Cassidy W M, Reynolds T B
Department of Gastroenterology, LSU School of Medicine, Baton Rouge.
J Clin Gastroenterol. 1994 Sep;19(2):118-21. doi: 10.1097/00004836-199409000-00008.
Acute hepatocellular injury, whether due to viral hepatitis, hepatic ischemia, or drug hepatotoxicity, results in elevated levels of serum aminotransferases (AST and ALT). Serum lactate dehydrogenase (LD) is reported to be markedly elevated in ischemic hepatitis. Thus, comparisons of the degree of elevation of serum levels of LD, ALT, and AST may be helpful in the differential diagnosis of acute liver injury. To study this, we reviewed serum enzyme patterns early in the course of acute liver injury in patients with acute viral hepatitis A and B (n = 51), ischemic hepatitis (n = 20), and acetaminophen injury (n = 26). All patients had serum ALT and/or AST at least five times the upper limit of normal. For a given ALT and AST level, LD was higher in ischemic hepatitis and acetaminophen injury than in viral hepatitis. The mean ALT/LD ratio for acute viral hepatitis was 4.65, for ischemic hepatitis 0.87, and for acetaminophen injury 1.46. Mean ALT/LD ratio for viral hepatitis was significantly higher (p < 0.0001) than for the other two groups combined. An ALT/LD ratio of 1.5 differentiated acute viral hepatitis from ischemic hepatitis and acetaminophen injury with a sensitivity of 94% and a specificity of 84%.
急性肝细胞损伤，无论是由病毒性肝炎、肝脏缺血还是药物性肝毒性引起，都会导致血清转氨酶（AST和ALT）水平升高。据报道，缺血性肝炎患者血清乳酸脱氢酶（LD）显著升高。因此，比较血清LD、ALT和AST水平的升高程度可能有助于急性肝损伤的鉴别诊断。为了研究这一点，我们回顾了急性甲型和乙型病毒性肝炎患者（n = 51）、缺血性肝炎患者（n = 20）和对乙酰氨基酚损伤患者（n = 26）在急性肝损伤病程早期的血清酶谱。所有患者的血清ALT和/或AST至少是正常上限的五倍。对于给定的ALT和AST水平，缺血性肝炎和对乙酰氨基酚损伤患者的LD高于病毒性肝炎患者。急性病毒性肝炎的平均ALT/LD比值为4.65，缺血性肝炎为0.87，对乙酰氨基酚损伤为1.46。病毒性肝炎的平均ALT/LD比值显著高于其他两组之和（p < 0.0001）。ALT/LD比值为1.5可将急性病毒性肝炎与缺血性肝炎和对乙酰氨基酚损伤区分开来，敏感性为94%，特异性为84%。
