慢性乙肝血清丙氨酸转氨酶活性逆向变化相关因素的研究

Factors associated with reverse change of serum ALT activity in patients with chronic hepatitis B

目的探讨慢性乙型病毒性肝炎(慢性乙肝)血清丙氨酸转氨酶(alanine aminotransferase, ALT)活性逆向变化的影响因素.方法将2010-09/2015-09在桂林医学院第二附属医院传染病科住院的516例慢性乙肝患者分为两组,其中,血清ALT活性≤40IU/L的病例为实验组,血清ALT活性>40 IU/L的病例为对照组.结果慢性乙肝患者血清A L T活性逆向变化率为25.78%(133/516),其中,合并肝硬化患者人群血清ALT活性逆向变化率为51.18%(65/127),显著高于未合并肝硬化患者血清A LT活性逆向变化率17.48%(68/389), P <0.05.与对照组相比,实验组血清白蛋白、直接胆红素、间接胆红素、总胆汁酸、钾离子、钙离子及甘油三酯含量较低, P<0.05,血清球蛋白及尿酸含量较高, P<0.05.多因素logistic回归分析显示,合并肝硬化及血清尿酸含量与血清ALT活性逆向变化呈正相关关系, P<0.05,而血清白蛋白、总胆汁酸、钾离子、钙离子及氯离子含量与血清ALT活性逆向变化呈负相关关系, P<0.05.结论合并肝硬化,血清球蛋白和尿酸含量升高,以及血清白蛋白、直接胆红素、间接胆红素、总胆汁酸、钾离子、钙离子、氯离子及甘油三酯含量等降低是慢性乙型病毒性肝炎患者血清ALT活性逆向变化相关的影响因素,因此,在临床上血清ALT活性与慢性乙肝临床症状不一致时,应同时注意这些因素可能会发生改变.

AIM To investigate the factors associated with the reverse change of serum alanine aminotransferase (ALT)activity in patients with chronic hepatitis B. METHODS The clinical information of 516 patients with chronic hepatitis B treated from September 2010 to September 2015 was collected.The patients with serum ALT activity ≤40IU/L were divided into a study group,while those with serum ALT activity >40IU/L was assigned to a control group. RESULTS The reverse change rate of ALT activity was 25.78% (133/516)in chronic hepatitis B patients.The reverse change rate of ALT activity was 51.18%(65/127)in the population with combined cirrhosis,significantly higher than that of patients without cirrhosis (17.48%,P<0.05). Compared to the control group,serum albumin,direct bilirubin,indirect bilirubin,total bile acids,potassium, sodium,calcium,and triglycerides in the study group were significantly lower,while serum globulin and uric acid were significantly higher (P <0.05).Multivariate unconditional logistic regression analysis showed that cirrhosis and serum uric acid were positively associated with the reverse change of ALT activity (P<0.05),while serum albumin,total bile acids,potassium,calcium,and chloride were negatively correlated with the reverse change of ALT activity (P<0.05).CONCLUSION Combined liver cirrhosis,increased serum globulin and uric acid,and declined serum albumin,direct bilirubin, indirect bilirubin,total bile acid,potassium,calcium, triglyceride,and chloride may be factors influencing the reverse change of serum ALT activity.When serum ALT activity is not consistent with clinical symptoms of chronic hepatitis B,attention should be paid to these factors as well.