HYPOAMINOTRANSFERASEMIA IN PATIENTS UNDERGOING LONG-TERM HEMODIALYSIS - CLINICAL AND BIOCHEMICAL APPRAISAL
HYPOAMINOTRANSFERASEMIA IN PATIENTS UNDERGOING LONG-TERM HEMODIALYSIS - CLINICAL AND BIOCHEMICAL APPRAISAL
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DOI：
10.1016/0016-5085(95)90591-x
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发表时间：
1995-10-01
期刊：
影响因子：
29.4
通讯作者：
IRIE, Y
中科院分区：
文献类型：
--
作者：
YASUDA, K;OKUDA, K;IRIE, Y
背景和目标：据报道，慢性肾衰竭患者由于维生素B-6缺乏而具有低血清天冬氨酸氨基转移酶（AST）和丙氨酸氨基转移酶（ALT）水平。慢性丙型肝炎在接受血液透析的患者中很常见，低转氨酶水平会导致诊断问题。本研究的目的是确定低氨基转移酶血症的原因。研究方法：采用高效液相色谱法对长期血液透析患者血清中维生素B-6及其辅酶水平与AST和ALT水平的关系进行了重新评估。结果如下：304例B型肝炎表面抗原和抗丙型肝炎病毒阴性患者的平均（+/- SD）血清AST和ALT水平分别为9.2 +/- 2.4和7.4 +/- 1.7 IU/L。在556名正常成人中，分别为22.7 ± 5.4和18.0 ± 4.0 IU/L（P < 0.001）。与对照组相比，接受透析的患者的平均血清维生素B-6和吡哆醛-5 '-磷酸盐水平没有降低，尽管偶尔患者的水平较低。日本的AST和ALT检测试剂不含添加的吡哆醛-5 '-磷酸盐;向试剂中添加吡哆醛-5'-磷酸盐（0.1 mmol/L）显著增加了两组的测量值，但增加程度相似。结论：血液透析患者血清AST和ALT水平很低，但不是维生素B-6缺乏的结果。在接受透析的患者中，AST和ALT水平的正常上限应大大降低，在诊断肝病时应谨慎解释这些水平。
Background & Aims: It has been reported that patients with chronic renal failure have low serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels as a result of vitamin B-6 deficiency. Chronic hepatitis C is common among patients undergoing hemodialysis, and low aminotransferase levels cause diagnostic problems. The aim of this study was to determine the cause of hypoaminotransferasemia. Methods: Serum levels of vitamin B-6 and its coenzyme weve reassessed in relation to AST and ALT levels in patients undergoing long-term hemodialysis using high-performance liquid chromatography. Results: The mean (+/- SD) serum AST and ALT levels in 304 patients negative for hepatitis B surface antigen and anti-hepatitis C virus were 9.2 +/- 2.4 and 7.4 +/- 1.7 IU/L, respectively. In 556 normal adults, they were 22.7 +/- 5.4 and 18.0 +/- 4.0 IU/L, respectively (P < 0.001). Mean serum vitamin B-6 and pyridoxal-5'-phosphate levels in patients undergoing dialysis were not reduced compared with the control, although occasionally patients had low levels. The AST and ALT assay reagents in Japan do not contain added pyridoxal-5'-phosphate; addition of pyridoxal-5'-phosphate (0.1 mmol/L) to the reagent significantly increased measurements to similar extents in both groups. Conclusions: Serum AST and ALT levels in patients undergoing dialysis are very low, but they ave not a result of vitamin B-6 deficiency. The upper normal limits of AST and ALT levels in patients undergoing dialysis should be reduced considerably, and these levels should be interpreted with caution in the diagnosis of liver disease.