肝硬化不同证型对 AST ALT 及 AST/ALT 比值的影响

The effect of different types of cirrhosis on AST,ALT and their ratio

本文对８９例６种证型肝硬化患者血清ＡＳＴ、ＡＬＴ检测及ＡＳＴ／ＡＬＴ比值分析显示：ＡＳＴ、ＡＬＴ及ＡＳＴ／ＡＬＴ比值均高于正常，其升高幅度以肝郁脾虚型为最低，以肝肾阴虚型（ＡＳＴ、ＡＳＴ／ＡＬＴ）和气滞血瘀型（ＡＬＴ）为最高，除肝郁脾虚型ＡＳＴ、ＡＬＴ及湿热蕴结型ＡＬＴ与正常人无显著差异外（Ｐ＞０．０５），其余各证型的各项指标与正常人比较均有显著性差异（Ｐ＜０．０５和０．０１）。研究表明，肝硬化证型不同，肝损害程度不一，随着中医病理发展和证型的变化，ＡＳＴ、ＡＬＴ及ＡＳＴ／ＡＬＴ比值逐渐升高，仍呈由代偿期的肝郁脾虚型逐渐向失代偿期水湿内停、脾肾阳虚和肝肾阴虚型递增趋势，但ＡＬＴ在证型中呈台阶式渐升，似乎无规律。因此，可考虑将ＡＳＴ及ＡＳＴ／ＡＬＴ比值作为肝硬化辨证分型诊断的客观指标之一。

The serum AST and ALT detection and AST/ALT stagnation analysis on 89 liver cirrhosis patients of 6 syndrome types show that AST ALT and AST/ALT stagnation are higher than those of normal persons.Liver Qi depression and spleen Qi deficiency type is the lowest whereas spleen-kidney Yang deficiency type and Qi stgnancy and both blood type the highest.There is marked difference ( P <0.05 and 0.01)between the indexes of all the other syndrome types and those of normal except liver Qi depression and spleen Qi deficiency type and retention of dampheat type ( P >0.05).The research suggests that the syndrome type of liver cirrhosis raries as well as liver injury.Along with the development of TCM pathological mechanism and the change of syndrome types,AST ALT and AST/ALT stagnation tend to rise gradually.They seem to present progressive increase tendency from liver Qi depression and spleen Qi deficiency type of compensatory phase to water-fluid retention type,spleen-kidney Yang deficiency type and liver-kidney Yin deficiency type of decompensation phase.However,ALT rises step by step and seems irregular.Therefore,we may consider AST and AST/ALT stgnation as one of the objective indexes for differentiation of symptoms and signs and the classification of syndrome types of liver cirrhosis.