血清谷氨酰转肽酶在慢性乙型肝炎诊断中的价值

The value of gamma-glutamyltransferase in the diagnosis of chronic hepatitis B

目的 探讨血清γ－谷氨酰转肽酶（ＧＧＴ）在慢性乙型肝炎（ＣＨＢ）不同程度肝脏病理损害中的变化规律及其在ＣＨＢ诊断中的价值。方法 测定２２１例ＣＨＢ患者血清ＡＬＴ、ＡＳＴ及ＧＧＴ水平，同时行肝活体组织检查，对肝组织进行炎症分级和纤维分期。分析ＡＬＴ、ＡＳＴ、ＧＧＴ与ＣＨＢ之间的关系。结果 （１）病理轻度和重度ＣＨＢ的ＧＧＴ正常率分别为９０．４％和１２３％（Ｐ＜００１）；（２）临床诊断为轻度、而病理诊断分别为轻、中、重度的ＣＨＢ患者中，ＧＧＴ依次递升（Ｐ＜０．０１）；（３）在活动性ＣＨＢＳ患者中，ＧＧＴ随ＡＬＴ的升高而升高，存在着正向线性相关（ｒ＝０．４６４；Ｐ＜０．００１）。在保肝治疗中，ＧＧＴ、ＡＬＴ较快降至正常的为轻度ＣＨＢ；ＧＧＴ持续在一个较高水平波动，而ＡＬＴ下降，甚至呈ＡＬＴ－ＧＧＴ分离的多分别为中或重度ＣＨＢ。结论ＧＧＴ是提高ＣＨＢ临床与病理诊断符会率的一个有价值的参考指标。

Objective To explore the change of serum gamma-glutamyltransferase (GUT) and its diagnosis value in chronic hepatitis B (CHB) patients with different degrees of liver damage. Methods Alanine-aminotransferase (ALT), aspartate-aminotransferase (AST) and GGT were measured in 221 CHB patients. Liver biopsy was conducted simulta- neously to determine the inflammation grade and fibrosis stage of the liver tissues. Results The rate of normal GGT in pathologically diagnosed mild and severe CHB patients was 90.4% and 12.3%, respectively (P<0.01). Increased level of GGT was parallel to the degree of liver pathological change (P<0.01). In active CHB patients, GGT rose with the ALT in- crease with a positive linear correlation between them (r=0.464. P<0.001). In pathologically diagnosed mild CHB patients, GUT had a tendency of rapidly declining to normal levels with ALT. In moderate CHB patients, GUT fluctuated at a rela- tively high level, and in severe CHB patients GGT exhibited a deviation from GGT. Conclusions GGT is conducive to improve the coincident rate between the clinical and pathological diagnosis of CHB.