mAST/AST比值在几种肝损害病程中的变化及临床意义

Changes of mAST/AST ratio and their clinical significance in several kinds of diseases concerning liver damage

目的探讨血清线粒体型天门冬氨酸氨基转移酶同工酶(mAST)/天门冬氨酸氨基转移酶(AST)比值在几种肝损害患者病程中的变化规律及其临床意义。方法用免疫抑制法测定肝损害患者血清AST和mAST的活力,计算出mAST/AST比值,观察其在发病期(入院时)与各治疗阶段的动态变化。结果正常人mAST/AST比值为0.117±0.018,重型肝炎、酒精性肝炎、急性肝炎、药物性肝炎、肝炎性肝硬化和慢性肝炎等发病期的mAST/AST分别为0.482±0.096、0.393±0.036、0.332±0.046、0.311±0.040、0.289±0.032和0.275±0.021,均显著高于正常人(P均<0.01);从治疗开始后的第1周起,酒精性肝炎组、急性肝炎组和药物性肝炎组mAST/AST比值呈逐步持续下降趋势;治疗第4周后,其mAST/AST比值已基本恢复正常,其他组则无明显变化。结论动态监测血清mAST/AST比值的变化有助于对肝实质细胞损伤的坏死程度进行评估,有利于急性肝炎、重型肝炎的预后判断和急性肝炎与慢性肝炎的鉴别诊断,对酒精性肝炎和药物性肝炎的评估和诊断治疗有指导价值。

Objective To investigate the changing way of serum mAST/AST ratio in patients with some diseases concerning liver damage, as well as their clinical significance.Methods By using immunoinhibition assays, the activities of the patients′ serum mAST and AST were measured. The mAST/AST ratio was calculated. The changes of laboratory results at the time point the patients entered hospital and during the convalescence periods (the first,second,third and fourth week respectively after treatment) were observed.Results The mAST/AST radio for healthy subjects was 0.117±~0.018 and that for patients when they first entered hospital was listed below: severe hepatitis 0.482±~0.096 , alcoholic hepatitis 0.393±0.036, acute hepatitis 0.332±0.046, drug hepatitis 0.311±~0.040 , hepatitis cirrhosis 0.289±0.032 and chronic hepatitis 0.275±0.021. The mAST/AST radio was significantly elevated in patients with liver damage as compared with healthy subjects(P<~0.01 ),and from the first week after treatment, a sharp and continuous decline in mAST/AST ratio in patients with alcoholic hepatitis, acute hepatitis and drug hepatitis was found. After four-week treatment, mAST/AST ratio for those patients with alcoholic hepatitis, acute hepatitis and drug hepatitis reverted to being almost close to a normal level while there was no noted changes in patients from the other groups.Conclusion Dynamically monitoring the changes in the serum mAST/AST Ratio may help to assess the extent which the substantial liver cells are damaged,and to faciliate the prognosis judgment of acute hepatitis and severe hepatitis, as well as the discrimination and diagnosis of acute and chronic hepatitis. This study will also have guiding value on the evaluation, diagnosis and treatment of alcoholic and drug hepatitis.