LD - laktátdehydrogenáza

27.7.2012 , Ondřej Komín

ld.jpg - kopie
ld.jpg - kopie
Laktátdehydrogenáza je enzym, který je přítomen v celé řadě buněk našeho organismu. Laktátdehydrogenáza hraje velice důležitou roli v metabolismu cukrů, kde umožňuje vznik laktátu, který vzniká při spalování glukózy za nepřítomnosti kyslíku v buňkách. Vyšetření laktátdehydrogenázy nám přináší užitečné informace o stavu srdce, svalů a jater.

LD neboli laktátdehydrogenáza

Laktátdehydrogenáza patří do velké skupiny látek, které mají za úkol zajistit, aby chemické reakce mohly probíhat rychleji nebo vůbec mohly probíhat za takových podmínek, jaké panují v lidském organismu. Touto skupinou látek jsou enzymy. Laktátdehydrogenáza se nachází v několika typech (takzvaných izoenzymech), které se účastní stejné reakce, ale nachází se v různých tkáních. Proto rozeznáváme LD buněk srdce, plic, svalů, erytrocytů (červených krvinek) a jater. LD je vázána do vnitřního prostředí buňky, při poškození orgánů se však porušují buněčné membrány a LD může zvýšeně unikat do krve. Vyšetření LD je tedy vyžadována při podezření na akutní nebo chronické poškození tkáně, nádorová onemocnění, hemolytickou anémii (onemocnění, kdy se zvýšeně rozpadají červené krvinky buď proto, že jsou neobvykle křehké nebo kvůli jejich nadměrnému mechanickému poškození – umělé chlopně). Dříve se používala zvýšená hladina LD k potvrzení infarktu myokardu, dnes však máme mnohem lepší ukazatele tohoto postižení (troponin, CK-MB a další).

Laktátdehydrogenáza a její podstata

Laktátdehydrogenáza je enzym, který je zapojený do metabolismu cukrů. Jeho hlavním úkolem je katalizovat (uskutečnit) vratnou přeměnu pyruvátu, který vzniká z cukru glukózy, na laktát – kyselinu mléčnou. Tato reakce probíhá za nedostatku kyslíku a všichni ji určitě ze života známe. Laktát totiž vzniká ve svalech při fyzické zátěži, kdy se snižuje dodávka kyslíku, a vzniklý kyselý laktát je důvodem toho, proč nás při běhu bolí nohy. Pro vyšetření koncentrace LD je zapotřebí pouze vzorek krve, jehož získání je naprosto rutinní a bezbolestnou záležitostí. Lékař nebo sestra Vám odebere žilní krev tenkým vpichem. Skutečnost, že jednotlivé typy enzymu odpovídají určitým orgánům, umožňuje lékaři přesně lokalizovat a určit příčinu poškození.

Laktátdehydrogenáza a její vyšetření

Snížená nebo normální hladina LD v krvi je z lékařského hlediska bez hlubšího významu. Naproti tomu zvýšená hladina může mít mnoho příčin. Základem je vždy poškození tkáně. Zvýšenou hladinu LD pozorujeme u poškození jater, slinivky, ledvin, srdce, svalů, mozkových příhodách, při anémiích (chudokrevnosti), po požití alkoholu, po fyzické zátěži, po podání některých léků (anestetika, aspirin, narkotika). Hodnoty se obvykle prudce zvýší bezprostředně po poškození, s postupem času se jejich hladina upravuje zpět k normálu. U chronického onemocnění probíhajícího delší dobu se může LD vyskytovat v krvi trvale zvýšená. Po fyzické zátěži se hladina LD zvyšuje, to je samozřejmě naprosto normální. Falešně zvýšená hladina LD může být způsobena komplikacemi při odběru nebo při nešetrném zacházení se vzorkem, kdy dojde k destrukci červených krvinek a uvolnění jejich LD.

LD a shrnutí

Stanovení LD a jejích jednotlivých typů je velice užitečné bezbolestné běžné vyšetření, které lékaři mnoho napoví o charakteru Vašich potíží. K přesnému určení diagnózy napomáhají lékaři i další, jiné parametry, které jsou zjišťovány v krvi spolu s LD.

 

Muži

2,25–3,75 µkat/L

Ženy

2,25–3,55 µkat/L

 

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