International Journal Of

Recent Scientific
Research
ISSN: 0976-3031
Volume: 7(3) March -2016

LEVEL OF SERUM CREATINE PHOSPHOKINASE IN ORAL ERYTHRO

LEUKOPLAKIA- A BIOCHEMICAL STUDY

Biju Baby Joseph and Shiny George

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INTERNATIONAL JOURNAL OF RECENT SCIENTIFIC RESEARCH (IJRSR)
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International Journal
of Recent Scientific
International Journal of Recent Scientific Research Research
Vol. 7, Issue, 3, pp. 9644-9647, March, 2016
ISSN: 0976-3031
RESEARCH ARTICLE
LEVEL OF SERUM CREATINE PHOSPHOKINASE IN ORAL ERYTHRO
LEUKOPLAKIA- A BIOCHEMICAL STUDY
Biju Baby Joseph1 and Shiny George2
1Department of Oral Medicine and Radiology Azezia College of Dental Sciences Kerala
2Department of Physiology Azezia Medical College Kerala

ARTICLE INFO ABSTRACT

Context: Oral cancer develop from a potentially malignant disorders.

Article History:
Early diagnosis of these are necessary in order to prevent them from developing into malignant
Received December, 2015 ones which can reduce the mortality and morbidity and improve the quality of life of a person .The
Received in revised form 21st different diagnostic procedures available now are histopathology, cytology, histochemistry and
January, 2016 Enzyme assays. However histopathology has many limitations which can be overlooked by an
Accepted 06th February, 2016 enzyme essay technique.
Published online 28th Keeping this in mind a study was planned to evaluate the association between the serum CPK and
March, 2016 oral Erytro Leukoplakia.
Aims: Aims and Objectives of the study-
Keywords: 1. To assess the level of CPK in erythro leukoplakic patients and normal subjects .
oral leukoplakia, creatinine 2. To compare the result
phosphokinase, erythroleukoplkaia. Study design Out patients visiting the department of Oral Medicine and Radiology, Coorg Institute
of Dental Sciences, Virajpet in the age range of 30-50 years old males. With smoking habit for more
than 5 yrs. 20 subjects were selected and the lesion was subjected to histopathological examination
and blood samples were collected and sent for biochemical analysis.
Statistical analysis used: student t test
Result: Mean CPK value of the control group was 96.6 and that of cases was 102.25 . Statistical
analysis was done using student t test and it was not statistically significant (p=0.441). Correlation
between age and CPK value was done and the correlation(r) is -0.083 but it was not significant
statistically (p=0.611).
Conclusions: From this study it can be concluded that a definite correlation between CPK enzyme
and oral erythro leukoplakia lesions cannot be obtained as it is dependent on different factors like
the severity of lesion, grades of dysplasia and invasiveness of lesion.

Copyright © Biju Baby Joseph and Shiny George., 2016, this is an open-access article distributed under the terms of the
Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided
the original work is properly cited.
malignancies. The concept of precancer was given 1972 in
INTRODUCTION WHO workshop2. But this concept of precancer was redefined
in a workshop held in UK 2005 to potentially malignant
Moderisation and fast food style habits has increased the disorders. These can transform into malignant lesions, by an
prevalence of different diseases one among being head and another concept of Field cancerization given by Slaughter was
neck cancer. The statics of cancer is estimated to be 22 explained3.
million out of which 10 million cases are diagnosed every
year. In a country between the races the cancer can show All these lesions show some amount of histopathological
variations. Generally the lung cancer is the most common and changes which are consistent to oral squamous cell carcinomas.
breast cancer in females. With regard to head and neck cancer The severity of histopathological changes depend upon the
also shows a similar sex predilection. Males are attacked more cancerous cell invasion. The severity cannot be judged
than females with respect to oral cavity in particular1. clinically by routine examination hence an early detection of
these lesions are necessary which well documented.4, 5
The most common site for oral cancer is from lining buccal
mucosa. The overall percentage being 5.5%. of all

*Corresponding author: Biju Baby Joseph

Department of Oral Medicine and Radiology Azezia College of Dental Sciences Kerala
 Biju Baby Joseph and Shiny George., Level of Serum Creatine Phosphokinase In Oral Erythro Leukoplakia-
A Biochemical Study

The different techniques and their significance is also well

documented.6-11 Bodily fluids are the most easily available eg. 120
saliva and serum. Lab investigation using these do not need a
complicated invasive procedure as is required in routine biopsy 100
and also the contraindication for biopsy are also overlooked
80
The importance of biological biomarkers and their significance
in relation with dyspalsia is also documented.12 Hence taking a 60 Mean
muscle enzyme CPK as a biological marker a study was
40 Standard deviation
planned. CPK had shown its significance in different studies
done by different authors.5 20

METHODS AND MATERIAL 0

Control Case
Out patients visiting the department of Oral Medicine and
Radiology, Coorg Institute of Dental Sciences Virajpet in the Figure 1 Mean CPK value in Case and Control
age range of 30-50 years old males. With smoking habit for
more than 5 yrs. 20 subjects were selected and the lesion was Age and CPK value in cases
subjected to histopathological examination and blood samples 140
were collected and sent for biochemical analysis. All the 120
demographic details were recorded along with dental status of 100
patient. 20 Patients were selected after through clinical
80
examination. A detailed case history was taken along with
description of the lesion on the buccal mucosa. Only classical 60
case of oral leukoplakia was included. The lesion was subjected 40
to toluidine blue staning and thereafter biopsy and 20
histopathological examination. 0
0 5 10 15 20 25
Inclusion criteria – All male patients of age 30-50 yrs having
a smoking habit for more than 5 years were selected and Age CPK value
patient willing for the study and treatment thereafter.
Figure 2 Age and CPK value in case.
The Exclusion criteria were physically and mentally disabled
and Patient with history systemic illness and patients not 120
willing for biopsy. 100

Result - Mean CPK value of the control group was found to be 80

96.6 with a standard deviation of 27.82 and a standard error of 60 Mean
6.22. (Table 1, figure 1). Mean CPK of the cases was 102.25
with a standard deviation of 16.73 and a standard error of 3.74. 40 Standard Deviation
(Table 1, figure 1). When the mean CPK of the cases are 20
compared with the controls using student t test it was not
statistically significant (p=0.441) (table 1, figure 1). 0
Correlation between age and CPK value the correlation(r) was - Age CPK
0.083 which means a probable negative correlation and the P
value was 0.611 which showed that it was not significant Figure 3 Mean of age and CPK in cases.
statistically.(figure 2 ,3).
Table 1 Mean and standard deviation DISCUSSION
Standard
Group Number Mean
deviation Oral Cancer like other cancers possess a great threat to life. It
Control 20 96.6 27.827 can leave a person debilitated for the remaining period of life
Case 20 102.3 16.739 and affecting a person’s quality of life. The annual incidence
Students t test ,P value =0.441 ,Not significant
of oral cancer is well documented. The etiological factors are
different deleterious oral habits. The prevalence of potentially
Table 2 Correlation between Age and CPK value malignant disorders from these habits are well documented .9
There are different studies done related to each of these lesions
Variable Mean Standard deviation showing the habitual significance. A study done by Shyam et
Age 39.8 5.331 al, Surendran et al and Prasad et al showed the significance of
CPK value 99.43 22.846 smoking. They also mentioned the prevalence of theses
Correlation = -0.083 , p=0.611 not significant lesions in their study along with other studies 13-15 When the

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 International Journal of Recent Scientific Research Vol. 7, Issue, 3, pp. 9644-9647, March, 2016

cells undergoes potentially malignant transformation then can be due to small sample group . However with similar less
dysplastic features can be identified as described by Dost et al study subjects the significance of CPK is shown in study done
in their study4 As degree of dysplastic changes denote the by Spoorthy et al16. This can be substantiated for the different
severity of the lesion for malignant transformation there are cytokines released during the chronic irritation to the oral
different methods for evaluating it other than the usual epithelium which in turn reflects its value in the serum,
biopsy.9,10 irrespective of the severity of muscle damage produced.
However when CPK alone is taken the amount of muscle
Our study outlines an alternative method to the usual biopsy- damage induced is of great importence. At this juncture it can
histopathology procedure where in biopsy can have many be said that the amount of muscle damage caused in our many
contraindications. Our study makes use of muscle enzyme in be sufficient for release of CPK.
the context that these lesions cause dysplastic in their later
stage which involve the muscle layer damage. The value is not constant but gets reduced as the muscle
recovers from the injury .This type of sudden muscle damage
Spoorthy et al has done a study on leukoplakia patients taking is more seen in cardiac muscle, after a myocardial infarction.17
enzyme CPK.16 Our study was centered to find out the Whatsoever when considereing enzyme CPK solely in cases
influence of CPK on oral erythroplakia patients .Similar to of oral leukoplakia irrespective of grade of dysplasia the P
this other studies were also carried out using micronutrients to value is not significant. This could be due mild dyspalsia. So
find out their influence.10 They have found out a positive much severe grades of dyspalsia or a carcinoma in situ might
correlation. The key factor could be that, the probable show an alteration in serum CPK value. With these factors it
alteration in CPK value of serum is centred on damage to the can be said that the study of oral leukoplakia lesions with
muscle layer in the involved buccal mucosa in these lesions respect t to CPK enzyme cannot be regarded as authenticated
.Similar studies were done on hamsters to find out the one until and unless a large volume of subjects with higher
influence of CPK on muscle damage in prostate , lung ,GIT grade of dyspalsia is studied.
cancers but got varying result showing an influence of this
enzyme.16 The influence of the CPK in muscle damage can be CONCLUSION
related to the fact that enzyme CPK is a constituent in muscle
fibre and is released during a muscle damage which was From this study it can be concluded that a definite correlation
stated in our previous study in Oral Submucous Fibrosis. between CPK enzyme and oral leukoplakia lesions cannot be
However the exact cause for release of this enzyme is not obtained as theit is dependent on different factors like the
clearly understood. The cause for muscle damage can be due severity of lesion, grades of dysplasia and invasiveness of
to the overuse, trauma and local irritation due to carcinogens, lesion etc. Furthermore a study with more samples might give
all which can cause damage to fibrils leading to release of the some significance of CPK with oral leukoplakia lesions.
enzyme.17 However considering the few limitation in our study were the
lesions size, grading of dyspalsia, duration, gender relation,
The overuse can be due to many deleterious habits like, pan individual physical activity which can be overcomed in a large
chewing, betel nut chewing, areca nut chewing and smoking. multicentre trials.
These habits can cause damage to the oral mucosa by forming
hyperkeratosis initially, and followed by invasion of deep References
layers on persisitent usage. The advanced clinical presentation
would be like non healing ulcers for long time.
1. Anupam Mishra, Rohit Meherotra. Head and Neck
Cancer: Global Burden and Regional Trends in India.
In our study we could not find a staticall significance between
Asian Pacific Journal of Cancer Prevention, Vol 15,
the CPK and oral erythrolekoplakia. The correlation between
2014
the age did not show much significance. The probable reason
1. Naoki Watanabe, Tsunemasa Ohkubo, Masahito
for the insignificance can be due to the damage done to muscle
Shimizu, and Takuji Tanaka. Preneoplasia and
in oral erythroplakia could be minimal even though the lesion
carcinogenesis of the oral cavity. Watanabe et al.
is active when compared to leukoplakia and OSMf.16,17 . This
Oncology Discovery 2015
can be attributed to the different pathophysiology of Oral
2. S. Warnakulasuriya, Newell. W. Johnson, van der Waal.
erythroplakia against OSMF where in there is muscle fibre
Nomenclature and classification of potentially malignan
fibrosis. Our study showed the correlation as 0.083 between
disorders of the oral mucosa. j Oral Pathol Med (2007)
age and CPK value which is negative. This shows that even
36: 575–80
though as the age increases there is no significant change in
3. F. Dost, BOralH, MPhil. Malignant transformation of
enzyme release in muscle when underlying mucosa and muscle
oral epithelial dysplasia: a real-world evaluation of
fibres are involved in dysplastic changes. However in our
histopathologic grading. OOOO : 117 (3)
previous study in OSMF there is considerable muscle damage
4. Biju baby joseph, shiny George. Level of serum
but not in oral leukoplakia.17 The statical insignificance of
creatine phosphokinase in oral submucous fibrosis - a
our study can be attributed to the altered pathophysiology of
biochemical study. Int J Cur Res Rev. july 2015; 7(13).
oral erytroleukoplakia whetrein this lesion does not show any
5. Jesper Reibel. Prognosis of oral pre-malignant lesions:
fibrosis. In our study all the participants had lesion which
significance of clinical, histopathological, and molecular
showed mild dysplastic changes but this alone cannot be taken
biological characteristics. Crit Rev Oral Biol Med. 2003
as marker for grading.18 Other factor for statiscal insignificance
14(1): 47-62
9646 | P a g e
 Biju Baby Joseph and Shiny George., Level of Serum Creatine Phosphokinase In Oral Erythro Leukoplakia-
A Biochemical Study

6. Esam Omar.Current concepts and future of noninvasive 12. Shyam sundar behura. Oral Mucosal Lesions
procedures for diagnosing oral squamous cell carcinoma Associated with Smokers and Chewers – A dCase-
- a systematic review. Omar Head & Face Medicine Control Study in Chennai Population. Journal of
.2015 11:6. Clinical and Diagnostic Research. July 2015; 9(7):
7. Vucicevic Boras Vanja. The Significance of Salivary ZC17-ZC22
Cytokines in Oral Leukoplakia. J Autacoids Horm. 5 13. Surendra Kumar. Tobacco Use and Oral Leukoplakia:
(1) Cross-sectional Study among the Gond Tribe in Madhya
8. pekesha RB. Estimation and Comparitiv evaluation of Pradesh. Asian Pacific Journal of Cancer Prevention,
serum iron, copper zinc, and copper/zinc ration in oral 2015; 16.
eukoplakia, oral submucous fibrosis, and squamopus 14. K N Prasad. Prevalence of Erythroplakia and
carcinopma. JIAOMR april –june 2010;22(2):73-26 Leukoplakia among the tobacco users aged above 60
9. Amith Kumar, Suchetha kumari. Estimation of Serum years in rural area of Pondicherry. Sch. Acad. J. Biosci.,
Micronutrient Levels and The Possible Risk Of Oral 2015; 3(1A):30-33.
Cancer And Premalignancy Amith Kumar, Suchetha 15. Spoorthy B R. serum creatinine phosphokinase :a
kumara. IJIRSCT.January 2014;3 (1). potential diagnostic tool for oral primaligant lesions-?.
10. Farzaneh Agha-Hosseini. Serum and saliva collagenase- A histopathological-biochemical study. Indian J
3 (MMP-13) in patients with ora lichen planus and oral Stomatol. 2011; 2 (2):86-90.
squamous cell carcinoma. MJIRI. June 2015; 29. (218). Biju Baby Joseph, Shiny George
11. Sunali Khanna. Aserum biomarkers in oral precancer 16. Level of serum creatine phosphokinase in oral
and squamous cell carcinoma. 13th int. symposium on submucous fibrosis – A biochemical study .
metal ions in biollgy and Medicine. 17. Brad W. Neville. Oral Cancer and Precancerous
Lesions. CA Cancer J Clin 2002;52:195-215

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How to cite this article:
Biju Baby Joseph and Shiny George.2016, Level of Serum Creatine Phosphokinase In Oral Erythro Leukoplakia- A
Biochemical Study. Int J Recent Sci Res. 7(3), pp. 9644-9647.

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