肝酶学改变与急性移植物抗宿主病严重程度的相关性研究

Correlation between the change in liver enzymology and the severity of acute graft-versus-host disease

目的探讨急性移植物抗宿主病（aGVHD）患者肝脏酶学变化与aGVHD严重程度的关系。方法回顾性分析82例发生aGVHD的患者肝脏酶学的变化情况及与aGVHD严重程度的关系。结果Ⅰ度aGVHD 15例（18．3％），Ⅱ度aGVHD 47例（57．3％），Ⅲ度aGVHD 13例（15．9％），Ⅳ度aGVHD 7例（8．5％）；ALT升高49例（59．8％），AST升高36例（43．9％），碱性磷酸酶（ALP）升高8例（9．8％）；其中34例（69．4％）患者ALT升高发生在aGVHD出现前，18例（50％）患者AST升高发生在aGVHD出现前，4例（50％）患者ALP升高发生在aGHVD出现前，ALT升高较AST升高提前出现；Ⅲ-Ⅳ度aGVHD组，ALT、AST升高的百分比（分别为80％和70％）明显高于Ⅰ～Ⅱ度aGVHD组（分别为53．2％和35．5％），但ALP升高的百分比无明显差异；Ⅲ～Ⅳ度aGVHD患者与Ⅰ～Ⅱ度aGVHD患者相比，ALT及AST峰值均明显升高；ALT升高组严重aGVHD的百分比明显升高。结论肝酶学改变在aGVHD的发生中很常见，并且与aGVHD的严重程度明显相关，肝酶学尤其是ALT可能有助于早期预警严重aGVHD的发生。

Objective To investigate the correlation between the change of liver enzymes and the severity of acute graft-versus-host disease （aGVHD）. Methods The liver enzyme and severity of aGVHD in 82 patients were analyzed retrospectively. Results Among the 82 aGVHD patients, 7 developed grade Ⅰ （18.3%）, 47 grade Ⅱ （57.3%） ,13 grade Ⅲ（15.9% ） and 7 grade Ⅳ（8.5% ） aGVHD. The elevation of ALT,AST and ALP was found in 49 （ 59.8% ）, 36 （43.9%） and 8 （ 9.8% ） patients respectively. Among these patients, 34（69.4% ） were ALT 〉40 U/L, 18（50% ） AST 〉40 U/L and 4 （50%） ALP 〉 132 U/ L before the onset of aGVHD. The elevation of ALT and AST was more common and the peak value was significantly higher in patients with grade Ⅲ - Ⅳ aGVHD than with grade Ⅰ - Ⅱ aGVHD, but those of ALP showed no difference between the two groups. Compared with the patients without ALT elevation, the proportion of severe aGVHD was higher in patients with ALT elevation. Conclusions The alteration of liver enzymology is common in aGVHD and its level is correlated with the severity of aGVHD. Liver enzymes, especially the ALT, may be used as a predictor of aGVHD.