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.

The Characteristics and the Prognostic value of AST/ALT Ratios in Chronic Liver Disease

Objective To analyze the characteristics and to assess the prognostic validity of the ratio of serum aspartate aminotransferase to alanine aminotransferase (AST/ALT ratio) in patients with chronic liver disease.Methods The AST/ALT ratios of 534 patients with liver cirrhosis and primary hepatic carcinoma were calculated. Receiver operating characteristic curves were used to compare the prognostic ability of AST/ALT ratio and the model for end-stage liver disease (MELD), Child-Turcotte-Pugh score and classification for short and medium term. The relationships between them were also evaluated.Results In the patients with primary hepatic carcinoma, the means of AST/ALT ratios were significantly higher than that of the means of patients with liver cirrhosis (P< 0.05). The means of AST/ALT ratios were not significantly different between the patients with viral and non-viral liver disease (P= 0.852). The ratios were significantly higher among patients who died compared with those who survived (P= 0.000). Among the CTP classification A, B and C, the AST/ALT ratios were significantly different (P< 0.05). The area under the ROC of the AST/ALT ratios and MELD scores, CTP scores and classification were 0.88, 0.92, 0.69 and 0.59 for 3-month prognosis, and were 0.64, 0.77, 0.65 and 0.63 for 1-yr prognosis respectively. The Spearman correlation coefficients between AST/ALT ratio, MELD scores, CTP scores and classifications were 0.185, 0.291, 0.297 respectively(P= 0.000).Conclusion An increase in the AST/ALT ratio is associated with progressive impairment of liver function. The AST/ALT ratio is a good index in prognosis for short-term survival as well as the MELD scores.