70例丙氨酸转氨酶大于15倍正常值上限肝损伤患者的临床分析

Clinical characteristics to identify the etiological diagnosis of hepatic injury in patients with alanine aminotransferase activities over 15 times the upper reference limit

目的通过分析ALT大于15倍正常值上限(15×ULN)肝损伤患者临床特征、ALT变化情况及肝炎血清标志物检测结果,探讨ALT大于15×ULN肝损伤病因诊断。方法检测70例ALT大于15×ULN肝损伤患者肝炎血清标志物、ALT、碱性磷酸酶(ALP)、凝血酶原时间(PT)、总胆红素(TBil)峰值,分析肝炎血清标志物构成、ALT动态变化,比较不同类型肝炎实验室指标。结果检出单一肝炎血清标志物阳性者52例,占74.3%;2种阳性者4例,占5.7%;未检出者14例,占20.0%。不同类型肝炎实验室指标差异无统计学意义。ALT水平随入院时间延长呈对数线性下降,戊型肝炎下降更为明显。结论血清肝炎标志物结合ALT动态变化可以指导ALT大于15×ULN肝损伤病因分析,作为临床诊断重要参考依据。

Objective To investigate distinguishing clinical features that may be useful for etiological diagnosis of hepatic injury, including changes in alanine aminotransferase （ALT） and immunological markers of viral infection. Methods Seventy patients with initial baseline ALT that was greater than 15 times the upper limit of normal （ 15 x ULN） were recruited to the study between January 2011 and December 2011. Hepatic function markers （bilirubin, ALT, prothrombin time, and alkaline phosphatase） were measured by standard biochemical as- says and immunological markers of hepatitis virus [ hepatitis B e antigen （HBeAg） and hepatitis B surface antigen （HBsAg） and HEV and HBV DNA ] were examined by immunoassays and quantitative PCR. Changes in ALT over several weeks were statistically analyzed for corre- lation with laboratory data. Results Among the inpatient study participants, 74.3% reacted with a single antibody, 5.7% reacted with two kinds of antibodies, and 20.0% reacted with no antibodies. There was no remarkable difference in laboratory data for these groups. Howev- er, ALT decreased in a logarithmic - linear manner in conjunction with the development of illness. In HEV - infected patients, the ALT lev- els decreased more rapidly. Conclusion Immunological markers of viral infection and changes in ALT can facilitate etiological diagnosis of patients with hepatic injury that present with 15× ULN of ALT.