Mahl T C
State University of New York at Buffalo, USA.
Lippincotts Prim Care Pract. 1998 Jul-Aug;2(4):379-89.
Patients with abnormal liver blood tests are frequently encountered by primary care practitioners. An understanding of the cellular implications of these abnormalities is helpful in determining the etiology of liver injury. Elevated serum aminotransferases suggest injury of hepatocytes. Elevations in alkaline phosphatase suggest injury to any part of the biliary tree. Neither of these enzymes measures liver function. Serum bilirubin and albumin levels, as well as prothrombin time, do measure function and can be used in conjunction with the physical examination and the specific etiology of the patient's disorder to determine a patient's prognosis. Many diverse disorders result in similar biochemical patterns of liver injury. The history, physical examination, and use of specific disease markers (hepatitis serology, autoimmune markers, and so forth) help to narrow the differential diagnosis. The definitive diagnosis of all liver diseases usually rests on histology: the liver biopsy is the gold standard. With the advent of treatments for liver disease, identifying and accurately diagnosing patients with liver disorders will result in improved quality of life and survival.
基层医疗从业者经常会遇到肝功能血液检查异常的患者。了解这些异常情况在细胞层面的影响有助于确定肝损伤的病因。血清氨基转移酶升高提示肝细胞损伤。碱性磷酸酶升高提示胆道树任何部位的损伤。这两种酶都不能衡量肝功能。血清胆红素和白蛋白水平以及凝血酶原时间则可衡量肝功能，并且可以与体格检查及患者疾病的具体病因相结合，以确定患者的预后。许多不同的病症会导致相似的肝损伤生化模式。病史、体格检查以及使用特定的疾病标志物（肝炎血清学、自身免疫标志物等）有助于缩小鉴别诊断范围。所有肝病的确诊通常都依赖于组织学检查：肝活检是金标准。随着肝病治疗方法的出现，识别并准确诊断肝病患者将改善生活质量并提高生存率。
