Maier K P
Fachbereich Gastroenterologie, Akademisches Lehrkrankenhaus der Universität Tübingen, Städtische Kliniken Esslingen.
Praxis (Bern 1994). 2005 Feb 2;94(5):139-43. doi: 10.1024/0369-8394.94.5.139.
The availability of serum blood chemistries for screening both symptomatic and asymptomatic patients has resulted in a marked increase in the number of abnormal liver chemistry tests that must be interpreted by physicians. Usually the first step in the evaluation of a patient with elevated liver enzymes is to repeat the test to confirm the result. If the result is still abnormal, it seems wise to differentiate between a predominant "necrotic pattern" of liver chemistry, as indicated by an elevation of ALT- or AST-activity or a predominant "cholestatic pattern", as indicated by elevated activities of g-GT and alkaline phosphatase. In patients with elevated serum amino transferases hepatic diseases should be excluded primarily with non-invasive serologic tests. The most common causes of elevated amino transferase levels are chronic hepatitis B and C, autoimmunhepatitis, non-alcoholic steatohepatitis, hemochromatosis, Wilson-disease and (only recently recognized) celiac sprue. In the case of a dominant "cholestatic pattern", primary biliary cirrhosis, primary sclerosing cholangitis, but also drugs and granulomatose hepatitis must be excluded. If non-invasive serologic studies remain inconclusive, ultrasound, mini-laparoscopy and liver biopsy will help to establish the final diagnoses.
通过血清血液化学检查来筛查有症状和无症状患者，这使得医生必须解读的异常肝脏化学检查数量显著增加。通常，评估肝酶升高患者的第一步是重复检测以确认结果。如果结果仍然异常，明智的做法似乎是区分以ALT或AST活性升高为特征的主要“坏死模式”的肝脏化学检查，或以γ-GT和碱性磷酸酶活性升高为特征的主要“胆汁淤积模式”的肝脏化学检查。对于血清氨基转移酶升高的患者，应主要通过非侵入性血清学检查排除肝脏疾病。氨基转移酶水平升高最常见的原因是慢性乙型和丙型肝炎、自身免疫性肝炎、非酒精性脂肪性肝炎、血色素沉着症、威尔逊病以及（最近才被认识到的）乳糜泻。如果出现主要的“胆汁淤积模式”，则必须排除原发性胆汁性肝硬化、原发性硬化性胆管炎，以及药物性和肉芽肿性肝炎。如果非侵入性血清学研究仍无定论，超声、微型腹腔镜检查和肝活检将有助于做出最终诊断。
