ALT、AST、TBil及PT变化趋势与慢加急性乙型肝炎肝衰竭预后的关系

目的分析ALT、AST、TBil、PT在慢加急性乙型肝炎肝衰竭患者病程中的动态变化趋势及其对预后判定的意义。方法499例慢加急性乙型肝炎肝衰竭的患者,按临床结局分为存活组和死亡组。入院后每周检测其血清ALT、AST、TBil、PT,分析上述指标动态变化趋势及与慢加急性乙型肝炎肝衰竭预后的关系。结果入院时两组间ALT水平差异无统计学意义,但入院第2～6周,死亡组ALT水平高于存活组(P<0.05),而死亡组AST水平则在入院第1～5周均高于存活组(P<0.05)。两组ALT及AST均随时间呈下降趋势,但在相同时间里死亡组ALT及AST下降幅度较存活组小,入院第6周后两组ALT、AST水平差异无统计学意义。死亡组患者TBil、PT水平在入院后各周检测均高于存活组(P<0.001)。在第一周内两组TBil均升高,但从入院后第二周开始,存活组TBil、PT达峰值后开始随时间逐渐下降,而死亡组TBil、PT则随时间持续升高。结论慢加急性乙型肝炎肝衰竭患者入院后早期ALT、AST、TBil、PT的变化趋势可以反映其预后,动态观察其变化有助于早期判断慢加急性乙型肝炎肝衰竭患者的预后。

The dynamic changes of AST, ALT, TBil and PT and their relationship with prognosis of acute-on-chronic hepatitis B liver failure

Objective To analyze the dynamic changes of serum alanine transaminase(ALT),aspartate aminotransferase(AST),total bilirubin(TBil),prothrombin time(PT) levels and their prognostic significance in acute-on-chronic hepatitis B liver failure.Methods 499 cases of hepatitis B patients with acute-on-chronic liver failure were divided into the survival group and death group according to the clinical outcomes.After admission,serum ALT,AST,TBil,and PT were detected every week.The dynamic changes of these indicators and relationship with prognosis of these patients were analyzed.Results 1.Serum ALT levels on admission were comparable between survival group and death group.However,serum ALT levels in patients of death group were significantly higher than those in survival group from 2nd-6th week(P<0.05),and serum AST levels in patients of death group were significantly higher than those of survival group from admission to 5th week(P<0.05).ALT and AST levels showed a downward trend over time.Six weeks later ALT,AST levels between the two groups were basically normal and comparable.2.The TBil and PT levels in patients of death group were significantly higher than those of survival group at every week(P<0.001).Within the first week,TBil and PT levels increased in both groups.However,from the second week,the TBil and PT levels gradually decreased from the peak in survival group,but elevated in death group over time.Conclusion In patients with acute-on-chronic liver failure,the dynamic changes of serum ALT,AST,TBil and PT levels in early stage after admission could predict the clinical outcomes,which could be useful in prognostic evaluation.