Horowitz H W, Dworkin B, Forseter G, Nadelman R B, Connolly C, Luciano B B, Nowakowski J, O'Brien T A, Calmann M, Wormser G P
Department of Medicine, Westchester County Medical Center, Valhalla, NY 10595, USA.
Hepatology. 1996 Jun;23(6):1412-7. doi: 10.1002/hep.510230617.
To evaluate the frequency, pattern, and severity of liver function test abnormalities in patients with Lyme disease associated with erythema migrans (EM), 115 individuals with no other identifiable cause for liver function test abnormalities who presented with EM between July 1990 and September 1993 were prospectively evaluated. For individuals with abnormal liver function tests, common causes of hepatitis, including hepatitis A, B, and C, were excluded. A local control group was used for comparison. Forty-six (40%) patients had at least one liver test abnormality, and 31 (27%) had more than 1 abnormality compared with 19 (19%) and 4 (4%) of controls, respectively (P < .01 for each comparison). gamma-Glutamyl transpeptidase (28%) and alanine transaminase (ALT) (27%) were the most frequently elevated liver function tests among Lyme disease patients. Anorexia, nausea, or vomiting was reported by 30% of patients, but did not occur more frequently in patients with elevated liver function tests compared with those with normal values. Patients with early disseminated Lyme disease were more likely to have elevated liver function studies (66%) compared with patients with localized disease (34%) (P = .002). After antibiotic treatment, elevated liver function tests improved or resolved in most patients. Liver function test abnormalities are common in patients with EM but were mild, most often not associated with symptoms, and improved or resolved by 3 weeks after the onset of antibiotic therapy in most patients.
为评估伴有游走性红斑（EM）的莱姆病患者肝功能检查异常的频率、模式及严重程度，对1990年7月至1993年9月期间出现EM且无其他可识别的肝功能检查异常原因的115名个体进行了前瞻性评估。对于肝功能检查异常的个体，排除了包括甲型、乙型和丙型肝炎在内的常见肝炎病因。使用一个本地对照组进行比较。46名（40%）患者至少有一项肝功能检查异常，31名（27%）患者有一项以上异常，而对照组分别为19名（19%）和4名（4%）（每次比较P<0.01）。γ-谷氨酰转肽酶（28%）和丙氨酸转氨酶（ALT）（27%）是莱姆病患者中最常升高的肝功能检查指标。30%的患者报告有厌食、恶心或呕吐，但肝功能检查值升高的患者与正常患者相比，这些症状并未更频繁出现。与局限性疾病患者（34%）相比，早期播散性莱姆病患者肝功能检查指标升高的可能性更大（66%）（P=0.002）。抗生素治疗后，大多数患者的肝功能检查指标升高情况有所改善或恢复正常。肝功能检查异常在EM患者中很常见，但程度较轻，大多数情况下与症状无关，且大多数患者在抗生素治疗开始后3周内情况改善或恢复正常。
