I.I. Goriushkin  
  - Pathogenesis of alcoholism (gamma-glutamyltransferase, aspartate aminotransferase and alanine aminotransferase)
// In: Горюшкин И.И.  МЕХАНИЗМЫ АЛКОГОЛИЗМА: регуляционно-структурные отношения (патогенез, лечение, диагностика), монография. М.: Спутник+, 2008:45-75.
Горюшкин И.И. - Патогенез алкоголизма (гамма-глутамилтрасфераза, аспартатаминотрансфераза и аланинаминотрансфераза) - русский ]

          Key words:   abstinence, abusing, gamma-glutamyltransferase, GGT, aspartate aminotransferase, AST, alanine aminotransferase, ALT, alcohol, carbohydrate, diagnostic, fat, metabolism, pathogenesis

- The sum and substance: 
           I.I. Goriushkin [  - I ask to excuse me for my translation from Russian on English. Later I plan will return to correct  ]


   1._ For an alcoholism, its 1st, an incipient state, characteristicly primary increase in blood serum of activity gamma-glutamyltransferase (GGT), with its yield for limits of borders of normal, at remaining within high bounds of normal activity aspartate aminotransferase (AST), alanine aminotransferase (ALT);

   2._ For 2nd, centre stage, an alcoholism characteristicly further increase in blood serum of activity of a GGT, and also - increase (with a yield for limits of borders of normal) and AST, at - normal of activity of the ALT remaining within high bounds;

   3._ While for 3rd, final stage of an alcoholism, increase for limits of borders of normal of activity of all three ferments is characteristic: both a GGT, and AST, and the ALT (though, it is fair it far not in all cases);

   4._ An alcoholism as procedural disease, differs sequence of involving of ferment systems in pathogenesis that finds the reflexion in initial, or primary, increase in blood of activity of a GGT, then - AST and, at last, the ALT;

   5._ Complex of ferment indexes: GGT, AST and ALT, - can be used with a view of objectivization of the clinical diagnosis of disease of the person an alcoholism;

   6._ And, for rising of objectivity and reliability of the diagnostic inference positioned on the basis of a complex of yielded ferments, repeated blood samplings are necessary for the analysis;

   7._ At the same time, it is necessary to mean, that 3rd stage of an alcoholism (on A.A.Portnov's classification) on character of changes of activity of the above-stated transferases of blood - nosologicaly do not represent homogeneous group;

   8._ The reason of increase of a GGT at abusing of the person alcohol (the beginning of an alcoholism, its 1st stage) are metabolic processes, namely, the adaptaion-regulatorial answer of an organism to the use of alcohol;

   9._ The hyperenzymatic of a GGT and AST (in 2 stages of an alcoholism) is also - result of intensifying of the general-metabolic adaptable-regulationary answer of an organism on proceeding use (and abusing) alcohol;

   10._ It, rising of activity of a GGT at an alcoholism (1я and 2я stages), are result of "necessity" of maintenance in an organism of conditions of "normal" passing of an exchange of alcohol (in the conditions of abusing it) - by maintenance in an organism more high speed of an exchange of a coenzyme A;

   11._ As abusing alcohol is often accompanied by deficiency of alimentary components, including, and proteins, and consequently, and deficiency of irreplaceable amino acids, which participating and in processes of an exchange of alcohol and lipids (such, for example, as cysteine or methionine);

   12._ The event at an alcoholism accumulation of fat in a liver, instead of in faty depots, is caused mainly by a condition of protein deficiency in an organism abusing alcohol and, consequently, enrichment of a ration abusing-complete protein - should promote prevention of processes and faty, and, following for it, a fibrous degeneration of a liver (cirrhosis);

   13._ Consequently, the adequate alimentary and therapeutic measures referred on elimination of protein deficiency and optimization of carbohydrate and faty exchanges at abusing alcohol, - should promote prevention of processes of a faty degeneration of a liver;

   14._ The mechanism of primary increase at an alcoholism of AST, instead of the ALT, - consists as in substrate activate of AST, and - substrate, but - limitation of the ALT;

   15._ And, for primary increase at an alcoholism of AST, instead of ALTs (in 2nd its stage) are responsible as processes of domination of fat metabolism (initiated by the use of alcohol), and, accompanying them, molecular braking mechanisms of carbohydrate metabolism.

   16._ In a condition of an alcoholic abstinence the organism of the patient urgently requires the enlarged quantities of a pyruvate (or alcohol!?) - for elimination of deficiency in acetyl-KoA and oxaloacetate, and also - for normalization of functioning of a cycle of tricarboxylic acids and, bound to it, processes of breath;

   17._ Thus, a carbohydrate foodstuff - natural, (instead of refined, type: sugar, pure glucose, etc.), as well as adequate pharmacological influences (thiamin, riboflavin, nicotinic acid, folic and ascorbic acids, etc.), referred on normalization of carbohydrate metabolism in an alcoholic abstinence, in principle, - should provide and the most pathogenetic and, consequently, "softer" replacement of alcohol; as well as, was probably, further and «nonalcoholic existence».

The bases of these statements
can be seen here:
[ Goriushkin I.I.  "Alcoholism: mechanisms of change of activity of a gamma-glutamyltransferase and an aspartate aminotransferase and possibility of prevention of faty infiltration of a liver"
// Vopr Narcolog, 2001; 1: 60-66. Russian]
       [ Goriushkin I.I.   "Probable mechanisms of increase of activity of some transferases at an alcoholism"
// Zh Nevrol Psikhiatr Im SS Korsakova 2002;7: 66-69. Russian ]

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