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肝生化和肝功能试验异常患者的评估

Author
Lawrence S Friedman, MD
Section Editor
Sanjiv Chopra, MD, MACP
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF
Translators
董军乐, 住院医师

引言

异常肝生化和肝功能试验常在无症状患者中被发现，因为许多血液筛查试验常规包括这些项目[1]。一项在1999-2002年在美国进行的人群调查估计8.9%的调查对象存在丙氨酸氨基转移酶(alanine aminotransferase, ALT)异常。尽管“肝功能试验”(liver function test, LFT)这一术语被广泛应用，但它并不精确，因为许多反应肝脏健康状况的检查并不是对肝功能的直接检测。此外，常用的肝生化试验即使在肝脏健康的患者中也可能出现异常。但是为了简洁，缩写词“LFTs”将在这篇专题中概括地用来表示肝生化和肝功能试验。

本专题将肝生化和肝功能试验异常患者的评估总结在此。单项试验将单独详细讨论。 (参见“检测肝细胞损伤的肝脏生化检查”和“胆汁淤积酶的测定(如碱性磷酸酶、5’-核苷酸酶、γ-谷氨酰转肽酶)”和“黄疸或无症状高胆红素血症的分类与病因”和“肝脏生物合成能力(如白蛋白、凝血因子和凝血酶原时间)的检查”)

常用肝生化和肝功能试验

常用于评估肝脏健康状况的血液检查包括肝酶水平、肝合成功能试验和血清胆红素水平。肝酶升高常反映肝损伤或胆道梗阻，而血清白蛋白或凝血酶原时间(prothrombin time, PT)异常可在肝合成功能受损的情况下出现。血清胆红素从某种程度上可检测肝对代谢物质的解毒能力和转运有机阴离子到胆汁的能力。

肝酶 — 在血清中检测的肝酶包括：

  • 血清氨基转移酶：丙氨酸氨基转移酶(alanine aminotransferase, ALT，旧称SGPT)和天冬氨酸氨基转移酶(aspartate aminotransferase, AST，旧称SGOT)。
  • 碱性磷酸酶
  • γ-谷氨酰转肽酶(Gamma-glutamyl transpeptidase, GGT)
  • 5'-核苷酸酶

                                     

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Literature review current through: 2017-06 . | This topic last updated: 2017-01-30.
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