Changes in liver enzymes and association with prognosis in patients with COVID-19: a retrospective case–control study

ObjectiveCOVID-19 has recently emerged as a serious threat to global health. This study examined the laboratory investigations of patients with COVID-19, with an emphasis on liver enzymes.MethodsThis retrospective, single-center study was performed on patients with COVID-19 who were admitted to Imam Reza Hospital, Iran from March 2020 to February 2021. Laboratory tests included a complete blood cell count, white blood cell (WBC) count, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), lymphocyte/monocyte ratio, and levels of aspartate aminotransferase, alanine aminotransferase (ALT), and alkaline phosphatase. Patient survival was among the outcome measures investigated in association with laboratory findings.ResultsWe enrolled 77 patients with COVID-19 and 63 healthy controls. In comparison with the control group, patients with COVID-19 showed COVID-19 increased ALT, WBC, neutrophils, NLR, and PLR, and decreased platelet counts and lymphocytes.ConclusionAlthough elevated levels of AST, NLR, PLR, and LMR were found in patients with COVID-19, they were not linked to mortality. Given the presence of AST in other tissues, the influence of SARS-CoV-2 on the liver should be interpreted with caution.     

经皮经肝选择性门静脉栓塞技术及其安全性评价

目的 探讨经皮经肝选择性门静脉栓塞术(SPVE)的技术要点和安全性.方法 对41例肝脏肿瘤患者(包括原发性肝癌13例,转移性肝癌28例)行SPVE,对其中32例同期行TACE术(SPVE+ TACE组),9例未行或未同期行TACE术(单纯SPVE组).术后回顾性分析SPVE的技术要点、并发症及临床安全性.结果 对41例均成功完成SPVE术,成功率100％;术后第3天患者ALT、AST、TB较术前升高,SPVE+TACE组升高更为明显,至术后第7天均明显下降.5例出现SPVE相关并发症,包括2例异位门静脉栓塞、1例暂时性肝功能衰竭、1例肝包膜下出血和1例肝内门静脉-静脉瘘.结论 SPVE作为肝脏外科手术和TACE术的重要辅助技术是可行的,但术后相关并发症应引起足够重视.     

Transient immune hepatitis as post-coronavirus disease complication: A case report

BACKGROUNDWe report a case of post-coronavirus disease (COVID) immune hepatitis occurring in a young male with no pre-existing comorbidities.CASE SUMMARYA previously healthy 21-year-old male patient was admitted to our hospital with mild COVID-19. During the course of in-hospital isolation and monitoring, he developed an alanine aminotransferase (ALT) and aspartate aminotransferase (AST) increase, with the enzymes peaking at day 24 (ALT 15 times the upper normal limit), with preserved liver function. The liver enzyme increase occurred 20 d after the complete clinical remission of COVID-19, and ALT dynamics paralleled the increase in total antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The case was interpreted as post-COVID immune hepatitis, with extensive laboratory investigations excluding other potential causes. The hepatocytolysis remitted 20 d after the peak ALT, without further intervention, with complete recovery, but the total anti-SARS-CoV-2 antibodies continued to increase the next 5 mo following the acute infection.CONCLUSIONClose attention should also be paid to young patients with mild forms of disease, and a high index of suspicion should be maintained for post-COVID complications.     

Epidemiological and clinical characteristics of 65 hospitalized patients with COVID-19 in Liaoning,China

BACKGROUNDCoronavirus disease 2019 (COVID-19) has spread rapidly to multiple countries through its infectious agent severe acute respiratory syndrome coronavirus 2. The severity, atypical clinical presentation, and lack of specific anti-viral treatments have posed a challenge for the diagnosis and treatment of COVID-19. Understanding the epidemiological and clinical characteristics of COVID-19 cases in different geographical areas is essential to improve the prognosis of COVID-19 patients and slow the spread of the disease.AIMTo investigate the epidemiological and clinical characteristics and main therapeutic strategy for confirmed COVID-19 patients hospitalized in Liaoning Province, China.METHODSAdult patients (n = 65) with confirmed COVID-19 were enrolled in this retrospective study from January 20 to February 29, 2020 in Liaoning Province, China. Pharyngeal swabs and sputum specimens were collected from the patients for the detection of severe acute respiratory syndrome coronavirus 2 nucleic acid. Patient demographic information and clinical data were collected from the medical records. Based on the severity of COVID-19, the patients were divided into nonsevere and severe groups. All patients were followed until March 20, 2020.RESULTSThe mean age of 65 COVID-19 patients was 45.5 ± 14.4 years, 56.9% were men, and 24.6% were severe cases. During the 14 d before symptom onset, 25 (38.5%) patients lived or stayed in Wuhan, whereas 8 (12.3%) had no clear history of exposure. Twenty-nine (44.6%) patients had at least one comorbidity; hypertension and diabetes were the most common comorbidities. Compared with nonsevere patients, severe patients had significantly lower lymphocyte counts [median value 1.3 × 10⁹/L (interquartile range 0.9-1.95) vs 0.82 × 10⁹/L (0.44-1.08), P < 0.001], elevated levels of lactate dehydrogenase [450 U/L (386-476) vs 707 U/L (592-980), P < 0.001] and C-reactive protein [6.1 mg/L (1.5-7.2) vs 52 mg/L (12.7-100.8), P < 0.001], and a prolonged median duration of viral shedding [19.5 d (16-21) vs 23.5 d (19.6-30.3), P = 0.001]. The overall median viral shedding time was 19.5 d, and the longest was 53 d. Severe patients were more frequently treated with lopinavir/ritonavir, antibiotics, glucocorticoid therapy, immunoglobulin, thymosin, and oxygen support. All patients were discharged following treatment in quarantine.CONCLUSIONOur findings may facilitate the identification of severe cases and inform clinical treatment and quarantine decisions regarding COVID-19.     

Efficacy of arbidol in COVID-19 patients: A retrospective study

BACKGROUNDTo date, no treatment has proven to be absolutely effective for coronavirus disease 2019 (COVID-19) patients, and further research is necessary. As a traditional antiviral drug, arbidol was widely used in Wuhan at the beginning of the COVID-19 epidemic and is of increasing interest for treating COVID-19 based on in vitro data suggesting activity against severe acute respiratory syndrome (SARS). Although arbidol has been widely used in China to treat COVID-19 patients, clinical trials to date have not clearly substantiated this approach.AIMTo evaluate the efficacy of arbidol for COVID-19.METHODSA retrospective study was conducted on 132 moderate and severe COVID-19 patients admitted to Jinyintan Hospital and Huoshenshan Hospital (officially designated for COVID-19 treatment) from February to March 2020 in Wuhan, China. This study mainly evaluated the efficacy of arbidol in patients with COVID-19 in the early stage of the SARS coronavirus 2 epidemic. Arbidol was administered at a dose of 200 mg, three times a day, with a 10-d course to adults not receiving any other drugs. Due to the shortage of beds at the time, not every patient could be admitted immediately. We looked for the early stages of the sudden outbreak, places of limited medical resources, limited ward beds, and delayed admission; thus, some patients naturally fit into the control group who did not receive any antiviral drugs. Out of the 132 patients, 72 received arbidol treatment, and 60 did not. We compared the disease course of the two groups and explored the predictors of extended disease duration.RESULTSSeventy-two patients commenced arbidol, and 60 patients did not receive arbidol treatment. The disease duration in the former group was shorter (23.42 ± 6.92 vs 29.60 ± 6.49, P < 0.001). Multivariate regression analysis showed that the risk of a prolonged course of disease increased by 7.158 times in the non-arbidol treatment group. Ferritin > 483.0 ng/mL and lactate dehydrogenase (LDH) > 237.5 U/L were found to be independent risk factors for protracted cases, with the risk of an extended disease duration increasing to 2.852 times and 5.946 times, respectively.CONCLUSIONThe duration course of moderate and severe COVID-19 patients is reduced by 6.183 d when arbidol is administered. Ferritin > 486.5 ng/mL and LDH > 239.5 U/L are independent risk factors for delayed recovery from COVID-19. Early oral administration of arbidol 200 mg t.i.d. with a 10-d course of treatment may be an effective management strategy in COVID-19 patients, particularly those with increased serum ferritin or elevated LDH.     

SARS患者的肝脏损害

目的　研究严重急性呼吸综合征 (SARS)患者肝脏功能和肝组织病理学的变化 ,探讨 SARS患者肝脏损害的可能机制及其临床意义。方法　依据中华人民共和国卫生部诊断标准 ,选择 2 0 0 3年 2— 6月收治的 SARS患者 110例检测肝脏功能 ,其中 8例死亡者行肝组织病理学检查 ;并与健康体检者 35例进行比较。结果　 SARS组患者血清丙氨酸转氨酶 (AL T)、天冬氨酸转氨酶 (AST)、总胆红素 (TBil)、乳酸脱氢酶(L DH)水平均显著高于对照组 ,分别为 (91.6 1± 5 0 .5 3) U/ L 比 (32 .91± 10 .5 6 ) U/ L,(78.6 8± 33.32 ) U/ L 比(2 9.4 3± 8.89) U/ L,(11.6 7± 4 .2 6 ) μmol/ L 比 (8.4 4± 3.86 ) μmol/ L,(42 9.95± 188.94 ) U/ L 比 (2 0 0 .83±4 4 .86 ) U / L ,P均 <0 .0 0 1;白蛋白 (AL B)和前白蛋白 (PAB)均明显低于对照组 ,分别为 (34.4 0± 5 .13) g/ L比(42 .0 9± 6 .79) g/ L和 (0 .2 0± 0 .0 6 ) g/ L比 (0 .34± 0 .0 5 ) g/ L ,P均 <0 .0 0 1;血清直接胆红素 (DBil)、总胆汁酸 (TBA)、γ谷氨酰转肽酶 (GGT )、碱性磷酸酶 (AL P)水平与对照组无差异 (P均 >0 .0 5 )。 AL T、AST、GGT、L DH变化范围较大 ,为正常范围 4～ 9倍 ,其余各项变化范围较小。AL T、AST和 PAB异常率达 80 .0 %以上 ,AL     

Risk factors for post-hepatectomy liver failure in 80 patients

BACKGROUNDPost-hepatectomy liver failure (PHLF) is a serious complication and a leading cause of death after hepatectomy, an accurate prediction of PHLF is important for improvement of prognosis after hepatectomy.AIMTo retrospectively analyze the risk factors for postoperative liver failure in patients undergoing hepatectomy for liver tumors.METHODSThe clinical data of 80 patients undergoing hepatectomy in our hospital from June 2018 to January 2020 were collected. With laboratory examination as well as pre- and post-operative abdominal three-dimensional reconstructive computed tomography, the demographic data, surgical data, biochemical indicators, coagulation index, routine blood tests, spleen and liver volumes, relative remnant liver volume, and other related indicators were obtained and compared between patients with PHLF and those without PHLF.RESULTSPHLF occurred in 19 (23.75%) patients. Univariate logistic regression analysis showed that gender, history of hepatitis/cirrhosis, and preoperative bilirubin, albumin, coagulation function, albumin-bilirubin ratio, aspartate amino-transferase-to-platelet ratio index (APRI), Model for End-Stage Liver Disease score, spleen volume (SV), spleen volume/liver volume ratio (SV/LV), and relative remnant liver volume were statistically associated with the occurrence of PHLF (all P < 0.05). Multivariate regression analysis showed that preoperative total bilirubin, platelets (PLT), APRI, and SV/LV were independent risk factors for PHLF (all P < 0.05). The area under the curve and cut-off values were 0.787 and 18.6 mmol/L for total bilirubin, 0.893 and 146 × 10¹²/L for PLT, 0.907 and 0.416 for APRI, and 0.752 and 20.84% for SV/LV, respectively.CONCLUSIONFor patients undergoing liver resection, preoperative total bilirubin, PLT, APRI, and SV/LV are independent risk factors for PHLF. These findings may provide guidance to safely perform liver surgery in such patients.     

Acute Poisonings with Breynia officinalis—An Outbreak of Hepatotoxicity

Abstract

Background.?In combination with other traditional Chinese medicines, Breynia officinalis, a species of Euphorbiaceae, has long been used to treat contusions, heart failure, venereal diseases, growth retardation, and conjunctivitis. B. officinalis, regarded as a poison, was mistaken for a similar plant, Securinega suffruticosa, and cooked in a soup used for the treatment of muscle soreness, lumbago, and as a tonic in this outbreak. Case series.?Nineteen patients, 11 males and 8 females (average age 49.2 ± 9.1 years) consumed an average of 130 mL (30–900 mL) of soup containing B. officinalis stems. Fourteen patients developed diarrhea, 10 experienced nausea and chilly sensations, 9 had sensations of abdominal fullness, and 7 suffered from vomiting. The results of liver function tests (LFTs) indicated that the observed maximum median level of alanine aminotransferase (ALT) was 647 U/L (range 89–9440 U/L), aspartate aminotransferase (AST) 314 U/L (range 47–7756 U/L), alkaline phosphatase 251 U/L (range 224–278 U/L), and gamma glutamyl transpeptidase 106 U/L (range 84–313 U/L). The median time to the observed median peak levels was 3 days for ALT, 2 days for AST, 5 days for alkaline phosphatase, and 12 days for gamma glutamyl transpeptidase. With supportive treatment, the majority of abnormalities in 14 of the cases resolved within 6 months of exposure. Conclusions.?The consumption of a soup containing B. officinalis Hemsley resulted in dose‐related toxic effects. Clinical toxicity consisted primarily of gastrointestinal symptoms and signs and hepatotoxicity. Hepatocellular liver injury rather than cholestatic liver injury was observed. Marked jaundice did not develop.     

Ecstasy-induced recurrent toxic hepatitis in a young adult

BACKGROUND: The drug 3,4-methylenedioxymethamphetamine (MDMA), otherwise known as “ecstasy,” is a synthetic amphetamine that produces euphoria, increases sociability and energy, and is often used as a “weekend” recreational drug by young adults.CASE SUMMARY: A 23-year-old male (height, 184 cm; weight, 68 kg) presented to the emergency department of Marmara University Hospital, Istanbul, Turkey, with jaundice and nausea lasting for 6 days. The patient reported that he had been a chronic user of MDMA for 2 years. He also reported that 1 week before presenting, he had ingested twice (2 tablets) the usual amount (1 tablet) of the drug at the same time. Blood tests were performed and hematologic findings were as follows: aspartate aminotransferase (AST), 1423 U/L (reference range, 10-37 U/L); alanine aminotransferase (ALT), 2748 U/L (10-40 U/L); alkaline phosphatase, 271 U/L (0-270 U/L); γ-glutamyl transpeptidase, 124 U/L (7-49 U/L); total bilirubin, 13.23 mg/dL (0.2-1 mg/dL); direct bilirubin, 8.75 mg/dL (0-0.3 mg/dL); amylase, 80 U/L (0-220 U/L); prothrombin time, 21.2 sec; activated partial thromboplastin time, 37.3 sec; and international normalized ratio, 1.66. Liver enzymes and bilirubin levels were found to be extremely high (AST = 40x normal, ALT = 70x normal, and bilirubin = 13x normal). Viral, autoimmune, and metabolic causes were excluded. Serologic tests for hepatitis A, B, and C viruses, mononucleosis, cytomegalovirus, and HIV infection were all negative. A diagnosis of ecstasy-induced toxic hepatitis was made. The patient's medical history further revealed that the current incident was actually his second occurrence of jaundice and acute hepatitis associated with the ingestion of higher amounts (twice the usual amount of MDMA he ingested at the same time). Supportive therapy (IV saline and vital sign monitoring) was initiated and liver enzymes, bilirubin levels, and prothrombin times were monitored daily. All had returned to normal values in 2 weeks.CONCLUSIONS: MDMA, or the recreational drug ecstasy, might be responsible for acute hepatitis and/or acute liver failure, particularly in young people. Physicians might need to be alert to the possibility of ecstasy-induced liver damage occurring in younger patients, although the presence of other hepatotoxins and alternative diagnoses requires exclusion. The use of this drug should be investigated in young patients with severe hepatitis of unknown origin.     

Case series of COVID-19 patients from the Qinghai-Tibetan Plateau Area in China

BACKGROUNDCoronavirus disease 2019 (COVID-19) is a serious infection caused by the new coronavirus severe acute respiratory syndrome coronavirus 2. The disease was first identified in December 2019 and has caused significant morbidity and mortality worldwide. AIMTo explore the clinical characteristics and treatments for COVID-19 in the Qinghai-Tibetan Plateau Area in China.METHODSWe retrospectively analyzed the blood cell counts (neutrophils and lymphocytes), blood gas analysis, and thoracic computed tomography changes of patients from Qinghai Province before, during, and after treatment (January 23, 2020 to February 21, 2020). In addition, we summarized and analyzed the information of critical patients. All data were analyzed using SPSS 17.0 (SPSS Inc., Chicago, IL, United States). The quantitative and count variables are represented as the mean ± SD and n (%), respectively.RESULTSThe main symptoms and signs of patients with COVID-19 were fever, dry cough, cough with phlegm, difficulty breathing, and respiratory distress with a respiration rate ≥ 30 times/min, finger oxygen saturation ≤ 93% in the resting state, and oxygenation index less than 200 but greater than 100 (after altitude correction). Eighteen patients with COVID-19, of whom three were critical, and the others were in a mild condition, were included. The main manifestations included fever, dry cough, and fatigue. Three patients developed difficulty breathing and had a fever. They were eventually cured and discharged. Adjuvant examinations showed one case with reduced white cell count (6%) (< 4 × 10⁹/L), six with reduced count of lymphocytes (33%) (< 0.8 × 10⁹/L), and one with abnormal blood glucose level. All 18 patients were discharged, and no death occurred.CONCLUSIONOur findings provide critical insight into assessing the clinical diagnosis and treatment for COVID-19 in the Tibetan plateau area.     

Mechanisms and possible causes of Alzheimer's disease

Abstract

Nonalcoholic fatty liver disease (NAFLD) is very prevalent in obese patients. However, increases in serum aminotransferase levels after weight loss have raised clinical concerns. This study documented sequential changes of serum aminotransferase levels for severely obese patients who lost a substantial amount of weight in a behavioral weight loss program. One hundred three severely obese patients who lost > 45.5 kg were treated in our clinic's weight management program. The prevalence of all risk factors except diabetes was higher among those with elevated (AE) baseline serum alanine transferase (ALT) levels than those with normal levels (AN). Weight losses at 8 and 24 weeks were 19.8 and 43.5 kg in the AN group (n = 79 patients) and 21.8 and 45.5 kg in the AE group (n = 24 patients), respectively. Total weight losses after completion of the program were 58.4 kg in the AN group and 57.6 kg in the AE group. The baseline levels for the AN group were: ALT, 25.4 U/L and aspartate aminotransferase (AST)/ALT ratio, 0.87. The baseline levels for the AE group were: ALT, 68.0 U/L and AST/ALT ratio, 0.61. Peak ALT levels were 75.4 U/L in the AN group and 94.0 U/L in the AE group. The final serum ALT levels were 23.7 U/L and 27.3 U/L in the AN and AE groups, respectively. This severely obese population had a very high frequency of ALT elevations with weight loss, but elevations were transient; values usually returned to below baseline levels after substantial weight loss.     

Retrospective analysis of T-lymphocyte subsets and cytokines in malignant obstructive jaundice before and after external and internal biliary drainage

ObjectiveTo study changes in T lymphocyte subsets, cytokines, and liver enzymes in patients with malignant obstructive jaundice (MOJ) before and after external biliary drainage (percutaneous transhepatic cholangiography drainage, PTCD) and internal biliary drainage (percutaneous transhepatic insertion of biliary stents, PTIBS).MethodsMOJ patients undergoing PTCD (n = 44) and PTIBS (n = 38) at our hospital were enrolled in the study from January 2017 until December 2019. Peripheral blood total bilirubin (TBIL), direct bilirubin (DBIL), aspartate aminotransferase (AST), alanine aminotransferase (ALT), CD3⁺%, CD4⁺%, CD4⁺/CD8⁺ ratio, interleukin (IL)-2, IL-6, and tumor necrosis factor (TNF)-α were measured before and 1 week after biliary drainage.ResultsThere was no significant difference in any parameter between the two groups before biliary drainage. TBIL, DBIL, AST and ALT following PTCD were significantly lower than before PTCD. By contrast, CD3⁺%, CD4⁺%, CD4⁺/CD8⁺ ratio, IL-2, IL-6 and TNF-α showed no significant difference before and 1 week after PTCD. TBIL, DBIL, AST, ALT, IL-6 and TNF-α were significantly lower following PTIBS than before PTIBS. CD3⁺%, CD4⁺%, CD4⁺/CD8⁺ ratio and IL-2 were significantly higher following PTIBS than before PTIBS.ConclusionBoth PTCD and PTIBS were effective for treatment of MOJ, but PTIBS was more beneficial for recovery of immune function.     

Efficacy of resveratrol supplementation on liver enzymes in patients with non-alcoholic fatty liver disease: A systematic review and meta-analysis

ObjectiveRandomized clinical trials (RCTs) examining the effects of resveratrol supplementation on liver enzymes in non-alcoholic fatty liver disease (NAFLD) have reported conflicting results. The aim of this systematic review was to summarize evidence of the effects of resveratrol supplementation on alanine aminotransferase (ALT), and aspartate aminotransferase (AST) levels in patients with NAFLD by performing a meta-analysis of RCTs.MethodsPubMed, Cochrane Library, Scopus, and Web of Science databases were electronically explored from inception to August 2020 for all relevant studies. Random effect models were used to estimate liver enzymes changes between resveratrol supplementation and control groups by evaluating the weighted mean differences (WMD) with 95 % confidence intervals (CIs).ResultsFive trials with a total of 216 patients were included in the meta-analysis. The pooled results showed that resveratrol supplementation did not result in significant changes in serum ALT (WMD= -2.48 IU/L; 95 % CI: -12.30, 7.34; P = 0.62), and AST (WMD = -2.90 IU/L; 95 % CI: -9.77, 3.98; P = 0.40) concentrations. Subgroup analysis revealed a significant reduction in serum ALT and AST concentrations in the participants with mean age <45 years, and studies with intervention dosage <1000 mg/day. In addition, ALT and AST levels were decreased significantly in studies with duration >12 weeks and participants with BMI < 30 kg/m², respectively.ConclusionsThe overall results indicated that resveratrol supplementation did not affect liver enzymes in patients with NAFLD. More studies examining the effect of resveratrol supplementation on liver enzymes are needed in the future.     

Analysis of the components of hypertransaminasemia after liver resection.

BACKGROUND: The increase in plasma aspartate (AST) and alanine (ALT) aminotransferase after liver resection is multifactorial, and a major problem is the difficult quantification of the impact of each factor involved. METHODS: Regression analysis of a large series of measurements for 92 hepatectomy patients was carried out to assess in detail the postoperative evolution of AST and ALT, together with related components. RESULTS: The best correlate of increased AST and ALT on postoperative day 1 was the duration of surgery (T-surg) (r(2)=0.31 and 0.29), with a lower correlation for intraoperative liver ischemia (T-isch) (r(2)=0.22 and 0.17, respectively; p<0.001 for all). Subsequently AST decreased more quickly than ALT and both followed an inverse exponential pattern. T-surg, T-isch, time after surgery and plasma bilirubin explained 77% and 51% of the variability of AST and ALT, respectively, for all postoperative measurements (p<0.001 for both). The best correlate of T-isch was a delayed increase in bilirubin, detected on postoperative day 7, attenuated by the use of intermittent liver ischemia. CONCLUSIONS: These data show that T-isch may not be the main determinant of increased transaminases after hepatectomy, and provide a quantitative analysis of the main impact of the trauma of liver resection, liver ischemia, and other factors on the postoperative evolution of transaminases.     

慢性肝病患者妇科腹腔镜手术耐受性分析

目的 探讨肝脏疾病基础的患者妇科腹腔镜手术的耐受性.方法 选择肝炎无症状携带者26例、轻型慢性肝炎28例、肝硬化代偿期患者21例进行妇科腹腔镜手术.均分别于术前及术后第1、3、7天抽血复查肝功能:丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、白蛋白(ALB)、总胆红素(TBil).结果 无症状携带者、轻型慢性肝炎患者妇科腹腔镜手术后第1天肝功能ALT、AST浓度较术前有上升,差异均有统计学意义[无症状携带者:ALT:术前(20.4±4.5) U/L,术后第1天(67.2±7.9)U/L,t=2.32;AST:术前(18.3±2.3)U/L,术后第1天(71.8±18.2) U/L,t=2.15.轻型慢性肝炎患者:ALT:术前(110.2±8.3)U/L,术后第1天(210.2±5.6)U/L,t=2.31;AST:术前(146.8±23.6)U/L,术后第1天(256.5±19.3)U/L,t =2.45.P均＜0.05];但术后第3、7天,2组以上两个指标的水平均接近术前,差异均无统计学意义(P均＞0.05);无症状携带者、轻型慢性肝炎者组术后各时期ALB、TBiL与术前比较,差异均无统计学意义(P均＞0.05).肝硬化代偿期组术后第1天表现为ALT、AST、TBiL浓度上升,差异均有统计学意义[ALT:术前(122.9±6.2) U/L,术后第1天(301.6±9.6) U/L,t =2.95;AST:术前( 156.6±12.7)U/L,术后第1天(327.8±21.8) U/L,t=3.11;TBiL:术前(28.2±2.1)μ mol/L,术后第1天(57.2±3.2)μmol/L,t =2.98.P均＜0.01];术后第3天略恢复,与术前相比差异有统计学意义[术后第3天:ALT( 235.4±7.9) U/L,t =2.41;AST( 241.5±20.7)U/L,t=2.33;TBiL(43.9±4.2)μmol/L,=2.67.P均＜0.05],但所有患者仍处于代偿期.术后第7天各项指标与术前相比差异均无统计学意义(P均＞0.05).结论 肝炎无症状携带者、轻型慢性肝炎、肝硬化代偿期患者妇科腹腔镜手术后可以出现肝功能的异常,但有可逆性.肝硬化代偿期患者手术后肝功能恢复较肝炎无症状携带者、轻型慢性肝炎患者迟,但患者仍处于代偿期.     

Prevalence of abnormal serum liver enzymes in patients with type 2 diabetes mellitus: a cross-sectional study from China

Objectives: This cross-sectional study aimed to determine the prevalence of elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in Chinese type 2 diabetic patients and identify contributing risk factors.

Methods: This cross-sectional study was conducted in rural areas of China, and 1,198 type 2 diabetic patients with complete data were recruited. Elevated ALT and AST levels were defined as >40 U/L. Prevalence of abnormal liver enzymes was analyzed and multivariable analysis was used to identify independent risk factors.

Results: 10.3% and 6.1% diabetic patients had elevated ALT and elevated AST, respectively. The prevalence of elevated liver enzymes was gender-related; it was 13.8% in men and 7.5% in women for elevated ALT, and 7.4% in men and 3.1% in women for elevated AST. High triglyceride was positively associated with both elevated ALT (OR 1.80, 95% CI 1.08–3.01, p = 0.024) and elevated AST (OR 2.24, 95%CI 1.08–4.65, p = 0.031), while taking anti-diabetes medicine was inversely related to both elevated ALT (OR 0.48, 95% CI 0.29–0.80, p = 0.005) and elevated AST (OR 0.37, 95% CI 0.17–0.82, p = 0.014). The risk of elevated ALT in diabetic patients increased with the presence of obesity (OR 2.54, 95% CI 1.07–6.01, p = 0.034), and was lower in women (OR 0.37, 95% CI 0.19–0.72, p = 0.003). Hypertension (OR 4.33, 95% CI 1.41–13.30, p = 0.011), current drinking status (OR 2.90, 95% CI 1.21–6.96, p = 0.017) and national minority (OR 3.26, 95%CI 1.31–8.12, p = 0.011) were risk factors for elevated AST.

Conclusion: A relatively high prevalence of abnormal serum liver enzymes in diabetic patients was demonstrated in China, especially in males. More attention should be paid to preventing liver injuries in diabetic patients.     

Establishing reference intervals for ALT,AST, UR,Cr, and UA in apparently healthy Chinese adolescents

BackgroundThe current child-specific reference intervals (RIs) are inadequate or even unavailable for many analyses in China. Many of the RIs used in Chinese laboratories were derived from Chinese adult standards or from foreign studies. The aim of this study was to establish specific RIs for alanine aminotransferase (ALT), aspartate aminotransferase (AST), urea (UR), creatinine (Cr) and uric acid (UA) for apparently healthy Chinese adolescents.MethodsOverall, 1682 apparently healthy adolescents were enrolled. Serum ALT, AST, UR, Cr and UA were measured by an ARCHITECT C-8000 automated chemistry analyzer. The 2.5th and 97.5th percentile RIs were determined using non-parametric methods.ResultsThe established reference intervals for ALT, AST, UR, CR and UA were 7.5–42.8 U/L, 12.8–40.2 U/L, 3.12–6.38 mmol/L, 42.7–91.2 μmol/L, and 180.2–409.6 μmol/L in boys and 6.5–32.8 U/L, 10.4–32.5 U/L, 3.05–6.47 mmol/L, 40.2–88.8 μmol/L and 176.5–394.0 μmol/L in girls, respectively. The median and upper and lower limits for the RIs of ALT, AST, Cr and UA were higher in boys than they were in girls (P < 0.05).ConclusionRIs based on adult criteria are not applicable to adolescents. It was necessary to establish specific, accurate and suitable RIs for Chinese adolescents. We have established reference intervals of ALT, AST, UR, Cr and UA that are defined specifically for Chinese adolescents and are appropriate for universal use among Chinese laboratories.     

肝酶学改变与急性移植物抗宿主病严重程度的相关性研究

目的 探讨急性移植物抗宿主病(aGVHD)患者肝脏酶学变化与aGVHD严重程度的关系.方法 回顾性分析82例发生aGVHD的患者肝脏酶学的变化情况及与aGVHD严重程度的关系.结果 Ⅰ度aGVHD 15例(18.3%),Ⅱ度aGVHD 47例(57.3%),Ⅲ度aGVHD 13例(15.9%),Ⅳ度aGVHD 7例(8.5%);ALT升高49例(59.8%),AST升高36例(43.9%),碱性磷酸酶(ALP)升高8例(9.8%);其中34例(69.4%)患者ALT升高发生在aGVHD出现前,18例(50%)患者AST升高发生在aGVHD出现前,4例(50%)患者ALP升高发生在aGHVD出现前.ALT升高较AST升高提前出现;Ⅲ～Ⅳ度aGVHD组,ALT、AST升高的百分比(分别为80%和70%)明显高于Ⅰ～Ⅱ度aGVHD组(分别为53.2%和35.5%),但ALP升高的百分比无明显差异;Ⅲ～Ⅳ度aGVHD患者与Ⅰ～Ⅱ度aGVHD患者相比,ALT及AST峰值均明显升高;ALT升高组严重aGVHD的百分比明显升高.结论 肝酶学改变在aGVHD的发生中很常见,并且与aGVHD的严重程度明显相关,肝酶学尤其是ALT可能有助于早期预警严重aGVHD的发生.     

Effects of curcumin/turmeric supplementation on liver function in adults: A GRADE-assessed systematic review and dose–response meta-analysis of randomized controlled trials

IntroductionLiver conditions are major burdens upon health systems around the world. Turmeric /curcumin is believed to possess therapeutic features in ameliorating various metabolic disorders. In this systematic review and meta-analysis of the randomized controlled trials (RCTs), we examined the effect of turmeric/curcumin supplementation on some liver function tests (LFTs).MethodsWe comprehensively searched online databases (i.e. PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar) from inception up to October 2022. Final outcomes included aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyl transferase (GGT). Weighted mean differences (WMDs) were reported. In case of between-study heterogeneity, subgroup analysis was conducted. Non-linear dose-response analysis was carried out to detect the potential effect of dosage and duration. The registration code is CRD42022374871.ResultsThirty-one RCTs were included in the meta-analysis. Turmeric/curcumin supplementation significantly reduced blood levels of ALT (WMD = −4.09 U/L; 95 % CI = −6.49, −1.70) and AST (WMD = −3.81 U/L; 95 % CI = −5.71, −1.91), but not GGT (WMD: −12.78 U/L; 95 % CI: −28.20, 2.64). These improvements, though statistically significant, do not ensure clinical effectiveness.ConclusionIt seems that turmeric/curcumin supplementation might be effective in improving AST and ALT levels. However, further clinical trials are needed to examine its effect on GGT. Quality of the evidence across the studies was low for AST and ALT and very low for GGT. Therefore, more studies with high quality are needed to assess this intervention on hepatic health.     

COVID-19 in gastroenterology and hepatology: Lessons learned and questions to be answered

BACKGROUNDAlthough coronavirus disease 2019 (COVID-19) presents primarily as a lower respiratory tract infection, increasing data suggests multiorgan, including the gastrointestinal (GI) tract and liver, involvement in patients who are infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).AIMTo provide a comprehensive overview of COVID-19 in gastroenterology and hepatology.METHODSRelevant studies on COVID-19 related to the study aim were undertaken through a literature search to synthesize the extracted data.RESULTSWe found that digestive symptoms and liver injury are not uncommon in patients with COVID-19 and varies in different individuals. The most common GI symptoms reported are diarrhea, nausea, vomiting, and abdominal discomfort. Other atypical GI symptoms, such as loss of smell and taste and GI bleeding, have also been reported along with the evolvement of COVID-19. Liver chemistry abnormalities mainly include elevation of aspartate transferase, alanine transferase, and total bilirubin. It is postulated to be related to the binding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus to the angiotensin converting enzyme-2 receptor located on several different human cells. CONCLUSIONStandardized criteria should be established for diagnosis and grading of the severity of GI symptoms in COVID-19 patients. Gastroenterology and hepatology in special populations, such as children and elderly, should be the focus of further research. Future long-term data regarding GI symptoms should not be overlooked.