Enzyme diagnostics involves diagnosing diseases or syndromes based on the determination of enzyme activities in human biological fluids. The principles of enzyme diagnostics are rooted in several key aspects:

• Cellular Damage Indicators: When cells are damaged in blood or other biological fluids, the concentration of intracellular enzymes from these damaged cells increases.
• Detectable Enzyme Amount: The amount of released enzyme is sufficient for detection.
• Stability of Enzyme Activity: The activity of enzymes in biological fluids, detectable during cell damage, remains stable over a considerable period, differing from normal values.
• Organ-Specificity: Certain enzymes predominantly or exclusively localize in specific organs, demonstrating organ-specificity.
• Intracellular Localization Differences: Various enzymes exhibit differences in intracellular localization.

Enzyme diagnostics progresses along two main paths:

• Selective Reagent Path: Utilizing enzymes as selective reagents to identify and quantitatively determine normal or abnormal chemical substances in blood serum, urine, gastric juice, etc. Examples include detecting glucose, protein, or other substances in urine that are normally not present.
• Enzyme Quantification Path: Directly identifying and quantifying enzymes in biological fluids in pathological conditions. Certain enzymes, termed “necrotic enzymes,” appear in serum during cell breakdown. Numerous enzyme tests, based on the quantitative determination of enzyme (and isoenzyme) activity, are applied in clinical diagnostics.

Key Enzymes in Clinical Diagnostics

Several enzymes are pivotal in clinical diagnostics, including:

• Aspartate Aminotransferase (AST)
• Alanine Aminotransferase (ALT)
• Amylase
• γ-Glutamyltranspeptidase (GGT)
• Creatine Kinase (CK)

Enzyme Therapy

Despite the challenges posed by their high immunogenicity, enzymes are actively employed in therapeutic capacities, primarily in two directions:

Substitute Therapy: Utilizing enzymes when their natural synthesis is insufficient.

Component of Comprehensive Therapy: Employing enzymes in conjunction with other therapeutic methods. [2, 336]

Substitute enzyme therapy proves effective in gastrointestinal diseases associated with insufficient secretion of digestive juices. For instance, pepsin is used in achlorhydria, hypo- and anacidic gastritis. Deficiency of pancreatic enzymes can be compensated significantly by orally administering preparations containing key pancreatic enzymes (e.g., Festal, Enzistal, Mezim-forte).

Beyond substitute therapy, enzymes serve as additional therapeutic agents for various conditions. Proteolytic enzymes like trypsin and chymotrypsin are locally applied to treat purulent wounds, aiding in the breakdown of proteins from dead cells. Enzyme preparations are widely employed in thrombosis and thromboembolism cases, utilizing fibrinolysin, streptolysin, streptodecase, urokinase, among others.

For the treatment of tumor diseases, plant enzymes and complexes of animal and plant enzymes were previously proposed; currently, asparaginase is used for leukemia. Drugs for the treatment of the cardiovascular system are unique. The cytochrome C drug, which is in short supply in Russia, is produced in a number of countries for the treatment of cerebral circulation and coronary atherosclerosis, and immobilization of newborns. The technique allows you to improve tissue respiration in case of disorders of the oxidative process in tissues; the presence of an antihypoxic effect and the absence of side effects make it more significant.

Enzyme preparations are drugs with low toxicity, are well tolerated by patients for a long time, have pronounced effects caused by enzymes, are observed in a small number of patients and are quickly transmitted after taking the drugs. The use of enzymes for medicinal purposes is a developing area and occupies an indispensable place in the complex of modern therapy.

In conclusion, enzymes, with their diagnostic and therapeutic potentials, significantly contribute to modern medical practices. Their precise application aids in the accurate diagnosis and effective treatment of a spectrum of conditions, showcasing the versatility and importance of these biological catalysts in the field of medicine.

Preterm premature rupture of membranes (PPROM) is a critical obstetric complication that occurs in approximately 2–3% of pregnancies and accounts for nearly 40% of preterm births. It is associated with increased risks of neonatal morbidity, maternal infections, and adverse pregnancy outcomes. Early and accurate diagnosis of PPROM is essential for timely clinical intervention and improved perinatal outcomes.

The aim of this study is to evaluate the role of general clinical and specialized medical examinations in the diagnosis and management of PPROM. The study objectives include:

- Assessing the diagnostic value of biochemical and microbiological markers in PPROM detection.

- Evaluating the role of ultrasound and instrumental methods in pregnancy prognosis.

- Analyzing the impact of biomarker-based clinical interventions on gestational prolongation and neonatal outcomes.

MATERIALS AND METHODS

This study is based on a systematic review of clinical trials, retrospective cohort studies, and case-control analyses focused on PPROM diagnosis and management. Data were collected from leading medical databases such as PubMed, Scopus, and Google Scholar, with a focus on studies published in the last decade.

Study Population:

The analyzed studies included pregnant women diagnosed with PPROM between 24 and 36 weeks of gestation. Selection criteria comprised:

- Confirmed PPROM diagnosis via clinical and laboratory tests.

- Availability of biochemical marker data (fFN, PAMG-1, IGFBP-1, CRP, IL-6, IL-8).

- Documented pregnancy outcomes, including latency period, neonatal morbidity, and maternal complications.

Diagnostic Methods Assessed:

- Biochemical Markers: fFN, PAMG-1, IGFBP-1, and inflammatory markers for detecting amniotic fluid leakage and intra-amniotic infections.

- Microbiological Examinations: Vaginal and cervical cultures to identify infection risks.

- Ultrasound and Cervical Length Assessment: To evaluate pregnancy prognosis and preterm birth risk.

RESULTS AND DISCUSSION

Key Findings:

- Biochemical Markers: fFN showed high sensitivity (60–80%) and specificity (70–90%) in predicting preterm labor. PAMG-1 demonstrated >95% specificity in confirming membrane rupture, while IGFBP-1 was a reliable indicator of amniotic fluid leakage.

- Inflammatory Markers: CRP levels exceeding 10 mg/L correlated with intra-amniotic infection risks, necessitating early antibiotic intervention.

- Ultrasound Evaluation: Shortened cervical length (<25 mm) was strongly associated with an increased risk of preterm birth following PPROM.

- Microbiological Studies: Subclinical infections were present in 40–50% of PPROM cases, justifying routine microbiological screening.

Clinical Implications:

- Combining biochemical markers with ultrasound examination enhances the accuracy of PPROM diagnosis and pregnancy outcome predictions.

- Biomarker-driven interventions, including corticosteroids, antibiotics, and tocolytics, significantly improve neonatal survival by prolonging gestation by an average of 5–7 days.

- Implementing a multidisciplinary approach optimizes patient management and reduces maternal and neonatal complications.

CONCLUSION

General clinical and specialized medical examinations play a crucial role in the early detection, risk assessment, and management of PPROM. The integration of biochemical markers, microbiological analysis, and ultrasound assessments enhances diagnostic accuracy and informs timely medical interventions. Further research is required to refine diagnostic strategies and improve accessibility to biomarker-based testing in diverse healthcare settings.