肝酶在镰状细胞贫血严重程度生化评估中的作用

Role of hepatic enzymes in the biochemical assessment of the severity of sickle cell anemia.

作者信息

Oparinde D P, Oghagbon E K, Okesina A B, Olatunji P O, Ojuawo A O

机构信息

Department of Chemical Pathology & Immunology, Ladoke Akintola University of Technology, College of Medicine, University of Ilorin, florin, Kwara State, Nigeria.

出版信息

Trop Gastroenterol. 2006 Jul-Sep;27(3):118-21.

PMID:17310554

Abstract

BACKGROUND AND OBJECTIVES

Various clinical and hematological indices have been used to assess the severity of Sickle Cell Anemia (SCA), however biochemical indices are lacking. Hepatomegaly has been a frequent finding in SCA and its persistence has been associated with increased disease severity. The association between hepatic enzymes and disease severity in SCA is undefined. This study was therefore designed to look at the association between clinical severity and hepatic enzymes in SCA subjects with persistent hepatomegaly (that is, lasting more than six months) in order to determine a possible role for hepatic enzymes as a biochemical index of severity.

MATERIALS AND METHODS

Serum levels of aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (SAP) and gamma-glutamyl-transferase (GGT) were determined in two groups of SCA subjects and in hemoglobin genotype AA (HbAA) controls. SCA group comprised of 37 subjects with persistent hepatomegaly equal to or greater than 10 cm (below right coastal margin) while the second group comprised another 38 SCA subjects without palpable hepatomegaly. 40 individuals with hemoglobin genotype AA served as control for both groups. Clinical and hematological parameters of severity which included steady state haematocrit, number of transfusions per year, number of crises per year and percentage HbF level were determined and scored in a manner similar to the Glasgow coma scale. Results obtained were analyzed with the aid of statistical package on EPI-INFO version 6.02.

RESULTS

There was a significant increase in serum ALT, ALP and GGT levels in SCA with persistent hepatomegaly over those without hepatomegaly (p < 0.05, p < 0.05 and p < 0.01 respectively). All the index scores and the final aggregate severity scores were also significantly higher in SCA subjects with persistent hepatomegaly. Only GGT demonstrated a fairly positive and significant correlation (r = 0.46, P < 0.05) with increased clinical severity among the hepatic enzymes.

CONCLUSION

Elevated serum level of GGT in SCA during steady state is suggestive of increased disease severity.

摘要

背景与目的

多种临床和血液学指标已被用于评估镰状细胞贫血（SCA）的严重程度，然而生化指标却有所欠缺。肝肿大在SCA中是常见表现，其持续存在与疾病严重程度增加相关。SCA中肝酶与疾病严重程度之间的关联尚不明确。因此，本研究旨在观察持续性肝肿大（即持续超过6个月）的SCA患者临床严重程度与肝酶之间的关联，以确定肝酶作为严重程度生化指标的可能作用。

材料与方法

测定两组SCA患者以及血红蛋白基因型为AA（HbAA）的对照组血清中天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）、碱性磷酸酶（SAP）和γ-谷氨酰转移酶（GGT）的水平。SCA组由37例持续性肝肿大且肿大程度等于或大于10 cm（右肋缘下）的患者组成，第二组由另外38例无可触及肝肿大的SCA患者组成。40例血红蛋白基因型为AA的个体作为两组的对照。测定并以类似于格拉斯哥昏迷量表的方式对包括稳态血细胞比容、每年输血次数、每年危象次数和HbF水平百分比等严重程度的临床和血液学参数进行评分。借助EPI-INFO 6.02版统计软件包对所得结果进行分析。

结果

与无肝肿大的SCA患者相比（p分别<0.05、<0.05和<0.01），持续性肝肿大的SCA患者血清ALT、ALP和GGT水平显著升高。持续性肝肿大的SCA患者所有指标评分及最终综合严重程度评分也显著更高。在肝酶中，只有GGT与临床严重程度增加呈现出相当显著的正相关（r = 0.46，P < 0.05）。