The diagnostic value of PIVKA-Ⅱcombined with AFP and AST/ALT ratio in the diagnosis of primary liver cancer with HBV infection / 国际检验医学杂志

Objective To investigate the expression level of protein induced by vitamin K absence or antagonist-Ⅱ (PIVKA-Ⅱ) in serum of primary liver cancer patients with HBV infection and combined with alphafetoprotein (AFP) and AST/ALT ratio in the diagnosis of primary liver cancer with HBV infection.Methods Sera of 68 HBV infection patients with primary liver cancer were collected.Meanwhile, sera of 109 HBV infection patients (8 cases of gallbladder diseases, 94 cases of benign liver diseases, 7 csaes of other organ diseases) were collected as controls.The serum levels of PIVKA-Ⅱand AFP were detected by the method of chemiluminescent immunoassay and electrochemical luminescence respectively.The rate method was used to detect the content of AST and ALT, and the ratio of AST/ALT was calculated.Compared the expression level of tumor markers in each group, and the receiver operating characteristic (ROC) curve was applied to evaluate the diagnostic efficacy of individual and combined application of each index in the diagnosis of primary liver cancer.Results The sera levels of PIVKA-Ⅱ, AFP and AST/ALT ratio in primary liver cancer with HBV infection group were all higher than those in control group (P＜0.01).ROC curve analysis showed that with the critical value of PIVKA-Ⅱ, AFP and AST/ALT ratio in serum were 100.42 mAu/mL, 232.35 ng/mL and 1.571 in the diagnosis of primary liver cancer with HBV infection, the area under the ROC curve (AUC) were 0.942, 0.786 and 0.723 respectively;the sensitivity were 89.70％, 58.80％and 51.50％;the specificity were 91.70％, 88.10％and 79.80％.The AUC of PIVKA-Ⅱcombined with AST/ALT ratio in the diagnosis of primary liver cancer with HBV infection was 0.955, the sensitivity and specificity wree 86.80％and 93.40％respectively.Conclusion The value of PIVKA-II in the diagnosis of primary liver cancer with HBV infection is obviously better than that of AFP and AST/ALT ratio.The combined detection with AST/ALT ratio will be helpful to improve the diagnostic efficacy of primary liver cancer with HBV infection.

Correlation between Aminotransferase Ratio (AST/ALT) and Other Biochemical Parameters in Chronic Liver Disease of Viral Origin.

Background: In recent years the ratio of aspartate aminotransferase (AST) to alanine aminotransferase (ALT) in patients of chronic liver disease (CLD) of various origins has gained much attention. This variable is readily available, easy to interpret, and inexpensive and the clinical utility of the AST/ALT ratio in the diagnostic workup of patients with CLD is quite promising. Objective: The present study was designed to find out the link between aminotransferase (AST/ALT) ratio with commonly measured biochemical parameters of liver function tests in CLD of viral origin. Materials and method: This cross sectional study was carried out in the department of Biochemistry, Sir Salimullah Medical College, Dhaka, Bangladesh. Forty four biopsy proven diagnosed subjects of chronic viral hepatitis without cirrhosis of both sex were selected purposively. With aseptic precaution 5 mL venous blood was collected from each subject and common liver function tests (serum AST, ALT, AST/ALT ratio, alkaline phosphatase, total bilirubin, serum total protein, serum albumin, serum globulin, serum albumin/globulin ratio, prothrombin time) and viral serology (HBsAg, Anti HDV antibody, Anti HCV antibody) were performed. Data were analyzed by SPSS version 19 for Windows. Pearson’s correlation test was done to determine association between AST/ALT with other biochemical parameters. Results: Mean(±SD) age of the study subjects was 32.55±10.55 years (range 20-50 years) with 48 (77.7%) male and 14 (22.6%) female subjects. Pearson’s correlation test was done between AST to ALT ratio with other biochemical parameters and prothrombin time showed significant positive correlation (p <0.01). Conclusion: In our study we found significant positive correlation between AST/ALT with prothrombin time in CLD subjects without cirrhosis.

Cytoprotective effect of silymarin against diabetes-induced cardiomyocyte apoptosis in diabetic rats / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>The beneficial effects of silymarin have been extensively studied in the context of inflammation and cancer treatment, yet much less is known about its therapeutic effect on diabetes. The present study was aimed to investigate the cytoprotective activity of silymarin against diabetes-induced cardiomyocyte apoptosis.</p><p><b>METHODS</b>Rats were randomly divided into: control group, untreated diabetes group and diabetes group treated with silymarin (120 mg/kg•d) for 10 d. Rats were sacrificed, and the cardiac muscle specimens and blood samples were collected. The immunoreactivity of caspase-3 and Bcl-2 in the cardiomyocytes was measured. Total proteins, glucose, insulin, creatinine, AST, ALT, cholesterol, and triglycerides levels were estimated.</p><p><b>RESULTS</b>Unlike the treated diabetes group, cardiomyocyte apoptosis increased in the untreated rats, as evidenced by enhanced caspase-3 and declined Bcl-2 activities. The levels of glucose, creatinine, AST, ALT, cholesterol, and triglycerides declined in the treated rats. The declined levels of insulin were enhanced again after treatment of diabetic rats with silymarin, reflecting a restoration of the pancreatic β-cells activity.</p><p><b>CONCLUSION</b>The findings of this study are of great importance, which confirmed for the first time that treatment of diabetic subjects with silymarin may protect cardiomyocytes against apoptosis and promote survival-restoration of the pancreatic β-cells.</p>

Hepatitis autoinmune, revisión a propósito de un caso / Autoimmune hepatitis, review in relation to a case

El presente es un caso de hepatitis autoinmune (HAI) con datos de citolisis importante (AST y ALT elevadas) e insuficiencia hepática (tiempo de protrombina prolongado y colinesterasa baja). El proceso que lleva al diagnóstico de esta entidad clínica es mostrado de manera detallada y evidente, resaltando las claves diagnósticas como la hipergammaglobulinemia. La clasificación del caso como hepatitis autoinmune del tipo I, sostenido en marcadores seroinmunológicos, como los anticuerpos antinucleares (ANA), antimúsculo liso (SMA), antiactina, en el presente caso estuvieron positivos, la ausencia de infección de virus hepatotropos y las condiciones epidemiológicas que dan luces al diagnóstico de HAI. Se instaura tratamiento inmunosupresor con prednisona y azatioprina y la remisión clínica y de laboratorio son evidentes. Se revisa factores pronósticos los cuales se asocia con los niveles y gravedad de las alteraciones de laboratorio, a las cuales se les da un peso importante al momento de indicar los inmunosupresores. Todos estos aspectos sostenidos por la más diversa evidencia.

This is a case of autoimmune hepatitis (AIH) with important cytolysis data (high AST and ALT) and liver insufficiency (prolonged prothrombin time an low cholinesterase). The process that leads to this diagnosis is showed in a detailed an obvious way, standing out the diagnosis keys such as hypergammaglobulinemia. Classification of the case as autoimmune hepatitis type I, sutained by seroimmunological markers such as antinuclear antibodies (ANA), anti smooth muscle (SMA), antiactina, in this case wer positive, the absence of infection by hepatotropic viruses and epidemiological conditions lighten the diagnosis of AIH. An immunosuppressive treatment is established with prednisone and azathioprine and clinical and laboratory remissions are evident. Prognosis factors are checked and are associated with levels and seriousness of laboratory alterations, which have importance at the time of prescribing the immunosupressives. All these aspects sustained by the most varied evidence.

Efficacy of AST to Platelet Ratio Index in Predicting Severe Hepatic Fibrosis and Cirrhosis in Chronic Hepatitis B Virus Infection / 대한소화기학회지

BACKGROUND/AIMS: An ideal noninvasive diagnostic test for hepatic fibrosis should be simple, inexpensive, and accurate. We aimed to find the simple marker for predicting hepatic fibrosis and to compare the accuracy of AST, platelet, AST/ALT ratio and AST to platelet ratio index (APRI) in chronic hepatitis B patients without clinical evidence of cirrhosis. METHODS: A total of one hundred and twenty-six chronic hepatitis B patients who underwent liver biopsy at the Ajou University Hospital from August 1998 to December 2003 were enrolled. Hepatic fibrosis was assessed using the Ludwig classification. Significant fibrosis was defined as fibrosis score of 3 or more. The AST/ALT ratio and APRI were calculated and correlations with hepatic fibrosis were analyzed. RESULTS: APRI showed a significant correlation (r=0.501, p=0.000) with hepatic fibrosis, and was superior to AST, AST/ALT ratio and platelet in predicting fibrosis. Patients with significant fibrosis (fibrosis stage 3, 4) can be identified to have APRI=1 with sensitivity 71.2% and specificity 70.3%. The sensitivity and specificity of an APRI = 1.5 for cirrhosis (stage 4) were 83.3% and 75.0%. CONCLUSIONS: Simple index using AST and platelet value can predict the presence of significant fibrosis and cirrhosis in chronic hepatitis B patients without clinical evidence of cirrhosis.

The Effectiveness of Hepatoprotectants on Elevated Liver Enzyme Induced by Atypical Antipsychotics / 대한정신약물학회지

OBJECTIVE: Atypical antipsychotics have been reported to induce the elevation of serum transaminase frequently in Korea, although most of them don't cause severe liver injury. Some hepatoprotectants are commonly prescribed in order to reduce the serum level of transaminase in patients with schizophrenia. We performed the chart review retrospectively for investigating the effect of two hepatoprotectants, biphenyl dimethyl dicarboxylate+garlic oil combination (BDD), and silymarin+silybin combination (SMR14) on the serum transaminase (AST/ALT) elevated by atypical antipsychotics. METHODS: We reviewed the clinical records of 54 schizophrenic patients who experienced the elevation of serum AST/ALT after the treatment with atypical antipsychotics. Patients with preexisting liver disease or elevated AST/ALT above in-house normal limitation at admission were excluded. We obtained the level of serum AST/ALT at the time of hepatoprotectants administration, 1 week, 2 weeks and 4 weeks after the administration. Repeated Analyses of variance were conducted in order to identify sequential change of serum AST/ALT level, and Fisher's exact test were performed to compare the number of patients whose AST/ALT levels were normalized after 4 weeks between two groups. RESULTS: 33 males and 21 females were included in this study and the mean age of those subjects was 36.28+/-10.92. Among all the patients, 35 were treated with BDD and 19 were treated with SMR14. After administration of hapatoprotectants, both serum AST and ALT level were significantly reduced during 4 weeks (F=10.56, p<0.001;F=17.92, p<0.001). BDD was superior to SMR14 in the number of patients whose ALT level reduced below in-house upper limitation after 4 weeks of treatment with hepatoprotectants (p=0.012), but there was no difference between BDD and SMR14 in aspect to AST level. CONCLUSION: Both hepatoprotectants, BDD and SMR14 were effective in reducing serum AST/ALT level which had been elevated by atypical antipsychotics. BDD was superior to SMR14 in normalizing serum ALT level within 4 weeks. Increased liver enzyme is prevalent in patients during the treatment with atypical antipsychotics. More research will be needed in this field.

Clinical Efficacy of AST/ALT Ratio and Platelet Counts as Predictors of Degree of Fibrosis in HBV Infected Patients without Clinically Evident Liver Cirrhosis / 대한소화기학회지

BACKGROUND/AIMS: Hepatic fibrosis is an important prognostic factor in chronic hepatitis B. Liver biopsy is a gold standard diagnostic tool but an invasive procedure, so it cannot be done on all patients. We evaluated the clinical efficacy of AST/ALT ratio and platelet counts as predictors of fibrosis in chronic hepatitis B. METHODS: We reviewed retrospectively clinical records of 323 patients, who visited Kyungpook National University Hospital for chronic hepatitis B and underwent liver biopsy from September 1998 to May 2002. Correlation with laboratory parameters with hepatic fibrosis stage was identified. RESULTS: Of 323 patients, there were 278 male patients with mean age 27 (9~59). Platelet counts showed a significant correlation (r=-0.343, p=0.000), and AST/ALT ratio showed a weak but significant correlation (r=0.137, p=0.013) with fibrosis stage. Patients with severe fibrosis or cirrhosis (stage 3 and 4) can be identified to have AST/ALT ratio > 1 and platelet counts 1 in combination with platelet counts. However, its sensitivity is too low to replace liver biopsy.

The Diagnostic Value of Serum Hyaluronic Acid, 7S Domain of Type IV Collagen and AST/ALT Ratio as Markers of Hepatic Fibrosis in Chronic Hepatitis B and Cirrhosis Patients / 대한간학회지

BACKGROUND/AIMS: The prognosis of chronic liver disease is closely related to the development of hepatic fibrosis. Liver biopsy is the gold standard method to assess inflammatory activity and fibrosis stage, but this is associated with morbidity and mortality. This study aimed to evaluate the diagnostic value of serum hyaluronic acid, 7S domain of type IV collagen and AST/ALT ratio as markers of hepatic fibrosis in chronic hepatitis B and cirrhosis. METHODS: This study included 100 patients with chronic hepatitis B and cirrhosis. Liver biopsy and histopathologic classification were done. Serum hyaluronic acid and 7S domain of type IV collagen were measured by one step sandwich binding protein assay and radioimmunoassay using polyclonal antibody to 7S domain of type IV collagen, respectively. RESULTS: The serum concentrations of hyaluronic acid, 7S domain of type IV collagen and AST/ALT ratio in the cirrhosis group (139 +/- 98.4 ng/mL, 6.9 +/- 3.5 ng/mL, 1.6 +/- 1.5) were significantly higher (p<0.01) than those in the normal and fatty liver group (20.2 +/- 12.5 ng/mL, 3.5 +/- 0.5 ng/mL, 0.7 +/- 0.3), mild hepatitis group (32.3 +/- 52.7 ng/mL, 3.9 +/- 1.4 ng/mL, 0.7 +/- 0.4), and moderate to severe hepatitis group (68.2 +/- 72.3 ng/mL, 5.3 +/- 2.4 ng/mL, 0.8 +/- 0.4). At the cutoff value of 77 ng/mL for hyaluronic acid and 6.3 ng/mL for 7S domain of type IV collagen and 0.62 for AST/ALT ratio, the sensitivities were 81.8%, 63.6%, 90.9% and specificities were 87.3%, 88.6%, 53.1% for discriminating cirrhosis (fibrosis score: 4) from the mild to severe fibrosis (fibrosis score: 0-3). CONCLUSIONS: Serum hyaluronic acid, 7S domain of type IV collagen and AST/ALT ratio measurement may be clinically useful as markers of hepatic fibrosis in chronic hepatitis B and cirrhosis.

The Clinical and Laboratory Features of Kawasaki Disease with Nonresponsibility to the Acute Antiinflammatory Treatment

PURPOSE: To assess the clinical features and laboratory findings in Kawasaki patients with nonresponsibility to the acute antiinflammatory treatment, and identify the risk factors for the nonresponsibility, we reviewed the medical records of patients with Kawasaki disease. METHODS: A retrospective study of 177 patients with Kawasaki disease at Wonkwang University Medical Center from June, 1997 to June, 2002, was performed. High dose intravenous immune globulin(IVIG) and aspirin were all used for the initial acute antiinflammatory treatment. Two groups, group A(n=19) of initial nonresponders and group B(n=158) of initial responders were compared clinically and laboratorically. RESULTS: Nineteen(10.7%) of 177 patients hardly responded to the initial antiinflammatory treatment. Patients with failure to respond to initial treatment(group A) did not differ from the control group in terms of age, sex, WBC count, coronary abnormalities, and evidence of pyuria. Compared with initial responders(group B), the patients who were retreated(group A) had a significantly shorter fever- admission interval(P=0.041), and a higher level of both AST/ALT(P=0.011) and ASO titier(P=0.000). CONCLUSION: Among Kawasaki disease patients studied, retreatment group with initial nonresponders had significantly shorter fever-admission interval, and higher both AST/ALT level and ASO titer, than the initial response group.

Influence of History of Alcohol Ingestion on AST and ALT Following Enflurane Anesthesia in Gastrectomy Patients / 대한마취과학회지

BACKGROUND: There are many factors including the operation site, duration of anesthesia, preoperative liver function and hepatitis, which cause postoperative hepatic dysfunction. The purpose of this study is to evaluate postoperative liver function with respect to a history of alcohol intake. METHODS: Seventy-five patients were divided into 2 groups:44 patients without alcohol intake (non-alcohol group), 31 patients with alcohol intake (alcohol group). All patients were anesthetized with about 1.5 vol% of enflurane combined with 50% nitrous oxide and 50% oxygen. AST (aspartate aminotransferase) and ALT (alanine aminotransferase) were measured before anesthesia, 1, 3 and 7 days after surgery in both groups, respectively. Postoperative AST and ALT values were compared to preoperative values within each group, and were also compared between groups. RESULTS: In the alcohol group, postoperative AST and ALT values were significantly higher than preoperative values (P < 0.05). In addition, postoperative ALT values significantly increased in the 1st and 7th day over the upper normal limit of ALT (P < 0.05). In the non-alcohol group, postoperative AST and ALT values increased over preoperative values, but those levels were within the normal limits of AST and ALT. CONCLUSIONS: The data suggest that when surgery can reduce hepatic blood flow, patients with a history of alcohol ingestion may have a risk of raised liver-derived enzyme in the first seven postoperative days.

A Study On Prevalence of The Elevated Transaminase(AST, ALT) and Hepatitis B, C Viral Markers in Dermatologic Patients / 대한피부과학회지

BACKGROUND: Recently, in dermatologic area, the number of skin biopsy for diagnosis and treatment has been increased and the dermatosurgery which should give patients satisfaction developed widely. As the frequency of direct contact with patients increases, we must recognize and prevent infectious diseases such as hepatitis B and C. Also, because drugs which may affect function of liver were used in many medical clinics and shops, we have more chance of evaluating liver function before the treatment. OBJECTIVE: We investigated the prevalence and associated diseases of the patients with elevated transaminase (AST,ALT), positive of hepatitis B surface antigen and anti-HCV Ab. And we tried to study the causes of elevated transaminase. METHOD: All the 1704 outpatients who visited the dermatologic clinic of Pusan National University Hospital from March 1996 to February 1999 were enrolled. AST and ALT level were assessed by kinetic method and elevated group comprised the subjects with AST and ALT levels exceeding the upper limit of normal for our laboratories (AST >40IU/L or ALT >37IU/L). HBsAg and anti-HCV Ab were tested by enzymeimmunoassay(EIA) and medical records were reviewed. RESULTS: The prevalence of elevated transaminase was 13.6% and the peak age was the sixth decade. Most common associated disease categories were drug druption, eruption & urticaria. The prevalence of positive hepatitis B surface antigen was 9.7% and the peak age was the fourth decade (42.4%). Associated diseases of antigen positive patients were lichen planus, urticaria, cryoglobulinemia, etc. The prevalence of positive anti-HCV Ab was 3.4% and the sixth decade was the peak incidence of age distribution. The diseases such as urticaria, erythema nodosum, psoriasis, alopecia, and so on were investigated in the patients. Common suspected causes of elevated transaminase(AST, ALT) were hepatotoxic drug and viral hepatitis. Conclusion: Increased hepatic parenchymal enzyme was investigated in a high percentage of studied patients. Also, the prevalence of HBV and HCV infection in dermatologic patients were relatively higher than that of reported normal Korean people. Therefore dermatologists should recognize these facts and be careful in dermatologic procedure.

The Study of Serum Aminotransferase and AST/ALT Ratio in Pediatric Patients with Acute Hepatitis

PURPOSE: Serum level of the aminotransferase is the most common test in use to assess hepatocellular injury and are sensitive test of hepatocyte necrosis, but both AST and ALT level in serum rise in a variety of hepatic disorders. Some clinical study reports that AST/ALT ratio was possible to predict prognostic outcome of infants with liver disease. We have tried to assess whether AST/ALT ratio is valuable or not for predict prognosis of hepatitis and differentiate cause of it. METHODS: Serum AST, ALT, and AST/ALT ratio were evaluated in the infants with acute hepatitis. They were grouped into 12 patients with Hepatitis B surface antigen positive only(group I), 23 patients with Hepatitis B surface antibody positive only(group II), and 12 patients with not-known cause of hepatitis(group III). The 24 patients were able to follow-up of AST and ALT for 2 months. They are grouped into 12 patients with normalized AST and ALT within 2 months(group A) and 12 patients not normalized within 2 months(group B). RESULTS: 1)There were no statistical difference of mean serum level of AST and ALT that were tested on admission day, one week and 2 week of admission respectively among the group I, II, and III. 2)The value of AST/ALT ratio were increased from 0.6 on admission day to 0.9 after 2 week of admission in group I(p<0.05), decreased from 1.1 to 0.8 in group II. It were not changed in group III. 3)The mean values of AST/ALT ratio were not statistically different in group A and B. 4)The mean values of serum alkaline phosphatase, total bilirubin, and prothrombin time were not statistically different among these groups, if we exclude two cases of cholestatic jaudice, one case of acute fulminant hepatitis, and one case of hepatitis C from these groups. CONCLUSIONS: On the basis of this study, we concluded that progression of hepatitis and damage of hepatic cell was different according to the cause of hepatitis. AST/ALT ratio of the acute phase hepatitis were not able to reflect the time duration of normalization of AST and ALT and it was not related to etiology of hepatitis. For predict prognosis of infant with acute hepatitis, long term follow up is needed in many more cases of infants with acute hepatitis.