正常血清谷丙转氨酶水平之间的同事不和的机理评估，并且

StephenW

PLoS One. 2015 Jul 31;10(7):e0134532. doi: 10.1371/journal.pone.0134532.
A Mechanistic Assessment of the Discordance between Normal Serum Alanine Aminotransferase Levels and Altered Liver Histology in Chronic Hepatitis B.Gong X1, Yang J1, Tang J1, Gu C1, Huang L1, Zheng Y1, Liang H1, Wang M1, Wu C1, Chen Y1, Zhang M1, Yu Z2, Mao Q1.
Author information

• 1Hepatology Unit, Xiamen Hospital of Traditional Chinese Medicine, Xiamen, Fujian, China.
• 2Shenzhen Key Lab for Endogenous Infection, Shenzhen Nanshan Hospital, Shenzhen, Guangdong, China.
  


AbstractTo understand the mechanisms underlying the discordance between normal serum alanine aminotransferase (ALT) levels and significant alterations in liver histology of chronic hepatitis B virus (HBV) infection with persistent normal ALT (PNALT) or minimally elevated ALT. A total of 300 treatment-naive chronic HBV-infected patients with PNALT (ALT ≤ upper limit of normal [ULN, 40 U/ml]) or minimally elevated ALT (1-2×ULN) were retrospectively enrolled. All patients underwent liver biopsy and histological changes were analyzed along with biochemical and HBV markers. Among 300 participants, 177 were HBeAg-positive and 123 HBeAg-negative. Significant histologic abnormalities were found in 42.9% (76/177) and 52.8% (65/123) of HBeAg-positive and HBeAg-negative patients, respectively. Significant fibrosis, which is a marker of prior injury, was more frequently detected than significant necroinflammation (suggesting active liver injury) in both HBeAg-positive and -negative groups, suggesting that liver injury occurred intermittently in our cohort. No significant differences were noticed in the percentage of patients with severe fibrosis between HBeAg-positive and negative phases or between ages 30 and 40 and over 40, suggesting that the fibrosis was possibly carried over from an early phase. Finally, lowering ALT ULN (30 U/L for men, 19 U/L for women) alone was not adequate to increase the sensitivity of ALT detection of liver injury. However, the study was limited to a small sample size of 13 HBeAg-positive patients with ALT in the revised normal range. We detected significant liver pathology in almost 50% of chronic HBV infected patients with PNALT (ALT ≤ 40 U/ml) or minimally elevated ALT. We postulated that small-scale intermittent liver injury was possibly responsible for the discordance between normal serum ALT and significant liver changes in our cohort.


PMID:26230094 [PubMed - as supplied by publisher]  

StephenW

公共科学图书馆之一。 2015年7月31日; 10（7）：e0134532。 DOI：10.1371 / journal.pone.0134532。
正常血清谷丙转氨酶水平之间的同事不和的机理评估，并且改变肝脏组织学在慢性乙型肝炎
龚X1，杨J1，唐J1，顾C1，L1黄，郑Y1，梁H1，王M1，吴C1，陈Y1，M1张，于Z2，毛泽东Q1。
作者信息

    1Hepatology单位，中国传统医药，厦门，福建，中国厦门医院。
    2Shenzhen重点实验室内源性感染，深圳南山医院，深圳市，广东省，中国。

抽象

要了解正常血清谷丙转氨酶（ALT）水平和显著改变慢性乙型肝炎病毒（HBV）感染与持续ALT正常（PNALT）或轻度ALT升高肝组织学之间的不一致背后的机制。一共有300初治慢性HBV感染患者的PNALT（ALT≤正常上限[ULN，40 U / ml的]）或轻度升高ALT（1-2×ULN）进行回顾性入选。所有患者接受肝活检组织学变化，生化和乙肝标志物分析沿。其中300人参加，177为HBeAg阳性和123 HBeAg阴性。显著组织学发现异常42.9％（一百七十七分之七十六）和HBeAg阳性和HBeAg阴性患者的52.8％（123分之65），分别。显著纤维化，这是先有损伤的标志物，被更频繁地检测到比显著坏死性炎症（暗示活性肝损伤）在HBeAg阳性和阴性组，表明间歇地发生在我们的队列肝损伤。无显著差异注意到患者HBeAg阳性和负相之间，或年龄30和40 40之间，并在严重纤维化百分比，这表明纤维化从早期阶段可能结转。最后，降低ALT ULN（30 U / L，男性，19 U / L女）独显不足以增加ALT检测肝损伤的敏感性。然而，这项研究仅限于13 HBeAg阳性患者的小样本与ALT在修订后的正常范围内。我们发现显著肝脏病理在慢性HBV感染者近50％PNALT（ALT≤40U / ml）或轻度升高ALT。我们推测，小规模的间歇性肝损伤有可能负责正常血清ALT，在我们的队列显著肝脏变化之间的不一致。