Division of Gastroenterology and Hepatology, Department of Medicine, Liver Disease Prevention Center, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America.
PLoS One. 2012;7(10):e47687. doi: 10.1371/journal.pone.0047687. Epub 2012 Oct 24.
Serum liver enzymes are frequently tested in clinics to aid disease diagnosis. Large observational studies indicated that these enzymes might predict cancer risk and mortality. However, no prospective study has reported on their relationships with the risk of HBV-related hepatocellular carcinoma (HCC).
METHODOLOGY/PRINCIPAL FINDINGS: We evaluated the predictive values of four routinely tested liver enzymes (alanine aminotransferase [ALT], aspartate aminotransferase [AST], alkaline phosphatase [ALP], and gamma-glutamyltransferase [GGT]) in HCC risk in a prospectively enrolled clinical cohort of 588 Korean American HBV patients. For all four enzymes, the baseline level as well as the average and maximum levels during the first 1 or 2 years of follow-up were analyzed using multivariate Cox proportional hazards model. Patients were categorized into a normal or an elevated group based on the clinical cut-off of each enzyme. During a median follow-up of 7.5 years, 52 patients (incidence rate, 8.8%) developed HCC. The incidence rates were higher in the elevated groups for all four enzymes. The most significant finding was for GGT, with the highest incidence rate of 16.4% in the elevated group compared to 4.6% in the normal group (P<0.001). Compared to patients with normal baseline GGT, those with elevated GGT exhibited a significantly increased HCC risk with a hazards ratio (HR) of 2.60 (95% confidence interval [CI], 1.41-4.77, P = 0.002). Further analyses revealed a cumulative effect between baseline GGT and ALP (HR = 3.41, 95% CI 1.54-7.56, P = 0.003).
Serum GGT might predict HCC risk in HBV patients individually or jointly with other enzymes.
血清肝酶经常在临床上用于辅助疾病诊断。大型观察性研究表明，这些酶可能预测癌症风险和死亡率。然而，尚无前瞻性研究报告这些酶与乙型肝炎病毒（HBV）相关肝细胞癌（HCC）风险之间的关系。
方法/主要发现：我们评估了四种常规检测的肝酶（丙氨酸氨基转移酶[ALT]、天冬氨酸氨基转移酶[AST]、碱性磷酸酶[ALP]和γ-谷氨酰转移酶[GGT]）在 588 名韩国裔美国 HBV 患者前瞻性入组的临床队列中对 HCC 风险的预测价值。对于所有四种酶，均使用多变量 Cox 比例风险模型分析基线水平以及随访第 1 或 2 年内的平均和最大水平。根据每个酶的临床切点，将患者分为正常或升高组。在中位随访 7.5 年期间，52 名患者（发病率为 8.8%）发生 HCC。所有四种酶的升高组发病率均较高。最显著的发现是 GGT，升高组的发病率最高为 16.4%，而正常组为 4.6%（P<0.001）。与基线 GGT 正常的患者相比，GGT 升高的患者 HCC 风险显著增加，风险比（HR）为 2.60（95%置信区间[CI]，1.41-4.77，P=0.002）。进一步分析显示基线 GGT 和 ALP 之间存在累积效应（HR=3.41，95%CI 1.54-7.56，P=0.003）。
血清 GGT 单独或与其他酶联合可能预测 HBV 患者的 HCC 风险。
