Webster Guy F, Webster Timothy G, Grimes Lorraine R
Department of Dermatology, Sidney Kimmel Medical School of Thomas Jefferson University.
Dermatol Online J. 2017 May 15;23(5):13030/qt7rv7j80p.
Current laboratory monitoring may not be optimal. A retrospective chart review was performed on thelaboratory results of 246 patients who were treated with isotretinoin for acne over a 9-year period. Tests obtained were CBC, lipid panel, AST, ALT, CK, GGT,and C-reactive protein. Thirty-five patients had an elevated AST and 35 of these had an elevated CK; 32 had an elevated ALT and 11 of these had an elevated CK. Thirteen patients had an elevated GGT; in 5 this was the only abnormality, whereas 8 had a GGT elevation accompanied by an elevated AST or ALT. Two had an elevated GGT and an elevated CK with normal AST and ALT. Fifty-two patients had a single episode of elevated CK, of which 22 were female. However, 57 had multiple CK elevations and only one was female. Thirty-five patients had CK elevations <2 times normal; 38 had levels between 2 and 3 times normal, 18 had levels between 3 and 4 times normal, and 18 had levels greater than 4 times normal. We suggest that ALT and AST are not useful for monitoring isotretinoin therapy and that GGT and CK may be of greater value in managing patients.
目前的实验室监测可能并非最佳。对246例在9年期间接受异维A酸治疗痤疮的患者的实验室检查结果进行了回顾性图表分析。检测项目包括全血细胞计数、血脂、谷草转氨酶（AST）、谷丙转氨酶（ALT）、肌酸激酶（CK）、γ-谷氨酰转移酶（GGT）和C反应蛋白。35例患者AST升高，其中35例CK也升高；32例ALT升高，其中11例CK也升高。13例患者GGT升高；5例仅此项异常，而8例GGT升高同时伴有AST或ALT升高。2例GGT和CK升高，AST和ALT正常。52例患者有单次CK升高，其中22例为女性。然而，57例有多次CK升高，仅1例为女性。35例患者CK升高<正常上限2倍；38例在正常上限2至3倍之间，18例在正常上限3至4倍之间，18例高于正常上限4倍。我们认为ALT和AST对监测异维A酸治疗并无用处，而GGT和CK在管理患者方面可能更有价值。
