Haber M M, West A B, Haber A D, Reuben A
Department of Pathology, Yale University, New Haven, Connecticut, USA.
Am J Gastroenterol. 1995 Aug;90(8):1250-7.
Serum aminotransferase levels characteristically fluctuate in chronic hepatitis C, but their relationship to grade (i.e., inflammatory activity) and stage (i.e., degree of fibrosis) of liver disease is uncertain. We therefore correlated aminotransferase levels and liver biopsy findings in 90 patients with serologically confirmed chronic hepatitis C.
Mode of transmission; disease duration; symptoms and signs of liver disease; alcohol intake; autoantibody, HIV, and hepatitis B virus status; and liver biochemistries were obtained from records. Liver biopsies were 1) given a morphological diagnosis, 2) evaluated for features of chronic hepatitis C, and 3) scored with a histological activity index.
Individual aminotransferase levels were not related to clinical or laboratory variables, nor were they reliably predictive of morphological diagnosis. No histological characteristics were associated with a particular range of aminotransferase values, except aminotransferases > 350 U/L, which were associated with piecemeal necrosis. Although mean values of aminotransferases were significantly lower among patients with chronic persistent hepatitis (CPH) (i.e., with minimal activity) compared with chronic active hepatitis (CAH) (mild to moderate activity) (ALT 110 U/L +/- 71 SD vs 256 +/- 211; AST 57 U/L +/- 34 vs 123 +/- 88) and in the absence of piecemeal necrosis compared with in its presence (ALT 133 +/- 84 vs 207 +/- 149; AST 73 +/- 47 vs 120 +/- 83), overlap of values was considerable between different histological groups.
Aminotransferases do not predict liver histological status in chronic hepatitis C, although > or = 10-fold elevations suggest that piecemeal necrosis is present.
血清转氨酶水平在慢性丙型肝炎中通常会波动，但其与肝病分级（即炎症活动度）和分期（即纤维化程度）的关系尚不确定。因此，我们对90例血清学确诊的慢性丙型肝炎患者的转氨酶水平与肝活检结果进行了相关性分析。
从病历中获取传播方式、病程、肝病症状和体征、酒精摄入量、自身抗体、HIV及乙肝病毒状态以及肝脏生化指标。肝活检结果：1）给出形态学诊断；2）评估慢性丙型肝炎特征；3）用组织学活动指数进行评分。
个体转氨酶水平与临床或实验室变量无关，也不能可靠地预测形态学诊断。除了转氨酶>350 U/L与桥接坏死相关外，没有组织学特征与特定范围的转氨酶值相关。尽管慢性持续性肝炎（CPH，即活动度最小）患者的转氨酶平均值显著低于慢性活动性肝炎（CAH，轻度至中度活动）患者（ALT 110 U/L±71标准差 vs 256±211；AST 57 U/L±34 vs 123±88），且无桥接坏死患者的转氨酶平均值低于有桥接坏死患者（ALT 133±84 vs 207±149；AST 73±47 vs 120±83），但不同组织学组之间的值重叠相当大。
在慢性丙型肝炎中，转氨酶不能预测肝脏组织学状态，尽管转氨酶升高≥10倍提示存在桥接坏死。
