McCormick S E, Goodman Z D, Maydonovitch C L, Sjogren M H
Gastroenterology Department, Walter Reed Army Medical Center, Washington, D.C., USA.
Am J Gastroenterol. 1996 Aug;91(8):1516-22.
Hepatic histological evaluation is currently the gold standard to determine the degree of liver injury in chronic hepatitis C. It is unclear whether degree of serum ALT elevation or quantitative hepatitis C virus (HCV) RNA can predict level of histological damage.
Fifty nine biopsies from 44 patients with chronic hepatitis C were reviewed. The amount of liver damage was quantified using the Histology Activity Index (HAI) and was compared with serum ALT and, in 26 biopsies, quantitative HCV RNA (branched DNA amplification, Quantiplex, Chiron).
A statistically significant linear relationship was noted between degree of ALT elevation and amount of liver injury based on HAI score (p < 0.05) although this relationship was not statistically strong (rs = 0.4900). No significant correlation was noted between serum ALT and HCV RNA titer (rs = 0.4044) or between quantitative HCV RNA titer and HAI score (rs = 0.3506). No individual component of the HAI correlated with ALT or HCV RNA.
Although there is a correlation between serum ALT and degree of hepatic injury based on HAI score, this relationship is weak and probably of no clinical use. There is no significant correlation between HCV RNA and serum ALT or HCV RNA and degree of hepatic injury in individual patients. Hepatic histological evaluation continues to be required for clinical assessment of patients with chronic hepatitis C.
肝组织学评估目前是确定慢性丙型肝炎肝损伤程度的金标准。血清ALT升高程度或丙型肝炎病毒（HCV）定量RNA是否能够预测组织学损伤程度尚不清楚。
回顾了44例慢性丙型肝炎患者的59份活检样本。使用组织学活动指数（HAI）对肝损伤量进行量化，并与血清ALT进行比较，对于26份活检样本，还与HCV定量RNA（分支DNA扩增，Quantiplex，Chiron公司）进行比较。
基于HAI评分，ALT升高程度与肝损伤量之间存在统计学显著的线性关系（p < 0.05），尽管这种关系在统计学上并不强（rs = 0.4900）。血清ALT与HCV RNA滴度之间（rs = 0.4044）或HCV定量RNA滴度与HAI评分之间（rs = 0.3506）均未发现显著相关性。HAI的各个组成部分均与ALT或HCV RNA无相关性。
尽管基于HAI评分血清ALT与肝损伤程度之间存在相关性，但这种关系较弱，可能无临床应用价值。在个体患者中，HCV RNA与血清ALT之间或HCV RNA与肝损伤程度之间均无显著相关性。对于慢性丙型肝炎患者的临床评估，仍需要进行肝组织学评估。
