Sheth S G, Flamm S L, Gordon F D, Chopra S
Department of Medicine, Beth Israel Deaconess Medical Center Hospital, Boston, Massachusetts 02215, USA.
Am J Gastroenterol. 1998 Jan;93(1):44-8. doi: 10.1111/j.1572-0241.1998.044_c.x.
A liver biopsy is necessary to grade and stage chronic hepatitis C virus (HCV) infection. In a previous study of patients with nonalcoholic liver disease, an aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio >1 suggested cirrhosis. We sought to examine the value of the AST/ALT ratio in distinguishing cirrhotic patients with chronic HCV infection from noncirrhotic patients and to correlate the ratio with the grade and stage of hepatitis and other biochemical indices.
We retrospectively studied 139 patients with chronic HCV infection. Routine biochemical indices were determined, and the histological grade of necroinflammatory activity and the stage of fibrosis of the liver biopsy specimens were scored.
The mean AST/ALT ratio in the cirrhotic patients (n = 47) was higher than in the noncirrhotic patients (n = 92) (1.06 +/- 0.06 vs 0.60 +/- 0.09; p < 0.001). A ratio > or =1 had 100% specificity and positive predictive value in distinguishing cirrhotic from noncirrhotic patients, with a 53.2% sensitivity and 80.7% negative predictive value. The ratio correlated positively with the stage of fibrosis but not with the grade of activity or other biochemical indices. Of the cirrhotic patients, 17% had no clinical or biochemical features suggestive of chronic liver disease except for an AST/ALT ratio > or =1.
The AST/ALT ratio is a dependable marker of fibrosis stage and cirrhosis in patients with chronic HCV infection.
肝活检对于慢性丙型肝炎病毒（HCV）感染的分级和分期是必要的。在先前一项关于非酒精性肝病患者的研究中，天冬氨酸氨基转移酶（AST）与丙氨酸氨基转移酶（ALT）的比值>1提示肝硬化。我们试图研究AST/ALT比值在区分慢性HCV感染的肝硬化患者与非肝硬化患者中的价值，并将该比值与肝炎的分级和分期以及其他生化指标相关联。
我们回顾性研究了139例慢性HCV感染患者。测定常规生化指标，并对肝活检标本的坏死性炎症活动的组织学分级和纤维化分期进行评分。
肝硬化患者（n = 47）的平均AST/ALT比值高于非肝硬化患者（n = 92）（1.06±0.06对0.60±0.09；p<0.001）。比值≥1在区分肝硬化患者与非肝硬化患者时具有100%的特异性和阳性预测值，敏感性为53.2%，阴性预测值为80.7%。该比值与纤维化分期呈正相关，但与活动分级或其他生化指标无关。在肝硬化患者中，17%除了AST/ALT比值≥1外，没有提示慢性肝病的临床或生化特征。
AST/ALT比值是慢性HCV感染患者纤维化分期和肝硬化的可靠标志物。
