McGill Mitchell R
Div. of Laboratory and Genomic Medicine, Dept. of Pathology and Immunology; Dept. of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
EXCLI J. 2016 Dec 15;15:817-828. doi: 10.17179/excli2016-800. eCollection 2016.
Laboratory testing is important in the diagnosis and monitoring of liver injury and disease. Current liver tests include plasma markers of injury (e.g. aminotransferases, γ-glutamyl transferase, and alkaline phosphatase), markers of function (e.g. prothrombin time, bilirubin), viral hepatitis serologies, and markers of proliferation (e.g. α-fetoprotein). Among the injury markers, the alanine and aspartate aminotransferases (ALT and AST, respectively) are the most commonly used. However, interpretation of ALT and AST plasma levels can be complicated. Furthermore, both have poor prognostic utility in acute liver injury and liver failure. New biomarkers of liver injury are rapidly being developed, and the US Food and Drug Administration the European Medicines Agency have recently expressed support for use of some of these biomarkers in drug trials. The purpose of this paper is to review the history of liver biomarkers, to summarize mechanisms and interpretation of ALT and AST elevation in plasma in liver injury (particularly acute liver injury), and to discuss emerging liver injury biomarkers that may complement or even replace ALT and AST in the future.
实验室检测在肝损伤和疾病的诊断及监测中具有重要意义。目前的肝脏检测包括损伤的血浆标志物（如转氨酶、γ-谷氨酰转移酶和碱性磷酸酶）、功能标志物（如凝血酶原时间、胆红素）、病毒性肝炎血清学指标以及增殖标志物（如甲胎蛋白）。在损伤标志物中，丙氨酸转氨酶和天冬氨酸转氨酶（分别为ALT和AST）是最常用的。然而，ALT和AST血浆水平的解读可能较为复杂。此外，两者在急性肝损伤和肝衰竭中预后效用不佳。新的肝损伤生物标志物正在迅速研发，美国食品药品监督管理局和欧洲药品管理局最近表示支持在药物试验中使用其中一些生物标志物。本文旨在回顾肝脏生物标志物的历史，总结肝损伤（尤其是急性肝损伤）时血浆中ALT和AST升高的机制及解读，并讨论未来可能补充甚至取代ALT和AST的新兴肝损伤生物标志物。
