易婷婷，罗光成，胡帅，刘素兰，张国元，蒋兴亮

(川北医学院附属医院检验科，四川 南充　637000)



血浆谷氨酸脱氢酶活性测定在肝胆疾病中的临床应用评价

易婷婷，罗光成，胡帅，刘素兰，张国元，蒋兴亮

(川北医学院附属医院检验科，四川 南充637000)

目的：探讨血浆谷氨酸脱氢酶(glutamate dehydrogenase，GLDH)活性测定在肝脏疾病中的临床意义。方法：采用速率法检测229例肝功能异常者(急性肝损伤25例；慢性乙型肝炎60例；肝硬化47例；肝衰竭31例；胆道梗阻性疾病29例；肝癌37例)及 120 例健康体检者(作为对照组)的血浆GLDH活性，并与 AST、ALT、ALT、GGT等常用肝胆疾病指标进行比较分析。结果：本室采用速率法测定GLDH活性的参考区间为4.4～13.3 U/L。胆道梗阻性疾病和肝癌患者血浆GLDH较对照组明显升高(P<0.05)，胆道梗阻性疾病患者的GLDH/AST比值也明显高于对照组(P<0.05)。血浆GLDH浓度与AST浓度呈显著的正相关(r=0.230，P<0.001)。血浆GLDH浓度与肝损伤程度相关，随病情好转而降低。结论：胆道梗阻性疾病和肝癌患者血浆GLDH升高最为明显，GLDH可作为判断肝细胞损伤程度和疗效观察的指标。

谷氨酸脱氢酶；肝损伤；天门冬氨酸氨基转移酶

【Abstract】Objective：To investigate the clinical significance of glutamate dehydrogenase (GLDH)in patients with liver disease.Methods：A total of 229 patients with liver disease (25 patients with acute hepatitis,60 CHB patients,47 patients with liver cirrhosis,31 patients with liver failure,29 patients with biliary obstruction,37 patients with liver carcinoma)and 120 healthy subjects were enrolled.The liver enzymes of GLDH,AST,ALT,ALT and GGT were determined.Results：The activity of GLDH in liver diseases,especially in patients with biliary obstruction and liver carcinoma,were significantly higher than that in healthy controls (P<0.05).The ratio of GLDH to AST in patients with biliary obstruction was significantly higher than that in healthy controls (P<0.05).The activities of GLDH closely related to the severity of liver damage and correlated with AST (r=0.230,P<0.001).Conclusion：The activity of GLDH was significantly increased in patients with biliary obstruction and liver carcinoma,and may be a biochemical marker for diagnosing and evaluating the liver injury.

谷氨酸脱氢酶(glutamate dehydrogenase，GLDH)是一种含锌的线粒体酶，广泛存在于肝脏、肾脏、脑及胰腺等多种组织细胞中，以肝脏的含量最高[1]。GLDH亚细胞定位于线粒体中，所以是一种反映肝实质细胞坏死的指标。GLDH与谷氨酸代谢和能量代谢有关，故在一些肿瘤患者中也表达异常[2-5]。而近年来采用连续监测法的GLDH检测试剂盒在临床上已广泛应用。本室也即将开展GLDH测定，作为一个重要的肝损伤指标，评价其临床应用价值显得尤为重要。

1　材料和方法

1.1研究对象

选取川北医学院附属医院2015年3至2015年6月的229例肝功能异常患者，患者入组参考《药物性肝损伤诊治指南》[6]，以ALT≥3 ULN作为肝功能异常的入组标准。研究对象包括男性139例，女性90例，年龄 16～61岁，其中急性肝损伤25例，慢性乙型肝炎60例，慢性乙型肝炎肝硬化47例，肝衰竭31例，胆道梗阻性疾病(结石和占位)29例，肝癌(原发性和转移性)37例。……