Shiels M T, Czaja A J, Ludwig J, McCullough A J, Jones J D, Go V L
Dig Dis Sci. 1985 Sep;30(9):819-23. doi: 10.1007/BF01309510.
To further assess the molar ratio of branched-chain to aromatic amino acids as a measure of disease activity, we correlated results of this test with histologic features of inflammation, standard biochemical tests, and prognosis in 68 patients with severe chronic active hepatitis. An abnormal molar ratio (less than 3.0) reflected histologic findings of chronic active hepatitis in 26 of 35 instances. A normal molar ratio (greater than or equal to 3.0), however, was associated with histologic features of chronic active hepatitis in nine of 14 instances. Molar ratio abnormalities occurred more frequently in patients with cirrhosis than without cirrhosis (95% vs 45%, P less than 0.01). Only one of 20 patients with cirrhosis had a normal ratio, and none of 12 followed serially during therapy improved the ratio to normal. No correlation was seen between the molar ratio and severity of inflammation or serum levels of aspartate aminotransferase, albumin, bilirubin, and gamma globulin. When corticosteroids were discontinued, relapse occurred as frequently in patients with a normal molar ratio as in others (80% vs 71%), and the presence of an abnormal ratio did not preclude a sustained remission after treatment. We conclude that the plasma molar ratio does not reflect histologic activity, correlate with standard liver function tests, or indicate disease behavior after treatment withdrawal. A normal molar ratio during or after treatment, however, may exclude cirrhosis.
为了进一步评估支链氨基酸与芳香族氨基酸的摩尔比作为疾病活动度的一项指标，我们将此项检测结果与68例重度慢性活动性肝炎患者的炎症组织学特征、标准生化检测及预后情况进行了相关性分析。异常摩尔比（小于3.0）在35例中有26例反映了慢性活动性肝炎的组织学表现。然而，正常摩尔比（大于或等于3.0）在14例中有9例与慢性活动性肝炎的组织学特征相关。摩尔比异常在肝硬化患者中比无肝硬化患者更常见（95%对45%，P小于0.01）。20例肝硬化患者中只有1例比值正常，且在治疗期间连续随访的12例患者中无1例比值恢复正常。摩尔比与炎症严重程度或天冬氨酸转氨酶、白蛋白、胆红素及γ球蛋白的血清水平之间未见相关性。停用皮质类固醇后，摩尔比正常的患者与其他患者复发频率相同（80%对71%），且比值异常并不排除治疗后持续缓解。我们得出结论，血浆摩尔比不能反映组织学活动度，与标准肝功能检测无相关性亦不能提示停药后的疾病行为。然而，治疗期间或治疗后摩尔比正常可能排除肝硬化。
