Levitt Michael D, Hapak Sophie M, Levitt David G
Medicine Service, Veterans Affairs Medical Center, Minneapolis, MN, 55417, USA.
Department of Medicine, University of Minnesota, Minneapolis, MN, 55455, USA.
Clin Exp Gastroenterol. 2022 Mar 15;15:41-49. doi: 10.2147/CEG.S345531. eCollection 2022.
While serum alkaline phosphatase activity has become a routine clinical measurement, we have found that physicians' knowledge of the pathophysiology of this enzyme is almost solely limited to the concept that an elevated serum alkaline phosphatase suggests disease of liver or bone. For example, physicians at all levels of training had no understanding of such basic physiological information as the function of alkaline phosphatase in the liver or how this enzyme is eliminated from the serum. Based on a patient with an enormously elevated alkaline phosphatase, this report provides a review of existing clinically relevant information concerning the pathophysiology of alkaline phosphatase with emphasis on the mechanisms involved in the homeostasis of this enzyme. A novel aspect of this paper is the discussion of the previously neglected concept that defective enzyme elimination could play a major role in the pathogenesis of serum alkaline phosphatase elevations.
虽然血清碱性磷酸酶活性已成为一项常规临床检测指标，但我们发现医生对这种酶的病理生理学知识几乎仅局限于血清碱性磷酸酶升高提示肝脏或骨骼疾病这一概念。例如，各级培训阶段的医生都不了解碱性磷酸酶在肝脏中的功能或该酶如何从血清中清除等基本生理信息。基于一名碱性磷酸酶大幅升高的患者，本报告对有关碱性磷酸酶病理生理学的现有临床相关信息进行了综述，重点关注该酶稳态维持所涉及的机制。本文的一个新颖之处在于讨论了先前被忽视的概念，即酶清除缺陷可能在血清碱性磷酸酶升高的发病机制中起主要作用。
