Non-alcoholic steatohepatitis with normal aminotransferase values

AIM： To investigate the aspects of liver histology in patients with non-alcoholic steatohepatitis （NASH） who had normal aminotransferase levels. METHODS： Thirty-four patients diagnosed with liver steatosis by ultrasonographic examination participated in the study. We compared all non- alcoholic fatty liver disease and NASH cases, according to aminotransferase level, aspartate aminotransferase （AST）/alanine aminotransferase （ALT） ratio and presence of metabolic syndrome. RESULTS： Sixteen of 25 patients with high aminotransferase levels were diagnosed with NASH and nine with simple fatty liver according to liver histology. Among the nine patients with normal aminotransferase levels, seven had NASH and two had simple fatty liver. The patients with normal and high liver enzyme levels had almost the same prevalence of NASH and metabolic syndrome. Liver histology did not reveal any difference according to aminotransferase levels and AST/ALT ratio. CONCLUSION： Aminotransferase levels and AST/AIT ratio do not seem to be reliable predictors for NASH. Despite numerous non-invasive biomarkers, all patients with fatty liver should undergo liver biopsy.     

Clinical study on the liver stiffness value measured by Fibro Scan and aspartate transaminase-to-platelet ratio index for evaluation of hepatic fibrosis in patients with chronic hepatitis B

正Objective To assess the clinical diagnostic performance of liver stiffness measurement(LSM)and aspartate transaminase(AST)-to-platelet(PLT)ratio index(APRI)for liver fibrosis in chronic hepatitis B(CHB)patients with alanine aminotransferase(ALT)less than or equal to five times of the apper limit of normal(≤5×upper limit of normal[ULN]).Methods Fibro Scan,blood routine and liver function test were conducted at     

天冬氨酸转氨酶与丙氨酸氨基转移酶比值和Child Pugh评分对肝硬化预后的评估

[目的]探讨天冬氨酸转氨酶(AST)/丙氨酸氨基转移酶(ALT)比值与Child Pugh评分对慢性乙肝肝硬化患者短、中期预后评估的价值.[方法]对173例肝硬化患者的生存率进行回顾性评估,随访1 a.计算每例患者入院当天的AST/ALT比值与Child Pugh评分,以受试者特征曲线(ROC)下的面积衡量两者预测患者预后的能力,分析AST/ALT比值与Child Pugh评分的相关性.[结果]AST/ALT比值与Child Pugh评分呈显著相关(r=0.53,P＜0.01).随访3个月及1 a内分别有30例及50例患者死亡,死亡者AST/ALT比值与Child Pugh评分显著高于生存者(P＜0.01).依据ROC曲线AST/ALT比值截断值为1.6,对患者1 a预后判断的敏感性为55%,特异性为72%;Child Pugh评分截断值为10,其敏感性76%,特异性68%,联合应用两者敏感性和特异性可分别提高至85%和76%.[结论]AST/ALT比值及Child Pugh评分均可有效地预测肝硬化患者的短期和中期预后,联合应用可提高其准确率.     

脂肪肝的诊断研究

0引言脂肪肝是一种多病因引起的获得性疾病,临床表现与其病因和病理类型有关.通常我们所说的脂肪肝主要指由肥胖、糖尿病和酒精等因素所致的慢性脂肪肝.1脂肪肝的实验室检查1.1肝功能改变1.1.1AST/ALT比值非酒精性单纯性脂肪肝肝功能多无明显改变.而非酒精性脂肪肝炎(NASH)和酒精性脂肪肝时转氨酶可轻度至中度升高,酒精性脂肪肝AST/ALT比值常大于2.0.NASH患者AST与ALT比值小于1.0.AST/ALT比值在1-2之间,与病毒性肝炎和坏死后性肝硬化有很大的重叠,但比值≥3.0高度提示酒精性肝病.因此AST/ALT比值对于酒精性肝病和NASH的诊…     

Aspartate aminotransferase-immunoglobulin complexes in patients with chronic liver disease

AIM: To determine the complex of AST and immunoglobulin and to investigate its clinical significance in patients with liver disease. METHODS: The complex of AST and immunoglobulin was determined by encounter immunoelectrophoresis and its clinical significance was investigated in 128 patients with liver disease. RESULTS: AST was bound to immunoglobulin of anti-immunoglobulin A (IgA) class, but any binding to anti-immunoglobulin G and anti-immunoglobulin M classes was not observed. Although the incidence of AST-immunoglobulin complex was 41.8% in chronic hepatitis (CH), the incidences in liver cirrhosis and hepatocellular carcinoma were 62.2 and 90.0%, respectively. In alcoholic liver disease with high level of serum IgA, the incidence of the complex was 66.7%, which was higher than that in CH. The ratio of binding to lambda-chain of IgA was higher than that to kappa-chain of IgA. The serum level of IgA and the ratio of AST/alanine aminotransferase (ALT) were significantly higher in patients with AST-IgA complex than in those without complex. CONCLUSION: These results suggest that AST-IgA complex in patients with progressive liver diseases and alcoholic liver injury can lead to elevation of the ratio of AST/ALT.     

不同非侵入性标记物预测肝硬化患者食管静脉曲张出血的效能分析

目的 评估不同非侵入性标记物预测肝硬化患者食管静脉曲张出血(esophageal varices blooding,EVB)的效能。方法 2016年1月至2019年2月,纳入了在6个月内接受CT和上消化道胃镜检查的86例肝硬化患者。通过ROC曲线评估瞬时弹性成像技术(FibroScan)、天冬氨酸转氨酶(AST)与丙氨酸转氨酶(ALT)比值(AST/ALT)、AST与血小板比值指数(APRI)、血小板计数与脾脏直径(PL/SD)、纤维化指数-4(FIB-4)、纤维化指数、King评分对EVB的诊断性能。结果 在86例肝硬化患者中,有21例出现EVB,发生率为24.4%。与非EVB组相比,EVB组患者的血红蛋白显著降低(P0.05),而FibroScan值显著升高(P0.05)。ROC分析结果显示,FibroScan值在预测EVB方面具有最高的特异性(75.3%)、PPV(51.3%)、AUC(0.70)和准确度(70.2%)。logistic回归分析显示,EVB与FibroScan值之间存在显著相关性(OR=1.57;95%CI:1.15-2.14),而其他非侵入性标记物(纤维化指数、King评分、APRI、PL/SD和AST/ALT)未显示与EVB存在显著关联。结论 FibroScan值是肝硬化患者EVB最可靠的预测因子。尽管诊断准确率低,FibroScan值是最有效的非侵入性肝纤维化标志物,可作为EVB的初步筛查工具。     

354例肝病患者四项血清酶检测的临床意义

笔者通过对354例肝病患者(其中急性肝炎258例,慢性肝炎66例,肝硬化30例)丙氨酸转氨酶(ALT),天门冬氨酸转氨酶(AST),碱性磷酸酶(ALP),γ-谷氨酰胺转肽酶(γ-GT)的检测,观察分析了4种酶学指标与肝病病情变化的关系及AST与ALT间比值变化的临床意义。     

AST/ALT比值在慢性肝病患者中的特点和判断预后价值

目的 分析不同病因、不同病情的慢性肝病患者天冬氨酸氨基转移酶和丙氨酸氨基转移酶比值(AST/ALT)的特点,评价AST/ALT比值判断慢性肝病患者预后方面的价值.方法 对534例不同病因的肝硬化、原发性肝癌患者的住院资料进行分析,比较各类患者AST/ALT比值的特点.运用接受者运行曲线(ROC)及曲线下面积,比较AST/ALT比值与终末期肝病模型(MELD)、Child-Turcotte-Pugh(CTP)分级(CC)和评分(CS)在判断慢性肝病患者中短期预后方面的准确性;运用非参数相关分析,计算Spearman相关系数,分析三者之间的相关性.结果 在原发性肝癌患者,AST/ALT比值明显高于肝硬化患者(P＜0.05);病毒性肝病患者和非病毒性肝病患者的AST/ALT比值无明显差异(P=0.852).死亡患者的AST/ALT比值明显高于生存患者的平均值(P=0.000);随着CTP分级的升高,AST/ALT比值也逐渐升高,A、B、C三级之间的AST/ALT比值具有显著差异(P＜0.05).AST/ALT比值和MELD、CS及CC在判断慢性肝病患者生存3个月的ROC曲线下面积分别是0.88、0.92、0.69和0.59,判断生存1年时间的ROC曲线下面积分别为0.64、0.77、0.65和0.63;AST/ALT比值与MELD、CS和CC三者之间的相关系数分别是0.185、0.291和0.297(P=0.000).结论 AST/ALT比值随着肝脏病变的加重而逐渐升高.AST/ALT比值和MELD在判断慢性肝病患者短期预后方面是较好的指标.AST/ALT比值和MELD、CS、CC三者之间具有显著相关性.     

血清ALT、AST联合NFS评分对非酒精性脂肪性肝硬化患者食管胃底静脉曲张严重程度的评估价值

目的:探讨血清中谷丙转氨酶(ALT)、谷草转氨酶(AST)联合非酒精性脂肪性肝纤维化评分(NFS)对非酒精性脂肪性肝硬化患者食管胃底静脉曲张(EGV)严重程度的评估价值。方法:回顾性分析2016年7月至2018年9月收治的130例该类患者的临床资料,根据其是否合并EGV分为A组(肝硬化未合并EGV,n=65)与B组(肝硬化合并EGV,n=65),比较两组患者血清中ALT、AST水平及NFS评分,比较EGV严重程度不同的肝硬化患者血清ALT、AST水平及NFS评分,采用Pearson相关分析肝硬化合并EGV血清ALT、AST水平及NFS评分的相关性,采用多因素Logistic回归分析肝硬化食管胃底静脉曲张的影响因素,分析血清ALT、AST联合NFS评分对非酒精性脂肪性肝硬化患者食管胃底静脉曲张的诊断效能。结果:B组患者NFS评分显著高于A组(P0.05);B组患者血清ALT、AST水平显著低于A组(P0.05);EGV严重程度不同的患者血清ALT、AST水平及NFS评分差异有统计学意义(P0.05);ALT与AST呈正相关(P0.05),ALT与NFS呈负相关(P0.05),AST与NFS呈负相关(P0.05);ALT、AST、NFS为肝硬化EGV的独立危险因素(P0.05);ALT、AST、NFS联合对该类肝硬化患者EGV的诊断效能明显优于各指标单项检测(P0.05)。结论:血清ALT、AST联合NFS与肝硬化患者EGV严重程度密切相关,三者联合检测对EGV出血的预测具有重要指导意义,可在临床推广应用。     

非酒精性脂肪性肝病患者血清Betatrophin水平评估病情严重程度的应用价值

目的研究非酒精性脂肪性肝病(NAFLD)患者血清Betatrophin水平评估病情严重程度的价值。方法选取我院2017年4月—2018年4月收治的50例NAFLD患者纳入研究对象,设为观察组;另外选取50名体检健康的志愿者作为对照组。对比两组及不同病情严重程度患者促代谢因子(Betatrophin)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆固醇(TC)、甘油三酯(TG)水平及身体质量指数(BMI)差异,另外以Spearman系数分析NAFLD患者血清Betatrophin与ALT、AST、TC、TG及BMI的相关性。结果观察组Betatrophin、ALT、AST、TC、TG及BMI显著高于对照组,差异有统计学意义(P0.05)。不同严重程度NAFLD患者Betatrophin、ALT、AST、TC、TG及BMI对比重度中度轻度,差异有统计学意义(P0.05)。经相关性分析血清Betatrophin水平与ALT、AST、TC、TG及BMI呈正相关,均有(P0.05)。结论 NAFLD患者Betatrophin水平呈现出高表达,且随病情严重程度的加重而上升,可用于NAFLD病情严重程度的评估,值得临床关注。     

健脾调脂饮联合阿托伐他汀在非酒精性脂肪肝中的疗效分析

目的:观察健脾调脂饮联合阿托伐他汀在非酒精性脂肪肝(non-alcoholic fatty liver disease, NAFLD)中的应用效果。方法:将2020年1月-2022年9月期间我院收治的NAFLD患者110例按照随机数字表法分为两组，各55例。两组均接受常规治疗，在此基础上，对照组采用阿托伐他汀治疗，研究组在对照组基础上采用健脾调脂饮治疗，两组均治疗3个月。比较两组临床疗效、治疗前后肝功能[谷丙转氨酶(alanine aminotransferase, ALT)、谷草转氨酶(aspartate aminotransferase, AST)、总胆红素(total bilirubin, STB)、直接胆红素(direct bilirubin, DBIL)、间接胆红素(indirect bilirubin, IPIL)]、脂代谢[总胆固醇(total cholesterol, TC)、甘油三酯(triglyceride, TG)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol, LDL-C)、高密度脂蛋白胆固醇(high densit...     

Transient elevation of hepatic enzymes in volunteers after intake of alcohol

BACKGROUND: In the organs that mediate alcohol effects on the human body and its health, the liver plays a particular important role. This study was designed to detect the changes of hepatic enzymes after alcohol intake and evaluate the corresponding damage to the human body. METHODS: Fifteen volunteers were included according to the criteria. After the intake of 80g ethanol containing beverage, alcohol levels were detected and blood samples were collected at 0.5-to 3-hour interval to detect the levels of hepatic enzymes simultaneously. RESULTS: After the intake of 80g ethanol, various symptoms occurred in volunteers while the concentration of blood alcohol peaked at 1 hour and normalized within 24 hours. The ratio of alanine aminotransferase (ALT) to aspartate aminotransferase (AST) increased significantly when the venous alcoholic concentration increased from 0g/L to 1.2g/L and the levels of alkaline phosphatase (ALP) and gamma-glutamyl transpeptidase(γ-GT) were elevated when the alcoholic concentration reached 0.4g/L. No significant changes were noticed in ALT, AST or cholinesterase (CHE). CONCLUSION: Acute alcohol intoxication may cause the changes of hepatic enzymes and prove the existence of reversible hepatic injury.     

石榴多酚对小鼠急性肝损伤的保护作用

目的观察石榴多酚对小鼠肝损伤的防护作用。方法用四氯化碳(CCl4)致小鼠急性肝损伤模型,观察石榴多酚(200、400、600mg/kg)对小鼠血清丙氨酸转氨酶(ALT)、天门冬氨酸转氨酶(AST)活性和肝脏组织超氧化物歧化酶(SOD)活性及丙二醛(MDA)含量的影响。结果石榴多酚能明显降低急性肝损伤小鼠血清ALT、AST水平;并可使肝脏中MDA含量降低,SOD活性升高。各实验组小鼠的肝体比值均低于肝损伤模型组。结论石榴多酚对肝损伤具有保护作用,其作用可能与抗氧化有关。     

非酒精性脂肪性肝病显著肝纤维化的无创诊断

目的:通过对非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)患者多个肝纤维化非创伤性诊断模型的验证和分析比较,评价其诊断价值.方法:选取29例NAFLD患者,进行肝组织活检和病理学分期,并检测血清指标,用受试者操作特征(ROC)曲线等方法评估APRI指数、AST/ALT比率、BARD评分等模型的诊断价值.结果:29例病例中17例(58.9%)为男性,平均年龄(51±12)岁,平均体质量指数为(27±5)kg/m2,糖尿病患者15(51.7%);病理肝纤维化分级提示显著纤维化S3-S4:6例(20.6%).各诊断模型对肝脏显著纤维化程度都具有一定诊断价值,其中AST/ALT比率表现最佳[其曲线下面积(AUROC)为0.83],其次为BARD评分(AUROC0.77)和APRI指数(AUROC0.67).AST/ALT比率和BARD评分模型的阴性预测值均大于90%(分别为93%和95%).阳性预测值均处于中低等水平.AST/ALT比率和BARD评分模型分别可使68.9%和37.9%的患者避免肝活检.结论:肝纤维化非创伤性诊断模型能较好地区分存在显著肝纤维化的NAFLD患者,其中以AST/ALT比率、BARD评分模型较为有效,可以避免部分患者行肝穿刺检查.     

Diagnostic criteria for acute liver failure due to Wilson disease

AIM: To describe the diagnostic criteria for acute liver failure due to Wilson disease (WD), which is an uncommon cause of acute liver failure (ALF). METHODS: We compared findings of patients presenting with ALF due to WD to those with ALF of other etiologies. RESULTS: Previously described criteria, such as low alkaline phosphatase activity, ratio of low alkaline phosphatase to total bilirubin or ratio of high aspartate aminotransferase (AST) to alanine aminotransferase (ALT), failed to identify patients with ALF due to WD. There were significant differences in low ALT and AST activities (53 ± 43 vs 1982 ± 938, P < 0.0001 and 87 ± 44 vs 2756 ± 2941, P = 0.037, respectively), low choline esterase activity (1.79 ± 1.2 vs 4.30 ± 1.2, P = 0.009), high urine copper concentrations (93.4 ± 144.0 vs 3.5 ± 1.8, P = 0.001) and low hemoglobin (7.0 ± 2.2 vs 12.6 ± 1.8, P < 0.0001) in patients with ALF caused by WD as compared with other etiologies. Interestingly, 4 of 7 patients with ALF due to WD survived without liver transplantation. CONCLUSION: In ALF, these criteria can help establish a diagnosis of WD. Where applicable, slit- lamp examination for presence of Kayser-Fleischer rings and liver biopsy for determination of hepatic copper concentration still remain important for the diagnosis of ALF due to WD. The need for liver transplantation should be evaluated carefully as the prognosis is not necessarily fatal.     

乙型肝炎核心抗原阳性患者的血清ALT和AST异常分析

乙型肝炎核心抗原(HBcAg)是Dane氏颗粒的核心部分,由于乙型肝炎病毒在肝细胞内的直接复制,可导致谷丙转氨酶(ALT)和谷草转氨酶(AST)的增高。我们对346例血清HBcAg阳性患者同时检测了ALT和AST,其结果报告如下。     

双歧杆菌三联活菌胶囊治疗非酒精性脂肪肝的临床观察

[目的]探讨肠道益生菌对非酒精性脂肪肝(NAFLD)的疗效。[方法]选取100例明确诊断为NAFLD的患者,随机分为治疗组与对照组。在健康宣教(低脂饮食+有氧运动)的基础上,治疗组给予口服肠道益生菌(双歧杆菌三联活菌胶囊,840mg/次,2次/d),持续用药3个月;对照组不予药物治疗。干预前后空腹采血测定总胆固醇(TC)、三酰甘油(TG)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、谷氨酰转肽酶(γ-GT)和肝脏硬度及脂肪衰减情况检查(肝脏瞬时弹性成像检查FibroTouch),计算并统计体质指数(BMI)。[结果]干预后,治疗组的TC、TG、脂肪衰减系数均小于对照组,差异有统计学意义(P0.05);2组干预后的BMI、ALT、AST、γ-GT、肝脏硬度均有所下降,但干预前后比较差异无统计学意义(P0.05)。[结论]口服益生菌具有一定辅助治疗NAFLD的作用。     

肝病患者精氨酸代琥珀酸裂解酶水平与肝病血清学指标的相关性研究

[目的]探讨肝脏疾病时患者精氨酸代琥珀酸裂解酶(argininosuccinate lyase,ASL)的分泌及与肝病血清学指标的关系.[方法]102例明确诊断的肝病患者,测定血清ASL、甘氨酸胆酸(GCA)、丙氨酸氨基转移酶(ALT)和天冬氨酸转氨酶(AST),并与71例非肝病患者以及40例健康体检者(健康对照组)进行对照比较.[结果]肝病组血清ASL水平显著高于非肝病组和健康对照组(均P＜0.01),而非肝病组和健康对照组间差异无统计学意义;GCA、ALT和AST 3组间差异均有统计学意义(均P＜0.01).受试者工作特征曲线(ROC Curve)显示ASL诊断肝脏疾病的诊断效率高于GCA、ALT和AST,相关性分析显示肝病患者血清ASL水平与GCA、ALT、AST呈正相关(均P＜0.01).[结论]ASL是反映肝脏疾病的灵敏指标,与常见的肝病血清学诊断指标有关联性,且诊断效率最高,适合临床开展肝病的鉴别诊断.     

阿托伐他汀对冠心病合并非酒精性脂肪肝患者ADMA及ALT的影响

目的观察冠状动脉粥样硬化性心脏病（冠心病）合并非酒精性脂肪肝患者服用阿托伐他汀前后血清非对称性二甲基精氨酸（asymmetric dimethylarginine。ADMA）、高敏c反应蛋白（highsensitively Creactive protein,hsCRP）、丙氨酸转氨酶（alanine aminotransferase,ALT）、天冬氨酸转氨酶（aspartate aminotransferase,AST）及γ-谷氨酰转肽酶（γ-glutamyltranspetidase,,yGT）浓度,以评价该药的疗效及安全性。方法按电脑数字随机表法选择广州医学院附属第一医院心血管内科冠心病合并非酒精性脂肪肝的患者80例,服用阿托伐他汀2年,分别测定治疗前后血清ADMA、hsCRP、ALT、AST、γ-GT、总胆固醇、三酰甘油、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇浓度,并进行比较。结果治疗后患者的血清ADMA[（2．77±0．35）μmol／Lvs（3．78±0．47）μmol／L,P〈0．05]、Aur[（34．2±9．3）U／Lvs．（83．4±16．7）U／L,P〈0．05]及hsCRP[（1．58±0．70）μg／LUS．（2．85±0．63）μg／L,P〈0．05]浓度均有下降,差异有统计学意义;AST、1-GT及高密度脂蛋白胆固醇、低密度脂蛋白胆固醇等指标得到了改善,且差异具有统计学意义（P〈0．05）。结论冠心病合并非酒精性脂肪肝患者服用阿托伐他汀疗效确切,安全性良好。     

Overlap of concurrent extrahepatic autoimmune diseases is associated with milder disease severity of newly diagnosed autoimmune hepatitis

Background:Concurrent extrahepatic autoimmune disorders(CEHAID) are frequently observed in autoimmune hepatitis(AIH).It is not clear whether there is any prognostic significance of CEHAID on AIH.The aim of this study was to examine the prognostic impact of CEHAID and the correlation with the disease severity of AIH.Methods:This study included 65 hospitalized subjects who fulfilled the accepted criteria for AIH during an 8-year period(2009–2016).All records were manually screened for presence of associated autoimmune diseases.Disease severity of AIH was assessed by liver laboratory tests including the ratio of aspartate aminotransferase to alanine aminotransferase(AST/ALT) and liver histology.Results:Among the enrolled patients,52(80%) were female(median age 61 years,IQR 45–75).Fifty-six(86.2%) were classified as type-1 AIH.In 26(40%) patients at least one additional extrahepatic autoimmune disease was diagnosed.Thirty-four subjects were referred to our hospital because of acute presentation of AIH(supposed by an acute elevation of hepatic enzymes) for subsequent liver biopsy resulting in initial diagnosis of AIH.This group was stratified into 3 subgroups:(A) AIH alone(n = 14);(B) overlap with primary biliary cirrhosis(PBC)/primary sclerosing cholangitis(PSC)(n = 11);and(C) with CEHAID(n = 9).AST/ALT ratio was the lowest in subgroup C(median 0.64,IQR 0.51–0.94;P = 0.023),compared to subgroup A(median 0.91,IQR 0.66–1.10) and subgroup B(median 1.10,IQR 0.89–1.36).Patients with AIH alone showed a trend to the highest grade of fibrosis(mean 2.3;95% CI:1.5–3.0) with no statistical significance compared to subjects with CEHAID(lowest grade of fibrosis;mean 1.5;95% CI:0.2–2.8;P = 0.380) whereas the ongoing inflammation was comparable.Conclusions:AST/ALT ratio and extent of fibrosis were lower in subjects with AIH and CEHAID,compared to subjects with only AIH.Therefore,the occurrence of CEHAID might be a predictor for lower disease severity of newly diagnosed acute onset AIH,possibly caused by an earlier diagnosis or different modes of damage.