of phosphatase activity in growing bones were reflected by a higher activity of the enzyme in the blood plasma of infants and children than in that of adults.
Since those early develoing days, many kind of phosphatases, both specific and non-specific ones, to the latter alkaline phosphatase belong, have been studied as tools of clinical assesment. Numerous investigations on the serum alkaline phosphatase had thus revealed: commensurate high levels of activity accompanied with the normal processes of growth and development in close correspondence; markedly increased levels of activity in disorders of the skeleton characterized by overactivity of substantial numbers of osteoblast and in disorders of the hepatobiliary system, notably those characterized by obstruction of the extrahepatic or intrahepatic biliary tract; and that of low levels in disorders of skeletal growth, of various etiology and possibly in some growth failure from malnutrition such as in kwashiorkor.
On the account that there are still a considerable number of children afflicted with protein-calorie malnutrition since eary infancy resulting in retardation from normal growth in Korea, author has undertaken studies of serum alkaline phosphatase (SAP) activity, and levels of serum calcium (Ca), inorgarnic phosphorus (Pi), calcium-inorganic phosphorus product (Ca×Pi), serum albumin, globulin and total protein in order.
A) to observe those of normative values by age and sex from birth to maturity in relation to growth and development,
B) to observe those values in mother at term with those values in corresponding offspring in connection with the latter´s growth in utero and possibly thereafter, or early infancy.
Method:
SAP was measured in Bessey, Lowry and Brock´s units(BLU) or sigma units which express micromoles of the para-nitrophenol disodium phosphate; Ca, with the flame photometry; Pi, Fiske-Subbarow´s method and total protein, albumin and globulin were examined by the Kingsley´s biuret method.
A. Study in Healthy Individuals from Birth to Maturit
Material:
Serum specimens were collected from apparantly healthy 56 newborns, 385 children and 110 adults during the period from October 1954 to September 1955.
1) The mean SAP activity was 2.95±1.08 BLU at birth and highest in the 1-3 month group averaging 5.94±1.20 units in male and 5.84±1.29 units in female (range was 3.15 to 7.85 BLU), thereafter there was a steady fall to the yearly average between 3.85 and 4.16 BLU for the 2to 9 year age groups. At adolescence, values rose again averaging 4.37±1.41 BLU for the range between 1.72 and 12.0 units. This rise started at 9 years of age in girls and 12 years in boys. After pubertal rise there was a steady fall until the adult range of 1.60±0.72 BLU reached at late-teens in girls and early twenties in boys.
2) The mean Ca concentration was highest at birth averaging 10.27±0.35 mg% and a decline to 9.51±0.37mg% followed during next first month of life. In the 1 to 2 year group, it rose again to 10.02±0.46mg%. Thereafter, it remained for the range between 9.60±0.26 to 10.04±0.45mg% during the life.
3) The mean Pi concentration was 5.40±0.65mg% at birth and highest during the following first month of life averaging 6.14±0.58 mg% during the last childhood and it declined further to 3.64±0.56 mg% in adults.
4) The mean Ca×Pi values was 55.45±7.19 at birth and highest as likewise that of Pi during the first month of life averaging 57.69±7.17. It was for the range between 55.40±5.82 to 45.70±5.03 during the rest childhood and declined to 36.01±5.51 in adults.
For the values of Ca, Pi and Ca×Pi, there were bouts of peaks for the 4 to 7 year and the 9 to 12 year groups in female and for the 5 to 8 year and the 12 to 14 year groups in male.
5) Serum concentration of the mean total protein, albumin and globulin were 5.65±0.90, 3.73±0.51 and 1.96±0.44gm% at birth and rose to 6.41±0.74, 3.97±0.36 and 2.37±0.51gm% uring next first to third months of life. From the later infancy through the childhood they were in the ranges between 6.81±0.55 to 7.28±0.63gm%, 4.19±0.56 to 4.45±0.33gm% and 2.48±0.62 to 2.79±0.42gm%. In adults, they were 7.14±0.59, 4.52±0.39 and 2.63±0.46gm%, respectively.
6) Albumin to globulin ratio were 1.09 at birth, 1.82 during the first month of life adn 0.68 up to 3 months shoeing a steady delcline. It was in the range between 1.69 to 1.61 from the later infancy to the childhood and reached 1.72 in adults.
7) Protein level approached in general to the adult level during the later infancy, and was highest in the 12-13 year group in boys and in the 14-15 year group in girls.
B. Study in Nutritional Deficiency
Material :
Next are three groups of nutrional deficiency subdivided.
Hypoproteinemia :
33 patients whise total serum protein levels showed below 5.5gm% and/or those of albumia, below 2.5gm% were studied. Their age span was from 2 to 12 years.
Anemia, moderate degree:
A total of 45 patients ranging in age from 2 to 12 years who had hemoglobin values below 10~11gm% and/or those of packed cell volume below 30~32%, corresponding to age, were studied.
As control for the above two groups, 40 healthy children with almost the same age sex distribution were examined.
Anemia, severe degree:
A total of 13 female patients who had hemoglobin values below 7 gm% and/or those of packed cell volume below 23% were studied. As control 14 healthy girls around the same age were observed.
In comparison with data obtained among the above three groups referring to respective controls, a summary is enumerated as following:
1) Levels of mean SAP, serum Ca, Pi and Ca×Pi were decreased in all three groups except that of SAP activity in the severe anemia where 12% increase of the activity was onserved instead of 41 and 38% of respective decrease of the activity in the hypoproteinmia group and moderate anemia.
2) Alteration of mean Ca, Pi and Ca×Pi values were also utmost in the hypoproteinmia (9, 30 and 35% decrease in each), then in the severe anemia (8, 23 and 26% decrease) and least in the moderate anemia (5, 15 and 17% decrease).
3) Decrease of mean albumin and globulin concentrations (43 and 5% decrease) were remarkable in the hypoproteinmia group and it was more pronounced in the albumin part than in that if globulin as reflected by the 2.46/2.46 or unity A/G ratio.
4) In the moderate and severe anemias, mean concentrations of respective albumin value showed 14 and 13% decrease and those of total preotein, 3% of common decrease, whereas those of globulin showed 11 and 10% increase in each. Accordingly, some higher A/G ratios in the anemia groups than in the hypoproteinmia were figured resulting in 3.74/2.96 or 1.27 in the moderate anemia and 3.79/3.04 or 1.24 in the severa anemia.
5) In proportions, decrease of the mean total protein and albumin concentrations in both severe and moderate anemias were nearly in the same range, or slighly lighter for that of albumin in the severe anemias than in the moderate anemia whereas decrease of the mean serum Ca, Piand Ca×Pi values were more pronounced in the severe anemia than in the moderate anemia indicating decrease of those values, even for calcium concentration, are not entirely related to that of serum protein levels.
6) It was thought that level of SAP activity has some proportional relationship to serum globulin concentrate anemia group where values of the Ca, Pi and Ca×Pi showed least decrease among three groups.
C. Difference between Mother-Newborn Pairs
Material:
Serum specimens were obtained from 56 mother-newborn pairs who had normal delivery at this hospital. They were devided to two groups of pairs, namely, 34 non-anemic and 22 anemia mother-newborn pairs depending on mother´s hemoglobin level shown above or below 11.5 gm%. Control for mother was set with 38 non-pregnant women of the same age decade.
1) Mean SAP activity in mother were increased about 2.7 and 2.1 folds, from 1.31±0.43 BLU in the control, to 3.59±0.89 and 2.70±0.82 BLU non-anemic and anemia mothers indicating the SAP activity in the anemic mother was not so much raised as that of SAP in the non-anemic mother (t=3.701, p＜0.005).
The SAP activity in the mother of the non-anemic pair was also higher than that of SAP in the corresponding offspring: 3.59±0.89 vs. 2.86±1.08 units, in the mother and offspring although the difference was not statistically significant.
In the connection it may be noted that mean serum globulin level in the anemic mother was lower than that level in the control: 2.37±0.39 vs. 2.65±0.13 gm%, however, there was no difference between the globulin level in the non-anemic mother and that level in the control: 2.65±0.48 vs. 2.65±0.13 gm%.
2) In the non-anemic mother whose SAP activity, subgrouped by their offspring´s sex, revealed higher activity in 14 male-born mothers group than in 20 female-born mothers showing 4.18±1.18 vs. 3.13±0.53 BLU (t=3.389, p＜0.005).
3) In comrarison the non-anemic mother with the non-pregnant control, mean Ca concentration was lower in the mother than in the control : 9.62±0.44 vs. 9.87±0.12 mg% (t=-8.6, p＜0.005), whereas mean Pi concentration was higher in the mother than in the control : 3.81±0.46 vs. 3.61±0.57 mg% (t=4.9, p＜0.005). However, mean Ca×Pi in both groups were within the same range with no statistical difference : 36.63±6.05 vs. 35.64±5.49.
On the other hand, levels of mean Ca, Pi and Ca×Pi were higher in both newborn groups than each corresponding mother group. It was assumed, therefore, decrease of Ca concentration in mother material for the calcification of the growing fetus.
4) Decrease of mean total protein and albumin concentrations in both non-anemic and anemic mother comparing with those concentrations in the control were noted and the decrease were more pronounced in the anemic mother.
5) Mean concentrations of total protein and albumin were decreased in both newborn groups of non-anemic and anemic mothers, comparing with respective mother groups, and the difference was slighter in the anemic pair than in the non-anemic pair. Meanalbumin concentration in the newborn groups of non-anemic mother was nealy equal with or slightly decreased than its mother group whereas that of increase was 5% in the newborn groups of anemic mothers comparing with its mother group.
6) There was no defference between respective levels od SAP, Ca, piand Ca×Pi in the newborn groups of anemic mother and levels of those in the newborn of the non-anemic mother or rather they were slighty higher in the former than the latter.
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