Alkaline phosphatase is reduced in women. Blood alkaline phosphatase level. Reasons for increased phosphatase

Doctors often prescribe one or another biochemical blood test, but if you have heard about most of them at least once throughout your life, an alkaline phosphatase test almost always takes you by surprise. What is it and why is it being studied? Why is alkaline phosphatase in the blood elevated?

What is alkaline phosphatase?

This is an enzyme that splits phosphate from molecules of organic substances. It is especially active in an alkaline environment - this is where its name comes from. IN Not large quantities ALP is found throughout the body. Most of this enzyme is in the liver, bone tissue and placenta.

A small amount of enzyme in the blood is considered normal, since cells tend to constantly renew themselves. But if they die in large quantities, then the analysis reveals that alkaline phosphatase in the blood is increased. The reasons for this phenomenon are varied. If the indicators differ significantly from the norm, then pathology of the bones, intestines, liver or a malignant process in the body can be suspected.

The levels of this enzyme depend on the age and gender of the person. In children, ALP is normally higher than in adults, and in women it is lower than in men. Average normal indicators phosphatase levels in the blood range from 20 to 140 International Units per liter.

When is an alkaline phosphatase test prescribed?

ALP analysis may be included in the list of mandatory tests for certain categories of workers who have contact with harmful substances, and at preventive examinations. An alkaline phosphatase test may be ordered in preparation for surgical intervention. It is also determined to evaluate liver function or diagnose jaundice.

This study can clarify the situation with pain in the abdomen, right hypochondrium, itching skin, weakness, loss of appetite, nausea, vomiting, bone lesions. With these pathological processes alkaline phosphatase is increased.

The influence of negative factors on alkaline phosphatase

There are factors that can affect the result of the analysis, that is, it will indicate pathology, but it may not actually be in the body. Such circumstances leading to false positive result, can be attributed to:

period of healing of fractures;
pregnancy;
time active growth bones;
some medicinal substances, affecting the activity of the enzyme: Paracetamol, antibiotics, acetylsalicylic acid;

Alkaline phosphatase is elevated due to errors at the preanalytical stage, for example, if the blood was cooled. When taking hormonal contraceptives, the indicator may decrease.

Why is alkaline phosphatase elevated?

Test results sometimes discourage us. A person is not always ready to accept that he has some health problems. Increased alkaline phosphatase in the blood - what does this mean? Most often this indicates pathology of the liver or biliary tract. The reasons include obstructive jaundice, which is associated with obstruction of the biliary tract. If alkaline phosphatase is elevated, this may indicate stones in the gallbladder, as well as scars of the biliary tract after operations. High level enzyme sometimes indicates cancer, cirrhosis, hepatitis or malignant process in the stomach.

Alkaline phosphatase is greatly increased in liver cancer and metastasis in it. Among infectious diseases, in which the enzyme level increases, infectious mononucleosis can be noted.

Alkaline phosphatase is also elevated in bone lesions. There is an increase in the level of this indicator in hyperparathyroidism, myocardial infarction, intestinal perforation, and ulcerative colitis.

Increased enzyme content in bone tissue

Why is alkaline phosphatase elevated in bone tissue? The fact is that bone tissue contains quite a lot of this enzyme, so it reacts to any changes in the bones. Bone ALP is secreted by osteoblasts, which are large cells with a single nucleus. They are located directly on the surface of the bone tissue, and it is in these places that its intensive formation occurs. ALP increases most in Paget's disease, which is characterized by overgrowth bone tissue and disruption of its very structure.

If osteosarcoma develops or bone metastases appear, ALP also increases. When there is insufficient calcium in the body, bones begin to soften. The enzyme reacts sensitively to this process, which is also called osteomalacia, and therefore its level in the blood increases.

Bone ALP increases during bone growth and fusion, so it is significantly higher in children and adolescents than in more mature patients. Its increase is observed in fractures.

Why does liver alkaline phosphatase increase?

Alkaline phosphatase is found in large quantities in the liver, so any changes in its work are reflected in the enzyme levels in the blood serum. It begins to be released in large quantities from hepatocytes, which is reflected in the blood picture, including in the analysis of alkaline phosphatase. Quite often, an increase in the enzyme indicates damage to liver cells or dysfunction of the liver itself.

Decreased alkaline phosphatase

ALP can not only be elevated, but the level of this substance can also decrease significantly. This is also associated with any diseases.

One such disease is hypophosphatasemia. This is a hereditary pathology, which consists in the fact that phosphatase is constantly excreted in the urine. Increased release of the body from this substance leads to its acute deficiency.

Hypothyroidism is another disease in which the level of alkaline phosphatase in the blood decreases. With decreased activity thyroid gland, due to a lack of certain microelements, the production of phosphatase also undergoes changes, which then affect human health.

Lack of vitamin B12, C, zinc or folic acid can also lead to a decrease in ALP. This disease is called pernicious anemia. Sometimes this substance can decrease due to a lack of growth hormone in children.

Experts pay special attention to the condition of the placenta during fetal maturation. If alkaline phosphatase in the blood of a pregnant woman is low, this indicates that the placenta is not developing fully. She is vital important body for the health of the child, so you need to monitor the levels of this substance in expectant mothers.

Decreased and increased alkaline phosphatase in the blood: what does this mean? We have already decided and learned what the consequences of vibrations of this substance can be. Be healthy!

Alkaline phosphatase is an indicator that often appears in a comprehensive biochemical blood test. This enzyme is responsible for the functions of many organs, primarily the liver and the osteoarticular system. It got its name because it is most active in an alkaline environment, where the pH is from 8 to 10. Normal concentrations of this substance are in a fairly wide range, so only significant deviations acquire clinical significance. To correctly interpret this analysis, it is necessary to have an idea of the function of the enzyme and its norms by age.

What is alkaline phosphatase used for?

Alkaline phosphatase is an enzyme from the group of hydrolases. Under its influence, dephosphorylation reactions occur in the body - the removal of phosphates from bioorganic compounds at the molecular level. There are several types of phosphatases based on localization:

intestinal;
hepatic;
placental;
bone;
renal.

In laboratories they determine general level alkaline phosphatases of the body, which reflect the functions of liver and bone tissue. The enzyme transfers phosphorus between molecules and cell membranes, and therefore participates in the regulation of phosphorus-calcium metabolism along with parathyroid hormone and calcitonin.

Alkaline phosphatase is synthesized in osteoblasts - the structural units of bones, as well as in hepatocytes - the cells that form the liver stroma. When the activity of these cells increases, or when they are destroyed, the production of the enzyme increases and its concentration in the blood increases.

Regulation of phosphorus-calcium metabolism. Alkaline phosphatase works in all organs taking part in it

The dominant site of enzyme production is the liver. After its synthesis by the cells of this organ, the enzyme, along with bile, enters the intrahepatic ducts, through which it flows outside the liver into the common bile duct, which flows into the duodenum.

If there is an obstruction to the flow of bile, alkaline phosphatase increases along with other components of bile synthesized in the liver, such as cholesterol. This condition is called cholestasis, in which alkaline phosphatase in the blood will always be elevated.

In second place in importance is bone alkaline phosphatase. It plays a role in bone renewal and regeneration. If bones grow or heal after fractures, then alkaline phosphatase activity increases and this is normal.

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Normal blood enzyme values

Fluctuations in alkaline phosphatase in the blood are normal phenomenon. Depending on the laboratory, enzyme values can range from 43 to 148 IU/L (international units per liter). The analysis results may be higher, and this will be the norm.

The level of alkaline phosphatase in the blood depends on a person's age and gender. In women during pregnancy, the enzyme is sometimes slightly higher than the average values, but this will be within normal limits. In children, rates are often higher than in adults. Such changes are explained by the characteristics of hormonal and other life systems at a certain period of life.

The results also depend on the reagents used in the laboratory: there is no standardized universal method for determining alkaline phosphatase. The table shows the average alkaline phosphatase norm values by age and gender.

For getting reliable results necessary proper preparation to research:

12 hours before the test, do not eat or drink water;
2 hours before the test, eliminate physical activity and stress;
do not smoke an hour before the examination.

Causes of increased alkaline phosphatase

If the patient has complaints such as fatigue, loss of appetite, discomfort or pain syndrome in the right hypochondrium, bone pain or nausea, then the level of alkaline phosphatase should be determined - in these situations it is often elevated. The most indicative result will be for the diagnosis of bone and liver diseases.

The detection of high enzyme values also occurs in the absence of any symptoms, for example when routine medical examination or during preparation for surgical operations. To clarify the activity in this case, you can take the test a second time, repeat high result indicates that there is a deviation.

An increase in alkaline phosphatase is assessed comprehensively: if other liver enzymes (AST and ALT) increase along with it, then this indicates diseases of the liver and gallbladder; if, along with the enzyme, the values of calcium and phosphorus deviate from the norm, then the bones and parathyroid gland must be examined .

There are 4 main groups of conditions that can lead to increased alkaline phosphatase:

1. Changes in the liver, biliary tract and pancreas systems. Variants of pathologies include obstructive jaundice due to gallstones or cancer of the head of the pancreas or stomach, liver cancer and cirrhosis, viral and autoimmune hepatitis. Infectious mononucleosis, which leads to liver enlargement, also increases the enzyme.
2. Bone diseases and parathyroid gland. These diseases include any lesions of the parathyroid gland with changes in calcium and phosphorus metabolism, osteomalacia, rickets, myeloma. Less common is Paget's disease, which affects the bone structure. Metastasis of any cancer to the bone can also cause an increase.
3. Other causes related to diseases. Myocardial infarction, ulcerative colitis and Crohn's disease, hematological diseases - all of them can lead to increased alkaline phosphatase, but quite rarely. Diagnosis of these diseases cannot be based solely on an increase in this enzyme.
4. Non-painful conditions. These include pregnancy, childhood and adolescence when the increase in alkaline phosphatase is physiological. The level of the enzyme is also affected by the intake of certain medicines- antibiotics, combined oral contraceptives and some others. After treatment with these medications is completed, the enzyme level returns to normal.

Reasons for the decline

Much less common is a decrease in alkaline phosphatase. This can either indicate dangerous diseases or be a sign of minor deviations from the norm, so you should not neglect a visit to the doctor. A decrease in the enzyme occurs in the following conditions:

large blood transfusions, large blood loss;
hypofunction of the thyroid gland and its diseases;
severe anemia with hemoglobin below 90 g/l;
magnesium and zinc deficiency;
hypophosphatasia - congenital deficiency of alkaline phosphatase, which is clinically manifested by softening of bone and dental tissue;
placental insufficiency in pregnant women.

Deformation of skeletal bones due to hypophosphatasia

Treatment

To qualitatively assess changes in the concentration of alkaline phosphatase in the blood, any doctor needs some additional methods examinations. This:

general and expanded biochemical analysis blood;
general urine analysis;
ultrasound examination of the liver and biliary tract;
X-ray of bones and joints, if there are complaints from them.

Only after this the doctor will be able to prescribe adequate treatment.

Treatment for elevated alkaline phosphatase is carried out in accordance with the detected pathology. If the liver suffers, then hepatoprotective and detoxification therapy is prescribed, supported by choleretic agents.The drugs used in treatment are:

1. Heptral.
2. Essentiale forte.
3. Chophytol.
4. Gepamertz.
5. Alphanormix.
6. Ursodeoxycholic acid.
7. Trimedat.

The listed medications come in different pharmacological groups, only a doctor is involved in selecting the dosage; independent use is unacceptable. Folk remedies (decoctions and infusions choleretic herbs- immortelle, wormwood, tansy, dandelion) are justified only if they reinforce the main drug therapy. At complex treatment You can reduce alkaline phosphatase faster.

If bone problems are identified, treatment is prescribed by a traumatologist or rheumatologist. Drugs that stimulate bone growth and vitamin D3 are commonly used. If hematological disorders are detected, the patient is referred to a hematologist. Treatment by a hematologist is specific, drugs are not sold in the pharmacy chain, traditional methods Treatments only harm your health.

Thus, if elevated alkaline phosphatase is detected, careful additional examination for staging correct diagnosis and carrying out correct treatment.

And a little about secrets...

A healthy liver is the key to your longevity. This body performs great amount vital functions. If the first symptoms of the disease were noticed gastrointestinal tract or liver, namely: yellowing of the sclera of the eyes, nausea, rare or frequent stool, you simply must take action.

Alkaline phosphatase- a necessary component of the body’s enzyme system, it is important to know if it is elevated, what it means and what it affects. This parameter is determined by biochemical analysis of serum. In itself, a change in the direction of increasing or decreasing ALP does not mean the presence of a specific disease, however, this indicator is very valuable for diagnosis.

Why does alkaline phosphatase in the blood increase?

The normal content of alkaline phosphatase, detected by biochemical analysis, ranges from 45 to 148 grams per mole. What does exceeding the specified level indicate? Increased alkaline phosphatase in the blood has certain reasons:

peculiarities healthy body;
liver pathologies: cirrhosis, (also with hepatitis B and C), tumors, postoperative period;
diseases of the gastrointestinal tract;
infectious lesions digestive system;
ulcerative colitis;
cholelithiasis and diseases of the biliary tract;
infectious mononucleosis, leading to decreased liver function;
bone diseases, for example, myeloma, rickets, osteomalacia, bone metastases;
myocardial infarction.

As can be seen from the list above, the cause of increased enzyme activity can be either a pathology or a feature of a relatively healthy organism as a variant of the norm.

Natural reasons why alkaline phosphatase is elevated

Here are some conditions that increase the parameter under consideration, but are not pathological:

hormonal changes (periods of growth and puberty, the end of bone growth);
functioning of the placenta later pregnancy;
recovery time in the postoperative period and after bone fractures;
treatment with certain medications, for example, aspirin, paracetamol, taking oral contraceptives (here we mean those medications that affect the condition of the liver, thereby increasing the content of various enzymes in the serum);
certain age periods: childhood due to active growth and in the elderly due to bone resorption;
bad habits negatively affecting the liver: tobacco and alcohol use, substance abuse;
lack of adequate physical activity;
unhealthy eating habits(significant predominance of fatty and trans-fat-rich foods in the diet);
obesity.

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If all other indicators, against the background of the fact that alkaline phosphatase is increased, are normal, then the person is healthy, and exceeding the norm of the parameter in this case is an individual version of the norm. Therefore, this condition does not require correction or treatment.

IMPORTANT! Many states causing an increase enzyme levels, which in themselves are not a pathology (bad habits, overweight, physical inactivity) can subsequently cause harm to health, so in these cases the patient’s lifestyle needs to be revised.

Why is ALP elevated in pregnant women?

An increase in enzyme activity during pregnancy is one of the manifestations of changes in this parameter according to physiological reasons. So, normally, the content of this enzyme in the serum always exceeds in the later stages of pregnancy, that is, in the third trimester.

This increase in enzyme content in the serum of pregnant women is due to the fact that at this time the placenta, which is responsible for feeding the child, is actively growing and developing. And this provokes an increase in metabolic processes, which is why the phosphatase parameter increases.

ATTENTION! Moreover, a decrease in alkaline phosphatase in a pregnant woman is much more serious problem, since it indicates placental insufficiency, which can lead to fetal hypoxia.

However, this does not mean that when alkaline phosphatase is elevated in a pregnant woman, no attention should be paid. After all, an excessive excess of the enzyme level may indicate such pathological conditions like eclampsia (preeclampsia late period). In order to identify this, one should carry out additional tests, since increases in enzyme levels, in particular ALP, can negatively affect placental cells.

IMPORTANT! If a woman had problems with the health of the gastrointestinal tract, biliary tract or liver even before pregnancy, then more careful attention needs to be paid to the fact that ALP is increased in the process of preparing for motherhood.

Symptoms of elevated alkaline phosphatase

The parameters of enzyme activity are shown by a biochemical blood test. For various age categories The normal content of this substance in the blood serum is as follows:

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If an increase in phosphatase level is detected in comparison with age norm, then the therapist will refer the patient for additional examinations and to a specialized specialist.

Mechanism for raising the ALP level

ALP is found in many human tissues, and the largest amounts are in the intestinal mucosa, bone cells (osteoblasts), in the bile ducts, in the developing placenta and in the glandular tissue of the breast during lactation. With the help of this enzyme, phosphoric acid and its organic derivatives are broken down, which occurs due to the high pH of the enzyme, that is, the corresponding pH of the alkali (for which this substance received its name). All this is necessary for the transport of phosphorus within the body.

Usually in diagnostic purposes used to determine liver activity and bone forms enzyme. What diseases can cause increased release of alkaline phosphatase from the liver and bones? Obviously, when these organs are destroyed. That is why detecting an elevated level in the blood may indicate the presence of a specific diagnosis.

When is a test prescribed to determine if ALP is elevated?

Why might a doctor prescribe a test to determine alkaline phosphatase activity? Analysis is prescribed in the following cases:

during medical examinations and medical examinations of citizens employed in hazardous industries;
in the complex of preparations for surgical intervention;
with jaundice;
if there are signs of damage to the liver, gastrointestinal tract and biliary system: abdominal pain (right under the ribs), itching, dyspepsia.

ATTENTION! It should be remembered that it is possible to determine whether alkaline phosphatase is increased only in comparison with the age norm, since normal values for a child and an adult differ significantly.

How to prepare for donating blood for alkaline phosphatase?

To obtain the most correct result, you need to donate blood from a vein strictly on an empty stomach. Since the enzyme content in the body is affected by the condition of the liver, before donation you should avoid excessive stress on it, namely:

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When does alkaline phosphatase decrease?

As a result biochemical research You can see not only when the enzyme level is elevated, but also the opposite situation. Decreased phosphatase may also indicate health problems:

about placental insufficiency, if we are talking about a pregnant woman;
hypothyroid condition (decreased thyroid function);
severe anemia, including iron deficiency;
microelement deficiencies (Mg, Ca, Zn and others);
congenital pathology - hypophosphatasia, which leads to osteomalacia.

In addition, a decrease in phosphatase activity can also be observed in the post-transfusion period if a large volume of blood or its components was transfused. If the results of biochemistry revealed a decrease in the enzyme, as in the case of an excess, the specialist will prescribe an additional examination to make a diagnosis and tell you how to increase alkaline phosphatase if necessary.

So, in itself, exceeding the normative value of the content of this indicator is not yet a reason to worry. Be sure to discuss this with your doctor to schedule further examination.

Alkaline phosphatase in the blood is determined during a biochemical analysis. Although the name is not very common, the diagnostic significance of this indicator is very high.

A blood test for alkaline phosphatase can identify problems with the liver, and the presence of hepatitis of various etiologies can be determined. It is also possible to identify primary malignant neoplasms in the liver.

The results of the analysis also reveal problems with musculoskeletal system. This study is especially important for older people.

It is also important to use diagnostic capabilities alkaline phosphatase with cardiovascular diseases. In this area this parameter good opportunities to detect problems.

The term alkaline phosphatase (ALP) implies that all enzymes with phosphatase activity exhibit maximum efficiency under conditions alkaline environment(that is, at a pH of 8.6 to 10.1), so alkaline phosphatase is not active in the blood and is normally found in minimal quantities.

The presence of alkaline phosphatase is noted in many tissue and organ structures of the body. However, the largest “reserves” of this enzyme are observed in:

osteoblasts;
hepatocytes;
nephrocytes;
small intestine;
placenta;
mammary gland during lactation.

Important. The overwhelming percentage of cases of increased alkaline phosphatase levels in the blood is associated with liver and bone diseases. Most rarely, alkaline phosphatase is elevated due to pathologies small intestine.

Normal alkaline phosphatase levels

To obtain the most correct results, blood sampling should be done on an empty stomach from a vein. Blood serum is used for the study. The standard period for completing the study is one day.

In adult men, normal values range from 40 to 130 IU/l, and in women from 35 to 105 IU/l.

ALP is elevated, what does this mean in an adult and a child?

Elevated alkaline phosphatase in a biochemical blood test usually indicates damage to the hepatobiliary system or bone tissue.

Alkaline phosphatase is elevated. Causes

A pronounced increase in enzyme levels is observed with cholestasis (stagnation of bile). This condition develops when the lumen of the bile duct is obstructed by a stone (GSD), as well as in the presence of a tumor or metastasis that prevents the normal outflow of bile.

More rare reasons cholestasis are postoperative strictures, primary sclerosing cholangitis (damage to the intrahepatic ducts) and primary biliary cirrhosis, accompanied by sclerosing of the bile ducts.

Very important! For hepatitis viral etiology, unlike aminotransferases, alkaline phosphatase may remain normal or increase slightly. A marked increase in this enzyme in biochemical blood tests in patients with hepatitis viral nature, is a poor prognostic sign. This indicates necrosis of hepatocytes and the development of cirrhosis.

Also, an increase in the level of alkaline phosphatase in the blood occurs with hepatitis of toxic etiology (alcohol poisoning, medicinal hepatitis). The greatest hepatotoxic effect is exerted by:

tetracycline antibiotics,
paracetamol,
valproic acid,
salicylates,
amiodarone,
antimalarial drugs,
synthetic estrogens (liver damage occurs during treatment with high doses; as a rule, a similar complication develops in patients with prostate cancer).

Alkaline phosphatase in the blood increases sharply with primary malignant neoplasms of the liver, as well as with its damage by metastases.

Attention! In women who long-term use of tablet hormonal contraceptives containing estrogen and progesterone, an increase in alkaline phosphatase is possible due to bile stagnation.

In addition to damage to the hepatobiliary system, similar changes in analyzes are observed with damage to the musculoskeletal system.

In bone tissue, ALP is found in osteoblasts - young bone-forming cells. Therefore, when bones are damaged, their work is activated, and, consequently, the activity of alkaline phosphatase increases.

This picture is typical for fractures, and alkaline phosphatase increases immediately after injury (due to bone damage) and persists throughout the healing of the fracture (due to the activation of osteoblasts).

Also, the level of the enzyme is sharply increased in Paget's disease. This is a pathology accompanied by increased destruction of bone tissue, bone deformation and frequent fractures, even after minor trauma. At severe course the disease develops chronic heart failure. It's connected with increased load on the heart, since for the constant regeneration of damaged bone structures increased blood supply is required.

In hyperparathyroidism, alkaline phosphatase in the blood increases due to stimulation of bone resorption (destruction) by parathyroid hormone. The disease is also accompanied by a pronounced disturbance in the metabolism of Ca and P.

Other reasons for increased alkaline phosphatase in the blood are:

thyrotoxicosis;
pulmonary or kidney infarction;
osteogenic sarcoma;
metastasis to bone tissue;
multiple myeloma;
Hodgkin's disease, accompanied by damage to bone structures.

Fanconi phosphorus diabetes is considered a rare cause of elevated alkaline phosphatase. This is a severe congenital disorder of P and Ca metabolism, caused by D-vitamin resistant rickets.

In patients with Fanconi diabetes, the process of reabsorption of phosphates by the renal tubules is impaired, the absorption of calcium in the intestine is reduced and the function of parathyroid glands. Clinically, the main manifestation of the disease is severe bone deformities leading to severe disability.

Also, alkaline phosphatase increases during severe intestinal infections.

If alkaline phosphatase is elevated. Reasons for a child

Normally, an increase in alkaline phosphatase is detected during the period of active bone tissue growth. This picture in a biochemical blood test is observed before puberty. Next, the level of alkaline phosphatase begins to decrease.

A pathological increase in the enzyme may be due to rickets, fractures, infectious mononucleosis, intestinal infections, Fanconi diabetes. This list also includes the same reasons for increased ALP as in adults ( cholelithiasis, malignant neoplasms with metastasis to the liver, hyperparathyroidism, etc.).

Can alkaline phosphatase be elevated during pregnancy?

In pregnant women, moderately elevated levels of alkaline phosphatase are considered normal. A sharp increase in the enzyme in the analysis can be detected in severe gestosis (preecampsia and eclampsia).

A decrease in alkaline phosphatase activity is characteristic of placental insufficiency.

Increased values in cardiovascular diseases

With congestive right ventricular failure, there is a pronounced overload of the right parts of the heart. Clinically, the disease is manifested by swelling of the jugular veins, high venous pressure, arterial hypotension, enlarged liver, edema (the severity of edema depends on the stage of the disease and can vary from edema to lower limbs to anasarca).

Upon examination, attention is drawn to yellowness of the skin and local cyanosis, affecting the tip of the nose, ears, chin and fingers.

Attention! An increase in alkaline phosphatase in right ventricular failure is directly proportional to liver damage. With pronounced venous stagnation the liver can become so enlarged that it bottom line will be located in the pelvis.

Right ventricular failure (RF) can develop against the background of severe left ventricular failure.

The causes of isolated PN are:

chronic lung pathologies;
congenital heart defects that occur with overload of the pancreas;
constrictive pericarditis;
congenital pulmonary insufficiency;
obesity and arterial hypertension;
severe kyphoscoliosis
heart tumors and metastases to the myocardium, etc.

Heart failure in primary malignant tumors myocardium (most often sarcoma), characterized by a rapid course, sharp deterioration contractility, severe violations rhythm and early defeat liver (characterized by a rapid and pronounced increase in alkaline phosphatase levels). Also, heart failure of the right ventricular type can develop due to massive metastasis of distant tumors to the lungs.

Severe liver atrophy and heart failure with subacute course characteristic of stomach cancer. A sharp increase In this case, alkaline phosphatase can be observed both when the tumor metastasizes to the gates of the liver, and in heart failure due to extensive metastasis of the lungs. In both cases, there is a pronounced and persistent increase in the enzyme in the analysis, due to liver atrophy.

Increased ALP may also occur in small intestinal cancer and carcinoid tumor Gastrointestinal tract (often metastasizes to the heart).

Important. A sharp increase in alkaline phosphatase can be observed during pulmonary infarction as a result of pulmonary embolism.

Elevated alkaline phosphatase may be diagnosed in HF with high cardiac output. Such HF is characterized by an accelerated heart rate and increased minute volume blood, the presence of congestion in the lungs and warm (without cyanosis of the fingers) extremities.

Diseases in which this HF develops are:

Paget's disease;
severe arrhythmias;
acute glomerulonephritis with arterial hypertension;
thyrotoxicosis.

For reference. After childbirth, increased readings may also be diagnosed. This is due to the fact that ALP is contained in the mammary gland during lactation. Therefore, in breastfeeding women, rates may be slightly increased.

Why is alkaline phosphatase low?

In contrast to elevated enzyme levels, decreased alkaline phosphatase is detected quite rarely.

In women, such changes in tests may be due to the use of oral contraceptives (however, they can also lead to stagnation of bile, and then alkaline phosphatase increases).

During pregnancy, a decrease in the enzyme is determined with the development of placental insufficiency.

Other reasons for a decrease in alkaline phosphatase in the analysis are:

congenital hypothyroidism;
congenital chondrodystrophy;
deficiency of vitamin C, Mg and Zn;
overdose of vitamin D;
hypothyroidism;
severe anemia and conditions after blood transfusions;
kwashiorkosis (a severe form of dystrophy that develops as a result of prolonged protein deficiency in the diet).

Important. If alkaline phosphatase is low, then this is one of the main diagnostic signs hypophosphatasemia (a congenital disorder of bone calcification, the disease is accompanied by severe bone deformities, frequent fractures, myasthenia gravis, convulsions, kidney damage, etc.).

Cardiovascular causes of decreased alkaline phosphatase in tests

For reference. High-output heart failure can develop in the setting of severe anemia, but in this situation, alkaline phosphatase will be reduced.

A decrease in alkaline phosphatase can be detected when it develops against the background of metabolic syndrome.

Also, similar changes in analyzes are observed in patients after bypass surgery.

Alkaline phosphatase is active enzyme the body, thanks to which phosphoric acid is broken down and the organs are enriched organic compound. The highest concentrations of the enzyme are found in the kidneys, bone tissue, bile duct and liver. The level of alkaline phosphatase is the foundation for the correct diagnosis of diseases internal organs. Therefore, careful monitoring of enzyme activity indicators is necessary.

Alkaline phosphatase - understanding the concepts

This enzyme is mainly found in the cells of the liver and bile ducts and affects biochemical reactions, being catalysts for splitting phosphoric acid. As a result of the destruction of the acid, its contents enter the blood, which explains the presence of the enzyme in almost any cell of the body.

As a result of the renewal process, a certain level of alkaline phosphatase is detected in the blood. If a significant number of organ cells die, the enzyme level may increase or decrease, depending on the cause of the damage.

Enzyme Features:

the main component of phosphatase is zinc, so an increase in the level of the enzyme is justified by a deficiency of food containing zinc;
Blood groups 1 and 3 are very sensitive to fatty foods; as a result of their intake, the enzyme level increases sharply. Therefore, before testing for alkaline phosphatase, it is recommended to abstain from eating for 12 hours;
phosphatase can be half eliminated from the body within 3-4 days, so monitoring tests should be a weekly event. Their more frequent use is prohibited;
the enzyme is contained in bone tissue in large quantities, so changes in its level are typical for older people, as they experience a decrease in bone mass;
It is impossible to determine the presence of abnormalities in the excretion of bile from the body in children by phosphatase.

The enzyme is found in cells various organs, therefore has a different structure. Depending on the isoenzymes, alkaline phosphatase is divided into:

bone;
renal;
spleen;
liver;
bone tissue;
intestinal mucosa;
biliary tract.

Clinical picture

Thanks to the enzyme, the human body maintains normal metabolism in all tissues and organs. If any organ is damaged, then some of its cells enter the blood and cause an imbalance of alkaline phosphatase. This state of affairs can cause diseases and damage to the liver, kidneys, and bone tissue.

To the most clear reasons disturbances in enzyme levels include malignant tumors.

Reception of many medicines may affect phosphatase levels. Such drugs include furosemide, papaverine, ftorotan and others.

Causes of abnormal enzyme levels in women:

3rd trimester of pregnancy and breastfeeding period;
excessive physical exercise;
poor nutrition;
menopause;
heart attacks lung tissue;
rickets;
inflammatory processes having an infectious nature;
avitaminosis;
thyroid diseases.

Why do the test?

An abnormality in enzyme levels is one of the main indicators for diagnosis. As a rule, the analysis is prescribed in combination with other methods clinical trial. This analysis is prescribed to all patients who have diseases of the kidneys, liver, digestive system, and bone tissue. A phosphatase test is ordered if the following symptoms are present:

nausea;
yellowing of the eyes;
loose stool;
sharp pain in a stomach;
suspicion of cholestasis.

The results of the analysis are directly proportional to a passive lifestyle and consumption of fatty foods. Abnormal enzyme levels can be caused by taking medications that thicken bile. Smoking increases phosphatase levels.

Preparing for analysis

The most popular research method is a biochemical blood test, which requires venous ulnar blood in a volume of 5 ml. In order for the analysis to provide the most complete information about the patient’s condition, it is necessary to follow some rules.

Firstly, it is recommended to stop eating any food 12 hours before donating blood. You cannot study in 48 hours physical exercise or work that requires complete exhaustion. It is recommended to give up even fitness and jogging.

It is not recommended to take it two days before the test. alcoholic drinks. Doctors prohibit the use of medications that increase alkaline phosphatase levels. In this case, the test results will not be objective and the patient may be prescribed incorrect treatment.

An hour before donating blood, smoking is strictly prohibited. It is not recommended to donate blood immediately after X-ray procedures (fluorography). As a rule, the analysis takes place in the morning; drinking coffee or tea is not allowed. The analysis results will be ready within 24 hours.

Normal for women

Depending on age, different enzyme levels are distinguished.

Deviations during pregnancy and after menopause are discussed individually with a doctor.

Increased phosphatase - what does this mean?

First of all increased level speaks about the presence of ailments of the liver and bile ducts. The most common disease is obstructive jaundice, a clear manifestation of which is obstruction of the biliary tract. Common causes of elevated levels are other liver diseases, which manifest themselves in the form of kidney stones, duct tumors, neoplasms of the head of the pancreas, cirrhosis of the liver, hepatitis, acute viral infection, sclerosing cholangitis.

Diseases of other organs can also cause an increase in the enzyme from the norm:

rickets - increased levels of the enzyme are observed 5 weeks before the disease shows its first symptoms, so it can be prevented and treated in a timely manner active treatment on early stages;
softening of the bones, which results in cancerous tumors;
osteitis deformans - an increase in the level of alkaline phosphatase is proportional to the development of the disease;
osteoporosis – the disease is characterized by a barely noticeable increase in enzyme levels;
hyperparathyroidism – has an active effect on the activity of the thyroid gland;
renal osteodystrophy – is a consequence renal failure;
kidney hypernephroma – malignancy;
intestinal ischemia;
ulcers on the intestinal walls;
regular loose stools and stomach disorders;
polymyalgia rheumatica;
chronic myeloid leukemia;
myocardial infarction;
ulcerative colitis.

An elevated level of the enzyme indicates the presence of one of these diseases. Therefore, to combat abnormal alkaline phosphatase levels, it is necessary to eliminate the provoking diseases. After neutralizing them, the enzyme level will return to normal by itself.

Reduced level

Reduced enzyme levels can be caused by the following diseases:

extreme degree of anemia;
volumetric blood transfusions;
significant zinc deficiency;
hypophosphatasemia is a disease that is hereditary;
hypothyroidism – a significant decrease in the activity of the thyroid gland;
pernicious anemia– the background for the development of the disease is an acute deficiency of vitamin B12;
disturbances in bone growth;
reception ;
irradiation;
placental insufficiency.

The level of the enzyme tends to increase or decrease even in healthy individuals. This may be caused by short term external factors, which quickly lose their influence. A change in phosphatase levels does not necessarily indicate the presence of dangerous diseases and pathologies.

In order for enzyme level tests to be objective, a comprehensive medical examination based on other medical data.

The following attending physicians can prescribe an examination:

specialist general practice;
infectious disease specialist;
gastroenterologist;
hematologist;
surgeon.