Steinberg E N, Cho-Steinberg H M, Howden C W
University of South Carolina School of Medicine, Columbia, USA.
Am J Manag Care. 1997 Feb;3(2):267-70.
This study sought to identify any benefit of routine liver function tests (LFTs) in chronically ill, geriatric patients and to assess which patients require evaluation for abnormal LFT levels. A retrospective chart review was carried out on 268 consecutive patients (M:F = 1.2, mean age 77 years, range 61-98 years) presenting for acute care from a long-term care facility. All were without jaundice, right upper quadrant pain, pruritus, bruising, or signs of chronic liver disease. The degree of LFT abnormality (aspartate aminotransferase, alanine aminotransferase, total bilirubin, or alkaline phosphatase) during admission was compared to the clinical diagnosis at the time of discharge. The most common diagnoses were pneumonia, urinary tract infection, and peripheral or coronary disease in 186 (60%). Thirty-seven patients (14%) had elevated LFT levels on admission. The levels normalized within 2 days in 26 of these patients, 25 of whom had a history of vascular disease (96%). Of the 11 remaining patients, 4 had coexistent vascular disease (36%), and 5 had LFT levels twice normal (none with vascular disease) and underwent abdominal ultrasound. One patient had a common bile duct stone successfully extracted. Enzyme abnormalities were due to hepatitis B or medication use in 10 of 11 patients. No patient had liver biopsy. All but one of the 268 patients were discharged without further evaluation. Over one year of follow up, no patient returned for a liver-related problem. Based on these findings, only those patients with LFT levels that are twice normal and which do not normalize within 2 days warrant further evaluation. Transient LFT abnormalities may be due to decreased liver perfusion.
本研究旨在确定常规肝功能检查（LFTs）对慢性病老年患者是否有任何益处，并评估哪些患者需要对异常的LFT水平进行评估。对268例连续从长期护理机构前来接受急性护理的患者（男：女 = 1.2，平均年龄77岁，范围61 - 98岁）进行了回顾性病历审查。所有患者均无黄疸、右上腹疼痛、瘙痒、瘀斑或慢性肝病体征。将入院期间LFT异常程度（天冬氨酸转氨酶、丙氨酸转氨酶、总胆红素或碱性磷酸酶）与出院时的临床诊断进行比较。最常见的诊断为肺炎、尿路感染以及外周或冠状动脉疾病，共186例（60%）。37例患者（14%）入院时LFT水平升高。其中26例患者的LFT水平在2天内恢复正常，其中25例有血管疾病史（96%）。在其余11例患者中，4例有并存的血管疾病（36%），5例患者的LFT水平为正常上限的两倍（均无血管疾病）并接受了腹部超声检查。1例患者成功取出胆总管结石。11例患者中有10例酶异常是由乙型肝炎或药物使用引起的。所有患者均未进行肝活检。268例患者中除1例之外均未作进一步评估而出院。经过一年多的随访，没有患者因肝脏相关问题复诊。基于这些发现，只有那些LFT水平为正常上限两倍且在2天内未恢复正常的患者才需要进一步评估。短暂的LFT异常可能是由于肝脏灌注减少所致。
