急性有机磷中毒合并肝损伤患者AST、ChE、CRP动态变化及对病情的评估价值

目的动态监测急性有机磷中毒(acute organophosphorus pesticide poisoning,AOPP)合并肝损伤患者天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)、胆碱酯酶(cholinesterase,ChE)和C反应蛋白(C-reactive protein,CRP)变化并评估其对病情转归的预测效能。方法选取2017年1月至2021年12月高邮市人民医院收治的60例AOPP合并肝损伤患者,根据病情转归情况分为生存组(31例)和病死组(29例),比较两组基线资料以及入院时、第3天和第7天AST、ChE、CRP变化,采用Cox回归分析AOPP预后的影响因素,采用受试者工作特征(receiver operator characteristic,ROC)曲线分析第3天AST、ChE、CRP对预后的预测价值。结果病死组有机磷暴露量多于生存组[(97.26±12.07)ml比(58.97±8.43)ml],APACHEⅡ评分[(31.23±6.86)分比(25.18±5.72)分]高于生存组;病死组入院第3天和入院第7天AST[3 d:(167.99±18.36)U/L比(91.35±16.58)U/L;7 d:(55.62±13.59)U/L比(28.71±6.44)U/L]、CRP高于生存组[3 d:(76.39±22.03)mg/L比(54.55±17.60)mg/L;7 d:(73.66±24.87)mg/L比(32.90±8.46)mg/L],ChE低于生存组[3 d:(44.59±7.08)%比(48.91±6.33)%;7 d:(43.12±8.53)%比(57.49±12.27)%],差异均有统计学意义(P均<0.05)。Cox回归分析表明有机磷暴露量(HR=15.791,95%CI:4.685~53.225,P<0.001)、APACHEⅡ评分(HR=12.166,95%CI:2.208~67.039,P<0.001)、入院第3天AST(HR=6.670,95%CI:1.162~38.283,P<0.001)、CRP(HR=8.208,95%CI:1.573~42.829,P<0.001)为AOPP患者预后不良的危险因素,入院第3天ChE为保护性因素(HR=0.362,95%CI:0.159~0.825,P<0.001)。入院第3天AST、ChE、CRP联合预测预后的ROC曲线下面积为0.900,均显著高于AST(0.852;Z=2.754,P=0.045)、ChE(0.804;Z=3.184,P=0.032)、CRP(0.818;Z=3.075,P=0.026)单独的ROC曲线下面积。结论AOPP合并肝损伤不同预后患者入院后AST、ChE、CRP呈现不同变化特点,动态监测三者变化有助于早期预测患者病情转归,为临床管理提供参考。

CT引导下射频消融术治疗肝细胞癌患者的效果及对AST、ALT水平的影响

目的探讨CT引导下射频消融术治疗肝细胞癌患者的效果及对天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)水平的影响。方法选择2019年8月至2022年8月本院收治的40例肝细胞癌患者为研究对象,根据随机数字表法将其分为对照组(20例,肝动脉栓塞化疗)和观察组(20例,CT引导下射频消融术+肝动脉栓塞化疗)。比较两组的治疗效果。结果治疗后,观察组的AST、ALT、总胆红素(TBIL)及甲胎蛋白(AFP)水平低于对照组(P<0.05)。治疗后,观察组的CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)高于对照组,CD8^(+)低于对照组(P<0.05)。观察组的近期治疗总有效率、并发症总发生率优于对照组(P<0.05)。结论CT引导下射频消融术可明显提高肝细胞癌患者的肝功能、免疫功能,调节AFP水平,且并发症发生率低,安全性更高。

AST/ALT、白蛋白与肝癌患者病理特征及TACE治疗预后的关系

目的 探究谷草转氨酶(AST)/谷丙转氨酶(ALT)、白蛋白与肝癌患者病理特征及经动脉化疗栓塞(TACE)治疗预后的关系。方法 选取2018年8月至2022年8月于临沂市肿瘤医院行TACE治疗的肝癌患者168例,据术后1年生存情况,将患者分为预后不良组27例和预后良好组141例,比较不同病理特征患者术前AST/ALT、白蛋白水平,比较不同预后TACE术后肝癌患者病理特征,比较不同预后TACE术后肝癌患者AST/ALT、白蛋白水平,采用ROC曲线分析其对肝癌患者TACE治疗预后的预测价值,采用Logistics二元回归方程分析AST/ALT、白蛋白对肝癌TACE治疗患者预后的影响作用。结果 年龄≥60岁、Child-Pugh B级、HbsAg阳性、肿瘤直径>5 cm、肿瘤多发、肿瘤分期更高、肿瘤低分化肝癌患者术前AST/ALT更高,术前白蛋白水平更低,差异均有统计学意义(P<0.05);两组年龄、HbsAg情况、肿瘤直径、肿瘤数量、肿瘤分期、分化程度比较差异均有统计学意义(P<0.05);预后良好组术前、术后AST/ALT低于预后不良组,术前、术后白蛋白水平高于预后不良组,差异有统计学意义(P<0.05);ROC结果显示,术前、术后的AST/ALT、白蛋白预测肝癌患者TACE治疗预后的AUC分别为0.887、0.787、0.854、0.580,联合预测的AUC为0.914(P<0.05);Logistic回归分析结果显示,年龄≥60岁、肿瘤直径>5 cm、肿瘤多发、肿瘤分期为Ⅲa期、肿瘤低分化、术前AST/ALT>1.82、术前白蛋白<33.21 g/L、术后AST/ALT>1.83、术后白蛋白<43.96 g/L均为肝癌患者TACE治疗预后不良的影响因素(P<0.05)。结论 AST/ALT、白蛋白水平在不同病理特征肝癌患者中具有差异性,具有预测TACE治疗预后的作用。

肝脏硬度值及血清CER、AST水平在ALT轻度升高乙肝患者肝纤维化中的评估价值

【目的】探讨肝脏硬度值(LSM)及血清铜蓝蛋白(CER)、谷草转氨酶(AST)在丙氨酸转氨酶(ALT)轻度升高乙肝患者肝纤维化中的评估价值。【方法】选取2020年6月至2022年6月本院收治的100例ATL轻度升高的乙肝患者,根据肝纤维化分期情况将其分为无纤维化组(n=10)和纤维化组(n=90)。根据肝纤维化严重程度情况将患者分为重度纤维化组(n=42)、中度纤维化组(n=36)、轻度纤维化组(n=12)。比较不同组别患者ALT、白蛋白(ALB)、AST及CER、LSM,绘制受试者工作特征(ROC)曲线分析CER、AST、LSM对ALT轻度升高乙肝患者肝纤维化的评估价值。【结果】两组患者ALT、ALB比较,差异无统计学意义(P>0.05);纤维化组AST、LSM均高于无纤维化组,CER低于无纤维化组,差异有统计学意义(P<0.05)。ROC曲线分析显示,AST、CER、LSM评估ATL轻度升高乙肝患者肝纤维化的曲线下面积分别为0.914、0.616、0.946(P<0.05)。重度纤维化组、中度纤维化组、轻度纤维化组CER逐渐升高,差异有统计学意义(P<0.05);重度纤维化组、中度纤维化组、轻度纤维化组AST、LSM逐渐降低,差异有统计学意义(P<0.05)。【结论】不同纤维化程度的ATL轻度升高乙肝患者AST、CER、LSM存在差异,其中AST、CER、LSM对于肝纤维化有一定评估价值,可用于临床对此类患者肝纤维化的早期诊断或评估。

mAST/ALT对严重发热伴血小板减少综合征患者预后的预测价值

目的探讨线粒体天门冬氨酸氨基转移酶(mAST)/丙氨酸转氨酶(ALT)与严重发热伴血小板减少综合征(SFTS)患者生存的相关性,并探讨其在诊断SFTS患者预后中的应用价值。方法选取2021年1月~2023年1月在我院确诊的317例SFTS患者,将全部SFTS患者和入住重症监护室(ICU)患者入院1周内的临床特征进行对比,使用Logistic多元回归分析影响全部SFTS患者和入住ICU患者死亡的独立危险因素,分析mAST/ALT在SFTS患者预后评估中的应用价值。结果死亡组的年龄、碱性磷酸酶(ALP)、ALT、AST、AST/ALT、胞质AST(cAST)、cAST/ALT、mAST、mAST/ALT、肌酸激酶同工酶(CK-MB)、肌酸激酶(CK)、γ-谷氨酰基转移酶(GGT)、α-羟基丁酸脱氢酶(α-HBDH)水平均高于生存组(P<0.05);入住ICU死亡者的年龄、AST、cAST、mAST、AST/ALT、cAST/ALT、mAST/ALT、CK及α-HBDH水平均明显高于幸存者(P<0.05);Logistic多元回归分析显示,年龄、α-HBDH、AST/ALT、cAST/ALT及mAST/ALT是所有SFTS患者死亡的独立危险因素(P<0.05),而AST/ALT、cAST/ALT及mAST/ALT是入住ICU患者死亡的独立危险因(P<0.05),且mAST/ALT的OR值最高;绘制受试者工作特征(ROC)曲线,上述参数的AUC值均大于0.7,有一定预测价值,且mAST/ALT的特异性和灵敏度最高,预后预测价值最好。结论AST/ALT、cAST/ALT及mAST/ALT水平和SFTS患者预后有关,其中mAST/ALT水平对重症SFTS患者预后价值最好。

血清AST、ALT、ESR及IL-21预测系统性红斑狼疮肝损伤的价值

目的探究血清天门冬氨酸基转移酶(AST)、丙氨酸氨基转移酶(ALT)、红细胞沉降率(ESR)及白介素-21(IL-21)预测系统性红斑狼疮肝损伤的价值。方法选取2020年3月-2022年3月我院收治的80例系统性红斑狼疮患者作为研究对象,根据是否发生肝损伤分为肝损伤组和未损伤组,获取患者临床资料,分析脂血清AST、ALT、ESR及IL-21的预测价值。结果经logistic回归分析显示,AST、ALT、ESR、IL-21是系统性红斑狼疮肝损伤独立影响因素(P<0.05)。经ROC曲线分析显示:当AST、ALT、ESR、IL-21截断值分别为(194.64)、(0.794)、(17.64)、(119.56)时可获得最佳预测效能,此时AUC为0.899(95%CI:0.866~0.932),敏感度为(92.26),特异度为(80.64)、约登指数为(0.618)。结论血清AST、ALT、ESR及IL-21是系统性红斑狼疮肝损伤影响因素,4项联合检测可提高对肝损伤预测价值。

肝脏硬度值和AST/ALT与原发性胆汁性胆管炎分期的相关性研究

目的:分析肝脏硬度值(LSM)和肝功能不同指标与原发性胆汁性胆管炎(PBC)分期的相关性,为临床无创性检测和评估该病选择新指标。方法:选取北京佑安医院和邯郸市传染病医院就诊的原发性胆汁性胆管炎患者83例,均做肝穿刺病理活检,按结果进行病理分期分组:Ⅰ期18例为小胆管炎症期(炎症组);Ⅱ期20例为细小胆管增生期,Ⅲ期9例为瘢痕期(此两期为纤维化组);Ⅳ期36例为肝硬化期(肝硬化组)。对照组为正常体检者30例,男10例,女20例;3组患者和对照组人员均进行肝脏瞬时弹性技术检测,计算LSM值;同时检测3组患者和对照组人员肝功能指标,包括丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、AST/ALT、碱性磷酸酶(ALP)和谷氨酰氨基转移酶(γ-GGT),分析各指标与PBC分期的相关性。结果:①83例患者和正常体检人的性别比较,差异有统计学意义(均P<0.05)。83例患者的ALT、AST、ALP、γ-GGT、AST/ALT和LSM与对照组比较,差异有统计学意义(均P<0.05)。②肝硬化组患者的年龄均值最大,与其他两组比较,差异有统计学意义(均P<0.001)。③肝硬化组患者的AST/ALT、LSM值最高,与其他两组比较,差异有显著性意义(P<0.05);肝纤维化组患者的ALT、AST、ALP、γ-GT水平最高,与其他两组比较,差异有显著性意义(P<0.05)。④采用Spearman等级相关分析,结果表明AST/ALT与LSM与PBC分期呈正相关,AST/ALT和LSM越高可判断PBC为肝硬化期。结论:LSM值和AST/ALT可作为临床评估PBC分期的无创检测指标。

Diagnostic value of gamma-glutamyltransferase/aspartate aminotransferase ratio, protein induced by vitamin K absence or antagonist II, and alpha-fetoprotein in hepatitis B virus-related hepatocellular carcinoma

BACKGROUND Researchers have investigated the diagnostic value of protein induced by vitamin K absence or antagonist II (PIVKA-II) and alpha-fetoprotein (AFP) in hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC), and obtained abundant clinical diagnostic data. However, PIVKA-II and AFP have unsatisfactory specificity and sensitivity in the diagnosis of early-stage HBV-related HCC. Gamma-glutamyltransferase (γ-GT) and aspartate aminotransferase (AST) are common biomarkers for evaluating liver function, and we hypothesized that the γ-GT/AST ratio in combination with PIVKA-II and AFP would improve the diagnosis of early-stage HBV-related HCC. AIM To evaluate the diagnostic value of γ-GT/AST ratio alone or in combination with PIVKA-II and AFP in HBV-related HCC. METHODS Serum levels of γ-GT, AST, PIVKA-II, and AFP were detected and analysed in 176 patients with HBV-related HCC and in 359 patients with chronic hepatitis B. According to tumour size and serum level of HBV DNA, HBV-related HCC patients were divided into the following categories: Early-stage HCC patients, HCC patients, HBV DNA positive (HBV DNA+) HCC patients, and HBV DNA negative (HBV DNA-) HCC patients. Receiver-operating characteristic (ROC) curves were used to analyse and compare the diagnostic value of the single and combined detection of various biomarkers in different types of HBV-related HCC. RESULTS Tumour size was positively correlated with serum levels of PIVKA-II and AFP in HCC patients (r = 0.529, aP < 0.001 and r = 0.270, bP < 0.001, respectively), but there was no correlation between tumour size and the γ-GT/AST ratio (r = 0.073, P = 0.336). The areas under the receiver-operating characteristic curves (AUROCs) of the γ-GT/AST ratio in early-stage HCC patients, HBV DNA+ HCC patients and HBV DNA- HCC patients were not significantly different from that in the total HCC patients (0.754, 0.802, and 0.705 vs 0.779, respectively;P > 0.05). When PIVKA-II was combined with the γ-GT/AST ratio in the diagnosis of earlystage HCC, HCC, and HBV DNA+ HCC, the AUROCs of PIVKA-II increased, with values of 0.857 vs 0.835, 0.925 vs 0.913, and 0.958 vs 0.954, respectively. When AFP was combined with the γ-GT/AST ratio in the diagnosis of early-stage HCC, HCC, HBV DNA+ HCC, and HBV DNA- HCC, the AUROCs of AFP increased, with values of 0.757 vs 0.621, 0.837 vs 0.744, 0.868 vs 0.757, and 0.840 vs 0.828, respectively. CONCLUSION The γ-GT/AST ratio may be better than PIVKA-II and AFP in the diagnosis of early-stage HBV-related HCC, and its combination with PIVKA-II and AFP can improve the diagnostic value for HBV-related HCC.

Diagnostic value of FIB-4, aspartate aminotransferaseto-platelet ratio index and liver stiffness measurement in hepatitis B virus-infected patients with persistently normal alanine aminotransferase

AIM To assess the diagnostic value of FIB-4, aspartate aminotransferase-to-platelet ratio index(APRI), and liver stiffness measurement(LSM) in patients with hepatitis B virus infection who have persistently normal alanine transaminase(PNALT).METHODS We enrolled 245 patients with chronic hepatitis B: 95 in PNALT group, 86 in intermittently elevated alanine transaminase(PIALT1) group [alanine transaminase(ALT) within 1-2 × upper limit of normal value(ULN)], and 64 in PIALT2 group(ALT > 2 × ULN). All the patients received a percutaneous liver biopsy guided by ultrasonography. LSM, biochemical tests, and complete blood cell counts were performed.RESULTS The pathological examination revealed moderate inflammatory necrosis ratios of 16.81%(16/95), 32.56%(28/86), and 45.31%(28/64), and moderate liverfibrosis of 24.2%(23/95), 33.72%(29/86), and 43.75%(28/64) in the PNALT, PIALT1, and PIALT2 groups, respectively. The degrees of inflammation and liver fibrosis were significantly higher in the PIALT groups than in the PNALT group(P < 0.05). No significant difference was found in the areas under the curve(AUCs) between APRI and FIB-4 in the PNALT group; however, significant differences were found between APRI and LSM, and between FIB-4 and LSM in the PNALT group(P < 0.05 for both). In the PIALT1 and PIALT2 groups, no significant difference(P > 0.05) was found in AUCs for all comparisons(P > 0.05 for all). In the overall patients, a significant difference in the AUCs was found only between LSM and APRI(P < 0.05).CONCLUSION APRI and FIB-4 are not the ideal noninvasive hepatic fibrosis markers for PNALT patients. LSM is superior to APRI and FIB-4 in PNALT patients because of the influence of liver inflammation and necrosis.

Validation of aspartate aminotransferase to platelet ratiofor diagnosis of liver fibrosis and prediction of postoperativeprognosis in infants with biliary atresia

Validation of aspartate aminotransferase to platelet ratiofor diagnosis of liver fibrosis and prediction of postoperativeprognosis in infants with biliary atresia pathological Metavir fibrosis score of the liver wedgespecimens of 91 BA infants. The prognostic value ofpreoperative APRI for jaundice persistence, liver injury,and occurrence of cholangitis within 6 mo after KP wasstudied based on the follow-up data of 48 BA infants.RESULTS： APRI was significantly correlated withMetavir scores （rs = 0.433; P 〈 0.05）. The mean APRIvalue was 0.76 in no/mild fibrosis group （Metavir scoreF0-F1）, 1.29 in significant fibrosis group （F2-F3）, and2.51 in cirrhosis group （F4） （P 〈 0.001）. The areaunder the ROC curve （AUC） of APRI for diagnosingsignificant fibrosis and cirrhosis was 0.75 （P 〈 0.001）and 0.81 （P = 0.001）, respectively. The APRI cut-offof 0.95 was 60.6% sensitive and 76.0% specific forsignificant fibrosis diagnosis, and a threshold of 1.66was 70.6% sensitive and 82.7% specific for cirrhosis.The preoperative APRI in infants who maintainedjaundice around 6 mo after KP was higher than thatin those who did not （1.86 ± 2.13 vs 0.87 ± 0.48, P 〈0.05）. The AUC of APRI for prediction of postoperativejaundice occurrence was 0.67. A cut-off value of0.60 showed a sensitivity of 66.7% and a specificityof 83.3% for the prediction of jaundice persistence.Preoperative APRI had no significant association withlater liver injury or occurrence of cholangitis.CONCLUSION： Our study demonstrated that APRIcould diagnose significant liver fibrosis, especiallycirrhosis in BA infants, and the elevated preoperativeAPRI predicts jaundice persistence after KP.

Serum γ-glutamyltransferase,alanine aminotransferase,and aspartate aminotransferase activity in Iranian healthy blood donor men

AIM: To determine serum γ-glutamyltransferase (GGT), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) activity, and to assess their correlation with demographic and clinical findings in healthy blood donors. METHODS: This cross-sectional study was performed in 934 male blood donors, aged 18 to 68 years, who consecutively attended Tehran blood transfusion service in 2006. All participants were seronegative for HBV or HCV infections, non alcohol users, and all underwent a standard interview and anthropometric tests. Clinical and biochemical parameters including AST, ALT, and GGT activities were determined. Patients taking drugs known to cause hepatic fat deposition were excluded. For AST, ALT, and GGT variables, we used 33.33 and 66.66 percentiles, so that each of them was divided into three tertiles. RESULTS: Mean AST, ALT, and GGT activities were 25.26 ± 12.58 U/L (normal range 5-35 U/L), 33.13 ± 22.98 (normal range 5-35 U/L), and 25.11 ± 18.32 (normal range 6-37 U/L), respectively. By univariate analyses, there were significant associations between increasing AST, ALT, or GGT tertiles and age, body weight, body mass index, and waist and hip circumferences (P < 0.05). By multiple linear regression analyses, ALT was found to be positively correlated with dyslipidemia (B = 6.988, P = 0.038), whereas ALT and AST were negatively correlated with age. AST, ALT, and GGT levels had positive correlation with family history of liver disease (B = 15.763, P < 0.001), (B = 32.345, P < 0.001), (B =24.415, P < 0.001), respectively.CONCLUSION: Although we did not determine the cutoffs of the upper normal limits for AST, ALT, and GGT levels, we would suggest screening asymptomatic patients with dyslipidemia and also subjects with a family history of liver disease.

Isolated elevated aspartate aminotransferase in an asymptomatic woman due to macro-aspartate aminotransferase: A case report

BACKGROUND Macro-aspartate aminotransferase(AST), a macroenzyme, is a high-molecular mass complex formed by self-polymerization or association with other serum components that are difficult for the kidney to clear, leading to the isolated elevation of serum AST activity. Cases of macro-AST formation are rare, with only 3 published in the English language literature up to September 2019 in China. In this paper, we present a case in which an asymptomatic woman with persistent isolated elevated AST was confirmed as having macro-AST by the polyethylene glycol precipitation method.CASE SUMMARY A 34-year-old woman was referred to our clinic for elevated AST levels with normal levels of other liver-associated enzymes on November 12, 2018. Her AST level of liver function test had been abnormal for 7 mo before she came to the clinic. The patient was asymptomatic with a normal physical examination. There was no relevant family history and no alcohol consumption or smoking. She had a several-month history of traditional Chinese medical taking and had stopped it 1 year prior. The laboratory tests in our clinic showed only the elevation of AST(89.5 U/L) with no other significant abnormalities. We performed the precipitation technique with polyethylene glycol to confirm the presence of macro-AST. Then for almost a year, her AST level still fluctuated in the abnormal range.CONCLUSION This case highlights that clinical physicians should be familiar with this rare condition of persistent isolated AST elevation due to the presence of macro-AST to avoid unnecessary investigation and patient anxiety.

Use of aspartate aminotransferase to platelet ratio to reduce the need for Fibro Scan in the evaluation of liver fibrosis

AIM To evaluate the performance of aspartate aminotransferase to platelet ratio(APRI) score against FibroS can in predicting the presence of fibrosis. METHODS Data of patients who concurrently had APRI score, Fibro Scan and liver biopsy to assess their hepatitis C virus(HCV) and hepatitis B virus(HBV) over 6 years were retrospectively reviewed and details of their disease characteristics and demographics were recorded. Advanced fibrosis was defined as ≥ F3. RESULTS Of the 3619 patients(47.5 ± 11.3 years, 97M:36F) who had Fibro Scans and APRI for HCV and HBV, 133 had concurrent liver biopsy. Advanced liver fibrosis was found in 27/133(20%, F3 = 21 and F4 = 6) patients. Although APRI score(P < 0.001, AUC = 0.83) and FibroS can(P < 0.001, AUC = 0.84) predicted the presence of advanced fibrosis, the sensitivities and specificities were only modest(APRI score: 51.9% sensitivity, 84.9% specificity; FibroS can: 63% sensitivity, 84% specificity). Whilst 13/27(48%) patients with advanced fibrosis had APRI ≤ 1.0, no patients with APRI ≤ 0.5 had advanced fibrosis, with100% sensitivity. The use of APRI ≤ 0.5 would avoid the need for FibroS can in 43% of patients. CONCLUSION APRI score and Fibro Scan performed equally well in predicting advanced fibrosis. A proposed APRI cutoff score of 0.5 could be used as a screening tool for FibroS can, as cut-off score of 1.0 will miss up to 48% of patients with advanced fibrosis. Further prospective validation studies are required to confirm this finding.

Aspartate aminotransferase-immunoglobulin complexes in patients with chronic liver disease

AIM: To determine the complex of AST and immunoglobulin and to investigate its clinical significance in patients with liver disease.METHODS: The complex of AST and immunoglobulin was determined by encounter immunoelectrophoresis and its clinical significance was investigated in 128 patients with liver disease.RESULTS: AST was bound to immunoglobulin of antiimmunoglobulin A (IgA) class, but any binding to antiimmunoglobulin G and anti-immunoglobulin M classes was not observed. Although the incidence of ASTimmunoglobulin complex was 41.8% in chronic hepatitis (CH), the incidences in liver cirrhosis and hepatocellular carcinoma were 62.2 and 90.0%, respectively. In alcoholic liver disease with high level of serum IgA, the incidence of the complex was 66.7%, which was higher than that in CH. The ratio of binding to lambda-chain of IgA was higher than that to kappa-chain of IgA. The serum level of IgA and the ratio of AST/alanine aminotransferase (ALT) were significantly higher in patients with AST-IgA complex than in those without complex.CONCLUSION: These results suggest that AST-IgA complex in patients with progressive liver diseases and alcoholic liver injury can lead to elevation of the ratio of AST/ALT.

Determination of the upper cut-off values of serum alanine aminotransferase and aspartate aminotransferase in Chinese

AIM:To determine the upper cut-off values of serumalanine aminotransferase(ALT)and aspartate aminotransferase(AST)in a Northern Chinese population.METHODS:A total of 3769 subjects in Jilin Province Northeast China were stratified to determine the potential factors affecting serum ALT and AST levels.The upper cut-off values of serum ALT and AST in these subjects were determined using receiver operating characteristic analysis and their sensitivity and specificity were evaluated.RESULTS:Stratification analysis revealed that serum ALT and AST levels were associated with gender,alcohol consumption,serum cholesterol and triglyceride levels,and body mass index.The upper cut-off values of serum ALT and AST were 22.15 U/L and 25.35 U/L for healthy men and 22.40 U/L and 24.25 U/L for healthy women,respectively.The new cut-off values had a higher sensitivity,but a slightly lower specificity than the current standards.CONCLUSION:Our results indicate that the new upper cut-off values of serum ALT and AST are markedly lower than current standards and may be valuable for the evaluation of liver function.

Development of Enzyme Biosensor for Amperometric Measurement of Aspartate Aminotransferase

An enzyme biosensor for amperometric measurement of aspartate aminotransferase has been developed.The working electrode was modified with a thin-film of redox polymer,then glutamate oxidase,with the immobilized reagent cast and dried on the electrode.The biosensor responses to AST by detecting hydrogen peroxide were produced by enzymical reaction at-0.1 V with a response time of 120 seconds.The electrode gave a detection limit of 32.5 U/L with a linear concentration range of 32.5 U/L～2000 U/L in serum.Due to more sensitive and lower detection limit,the biosensor is expected mainly to be used for physiological identification and physical performance of athletes in the future.Extended application will also affect the practice of clinical medicine for the diagnosis of heart and liver disease.

AST/ALT比值与川崎病并发冠状动脉病变的相关性研究

目的探讨AST/ALT比值(AAR)与川崎病(KD)并发冠状动脉病变(CAL)的相关性。方法选择2010年1月至2019年12月嘉兴市第二医院收治的KD患儿461例,根据有无CAL,将患儿分为CAL组122例和无CAL组339例。比较两组患儿的临床资料,采用logistics回归分析KD患儿并发CAL的危险因素,采用ROC曲线评价AAR对KD并发CAL的预测价值。结果CAL组年龄<6个月比例、起病到确诊时间、应用静脉注射免疫球蛋白(IVIG)治疗时病程>10d比例、CRP和D-二聚体高于无CAL组,AAR低于无CAL组,差异均有统计学意义(均P<0.05)。logistics回归分析显示,年龄<6个月、应用IVIG治疗时病程>10d、D-二聚体和AAR均为KD并发CAL的危险因素(均P<0.05)。ROC曲线分析显示,AAR预测KD并发CAL的最佳预测值为1.49,AUC为0.730,灵敏度和特异度分别为0.791和0.680。结论AAR与KD并发CAL密切相关,AAR≤1.49的KD患儿CAL发生率升高。

术前血清ALT/AST值对早期胃癌患者术后复发的预测价值

【目的】探讨术前血清丙氨酸氨基转移酶(ALT)/天冬氨酸氨基转移酶(AST)值(LSR)对早期胃癌患者术后复发的预测价值。【方法】选取本院收治的165例拟行胃癌根治术患者,术前均检测LSR水平。随访6~24个月,失访7例。根据预后情况将158例患者分为复发组(n=25)和未复发组(n=133)。比较两组患者术前LSR水平及相关的临床资料,以Logistic回归分析早期胃癌患者术后复发的危险因素,以受试者工作特征(ROC)曲线下面积(AUC)判定术前血清LSR水平对早期胃癌患者术后预后复发的预测价值。【结果】复发组TNM分期为Ⅲ期、淋巴脉管侵袭例数占比、肿瘤直径及术前NLR、LSR水平均高于未复发组(P<0.05);Logistic多因素分析结果显示,淋巴脉管侵袭、TNM分期为Ⅲ期、术前LSR均为早期胃癌患者术后复发的危险因素(P<0.05);ROC曲线结果显示,术前LSR预测早期胃癌患者复发的AUC值为0.783(P<0.05)。【结论】术前检测LSR对早期胃癌患者术后复发具有一定的预测价值,值得临床推广使用。

非酒精性脂肪性肝病患者血清ALT、AST与肝纤维化的关系

目的观察血清丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)的水平变化,分析非酒精性脂肪性肝病(NAFLD)患者发生肝纤维化的可能性。方法86例NAFLD患者,根据影像学检查结果分为无肝纤维化组(59例)、肝纤维化组(27例)。比较两组患者血清ALT、AST及肝纤维化指标[透明质酸酶(HA)、层粘连蛋白(LN)、Ⅲ型前胶原(PCⅢ)]水平,采用二元Logistic回归模型分析NAFLD患者肝纤维化的影响因素,采用Pearson相关分析NAFLD患者血清ALT、AST与肝纤维化的相关性。结果肝纤维化组患者血清FBG、ALT、AST、HA、LN、PCⅢ水平分别为(6.41±1.02)mmol/L、(93.64±10.21)U/L、(61.59±5.23)U/L、(94.64±10.25)ng/ml、(110.79±11.82)ng/ml、(119.24±12.72)ng/ml,均明显高于无肝纤维化组的(5.69±0.97)mmol/L、(71.99±10.39)U/L、(50.68±5.51)U/L、(81.04±6.01)ng/ml、(85.62±8.61)ng/ml、(91.61±10.06)ng/ml,差异具有统计学意义(P<0.05)。两组患者血清TC、LDL-C、TG水平比较差异无统计学意义(P>0.05)。二元Logistic回归分析显示:血清ALT、AST水平是NAFLD患者肝纤维化的影响因素(P<0.05)。Pearson相关分析显示:NAFLD患者血清ALT、AST水平与LN、PCⅢ均呈明显正相关(P<0.05),但与HA水平无明显相关性(P>0.05)。结论血清ALT、AST是NAFLD患者出现肝纤维化的影响因素,且NAFLD患者血清中ALT、AST水平与肝纤维化指标LN、PCⅢ均呈明显正相关,通过检测ALT、AST水平可以评估NAFLD患者是否有肝纤维化发生。

Influence of liver function after laparoscopy-assisted vs totally laparoscopic gastrectomy

BACKGROUND Previously,some studies have proposed that total laparoscopic gastrectomy(TLG)is superior to laparoscopic-assisted gastrectomy(LAG)in terms of safety and feasibility based on the related intraoperative operative parameters and incidence of postoperative complications.However,there are still few studies on the changes in postoperative liver function in patients undergoing LG.The present study compared the postoperative liver function of patients with TLG and LAG,aiming to explore whether there is a difference in the influence of TLG and LAG on the liver function of patients.AIM To investigate whether there is a difference in the influence of TLG and LAG on the liver function of patients.METHODS The present study collected 80 patients who underwent LG from 2020 to 2021 at the Digestive Center(including the Department of Gastrointestinal Surgery and the Department of General Surgery)of Zhongshan Hospital affiliated with Xiamen University,including 40 patients who underwent TLG and 40 patients who underwent LAG.Alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP),γ-glutamyltransferase(GGLT),total bilirubin(TBIL),direct bilirubin(DBIL)and indirect bilirubin(IBIL),and other liver function-related test indices were compared between the 2 groups before surgery and on the 1^(st),3^(rd),and 5^(th) d after surgery.RESULTS The levels of ALT and AST in the 2 groups were significantly increased on the 1st to 2nd postoperative days compared with those before the operation.The levels of ALT and AST in the TLG group were within the normal range,while the levels of ALT and AST in the LAG group were twice as high as those in the TLG group(P<0.05).The levels of ALT and AST in the 2 groups showed a downward trend at 3-4 d and 5-7 d after the operation and gradually decreased to the normal range(P<0.05).The GGLT level in the LAG group was higher than that in the TLG group on postoperative days 1-2,the ALP level in the TLG group was higher than that in the LAG group on postoperative days 3-4,and the TBIL,DBIL and IBIL levels in the TLG group were higher than those in the LAG group on postoperative days 5-7(P<0.05).No significant difference was observed at other time points(P>0.05).CONCLUSION Both TLG and LAG can affect liver function,but the effect of LAG is more serious.The influence of both surgical approaches on liver function is transient and reversible.Although TLG is more difficult to perform,it may be a better choice for patients with gastric cancer combined with liver insufficiency.