생화학적 간기능 검사의 임상적 적용

고문수 동국대학교 의학연구소 2009 東國醫學 Vol.15 No.2

간은 우리 몸에서 가장 큰 기관 중의 하나이며 단백 합성, 해독작용 담즙생성 및 다양한 대사기능을 하는 것으로 알려져 있다. 그러므로 한 가지 검사만으로 간기능을 평가하기에는 어려움이 있어 임상에서는 간의 기능을 다면적으로 평가 하기위해 여러 종류의 생화학적 간 기능검사를 묶음으로 사용한다. 생화학적 간기능 검사는 비침습적이면서 적은 비용으로 임상에서 쉽게 사용 가능하며 동시에, 비교적 예민하고 간질환의 감별진단이 가능한 장점이 있다. 또한 간손상의 정도를 어느 정도 반영하며 치료 전후 추적 검사에 매우 유용하다. 임상에서 쓰이는 간기능 검사에는 간손상을 반영하는 AST/ALT로 알려진 아미노전이효소, 간의 합성능을 반영하는 알부민, 대사와 배설능을 보여주는 빌리루빈을 포함한 다양한 표지자가 사용된다. 그러므로 간질환을 다루는 의사뿐만 아니라 임상의라면 각각의 간기능 점사 표지자의 생화학적및 생리학적 특성을 이해하고 분석 하는 능력은 반드시 필요하다. The liver is one of the most biggest organ in body and carries out thousands of biochemical functions in metabolism. Therefore it is difficult to evaluate liver function using single test. The liver function test used as a battery for multi-disciplinary evaluation of liver function. Biochemical liver function test that is not invasive and inexpensive can be used to detect the presence of liver disease, distinguish among different type of liver disease, estimated liver damage extent and follow up after treatment. Biochemical liver function test consist with various markers such as transaminase that was reflect liver demage as known alanine transaminase(ALT)/aspartate transaminase (AST), albumin that related synthetic function and bilirubin that excretory and metabolic function. Not only if doctor who care liver disease, clinician should have ability to evaluate and understand to biochemical and biological feature of liver function test.

20대 남성 간기능 이상자의 임상적 특징

김혜정 圓光大學校 醫科學硏究所 1999 圓光醫科學 Vol.15 No.1

Background: Abnormal liver function is commonly seen in medical practice. In the past, hepatitis B was considered to be the primary cause of abnormal liver function in Korea. It is considered that, due to wide spread immunization, improved hygiene and changes in diet, hepatitis B has decreased while fatty livers have become the primary cause of abnormal liver function. This study was designed to evaluate the change in the distribution of causes of abnormal liver function. Methods: The subjects of this study were 168 males in their twenties who were diagnosed with abnormal liver function during a routine health examination. The study covers the period of January 1994 to February 1996. All subjects were given a liver function test using aspartate aminotransferase, alanine aminotransferase, hepatitis B serologic markers(HBs Ag and Anti-HBs) and abdominal sonograms. Results: Among the 168 subjects, 89(52.9%) were overweight and obesity, and 45(26.8%) has history of drinking alcohol and 20(11.9%) were HBsAg positive. The causes of abnormal liver function were: obesity 56(33.3%), alcohol 45(26.8%), hepatitis B 20(9.6%), medicine 16(9.5%), exercise 9(5.4%), presumption to HCV infection 9(5.4%). The rate of abnormal ultrasonogrphy finding was 36.3%(61) and among them, fatty liver was the most common finding in 55 subjects(90.2%). The causes of fatty liver were obesity 39(70.9%), unknown 10(18.2%), alcohol 15(27.3%), and medicine 4(7.3%). Conclusions: In the males in their twenties, overweight and obesity was found as the major cause of abnormal liver function. On the other hand, fatty liver caused primarily by obesity was major cause of abnormal ultrasonographic findings.. It is proposed that one take special care in preventing obesity and fatty liver, especially nonalcoholic steatohepatitis, since these are expected to keep increasing in the future.

여성에서 경도 간기능 이상과 비만과의 관련성

손혜숙 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.3

Objective : This study investigated any correlation between obesity and mild abnormality of liver function. This investigation would support the necessity of the early management of obese people through detection of liver abnormality from a regular health check. Methods and Materials : This study included a total of 748 female subjects age 20 to 70 years who have less than two times the standard liver function level. Measurements on Body Mass Index. Alcohol, HbsAg, HbsAb, High density lipoprotein (HDL), Triglyceride(TG), Total cholesterol(TC) in relation to the liver function-Aspartate Aminotransferase(AST), Alanine Aminotransferase(ALT), and -Glutamyl Transferase-were evaluated for both normal liver function group and mild abnormal liver function group(higher than the standard level but lower than two times the standard level). Results : Using the logistic regression analysis, the odds ratio to the mild abnormality of liver function was that ALT with HbsAg was 5.9 fold, BMI level higher than 25㎏/㎡ was 2.17, TC level higher than 200㎎/dL was 2.14, and ALT with BMI higher than 25㎏/㎡ was 3.59. GTP with TC and TG higher than 200㎎/dL were 3.76 and 3.04 respectively. Conclusion : It is found that there is a positive correlation between obesity and mild abnormality of liver function in female population. When mild abnormality of liver function is detected in female population, obesity and fat level in blood should be closely observed to prevent and to manage liver disease in female population.

Assessment of Liver Function Parameters in Thyroid Dysfunction Patient Attending Tertiary Care Hospital

( Sumitra Ghimire ),( Shreena Shakya ),( Deepa Satyal ),( Anjeela Vetwal ),( Anjila Maharjan ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: A high number of world’s population is affected from thyroid dysfunction. Thyroidism, a highly overriding endocrine disorder, is also encountered in iodine deficient country Nepal with a prevalence rate of 17.42 % in western part of Nepal and 30 % in eastern part of Nepal alone and is presumed to be inclining at high rate. Fluctuation of thyroid hormone level following thyroid dysfunction may cause alteration of liver enzymes thereby, modulating the liver function. Primary assessment of liver function in thyroid disorder patient helps in timely diagnosis, prevention, proper management and cure of possible liver damage. Although, thyroid disorder is prevailing at high rate, limited studies regarding the associated liver disease necessitates the present study. Hence, the present study was commenced to assess the liver function test in thyroid patient. Methods: A total of 105 subjects (35 hyperthyroid, 35 hypothyroid and 35 euthyroid) aged from 20 to 70 years were studied in the Department of Biochemistry, Manmohan Memorial Teaching Hospital. Thyroid hormone profile including Free T3 (FT3), Free T4 (FT4), Thyroid Stimulating Hormone (TSH), and liver function profile covering Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT), Alkaline Phosphatase (ALP), Total Protein (TP) and albumin were estimated in the serum of participants using standard protocol. Data were analyzed using SPSS version 20 and Microsoft Excel 2013. Student’s t-test was used to analyze differences in liver parameter of case and control. P-value <0.05 was considered statistically significant. Results: AST and ALT level were increased in 24 (68.5%) and 15 (42.8%) hyperthyroid subjects respectively. Similarly AST and ALT level were increased in 17 (48.5%) and 10 (28.5%) hypothyroid subjects respectively. Level of AST and ALT both increased significantly in hyperthyroid subjects whereas only AST level increased significantly (P-value <0.05) in hypothyroid subjects. Total protein and albumin were found to be decreased significantly (P-value <0.05) in both the study subjects as compared to euthyroid group. Increase in level of ALP was not significant in both the subjects. Conclusions: Potentially adverse changes in liver function parameter such as increase in enzyme activity and decrease in protein and albumin in subjects with thyroid disorder suggest the possible liver injury in near future. Hence, it is essential to screen liver function in every thyroid disorder patients.

Original Articles : Thrombocytopenia represents a risk for deterioration of Liver function after radiofrequency ablation in patients with hepatocellular carcinoma

( Hyun Seok Lee ),( Soo Young Park ),( Sung Kook Kim ),( Young Oh Kweon ),( Won Young Tak ),( Chang Min Cho ),( Seong Woo Jeon ),( Min Kyu Jung ),( Hyun Gu Park ),( Dong Wook Lee ),( So Young Choi ) 대한간학회 2012 Clinical and Molecular Hepatology(대한간학회지) Vol.18 No.3

Background/Aims: We evaluated changes in liver function parameters and risk factors for the deterioration of liver function 12 months after percutaneous radiofrequency ablation (RFA) therapy in patients with hepatocellular carcinoma (HCC). Methods: The subjects in this retrospective study comprised 102 patients with HCC who had undergone RFA therapy and exhibited no recurrence of HCC 12 months thereafter. Serial changes in serum total bilirubin and albumin, prothrombin time, and Child-Pugh score were evaluated before RFA and 3, 6, 9, and 12 months thereafter. Deterioration of liver function was defined when the Child-Pugh score increased by at least 2 at 12 months after RFA therapy. We determined the factors related to aggravation of liver function after RFA therapy. Results: Liver function had deteriorated 12 months after RFA in 29 patients (28.4%). Serum albumin levels decreased significantly from before (3.7±0.1 g/dL, mean±SD) to 12 months after RFA therapy (3.3±0.1 g/dL, P=0.002). The Child-Pugh score increased significantly during the same time period (from 6.1±0.2 to 7.2±0.3, P<0.001). Pre-RFA thrombocytopenia (≤100,000/mm3) was revealed as a significant risk factor for the deterioration of liver function after RFA. However, no patients had episodes of bleeding as a complication of RFA. Conclusions: Among the liver-function parameters, serum albumin level was markedly decreased in HCC patients over the course of 24 months after RFA therapy. A pre-RFA thrombocytopenia represents a major risk factor for the deterioration of liver function. (Clin Mol Hepatol 2012;18:302-308)

기능성 소화불량 환자의 간 기능에 대한 한약 투여의 안전성: 단일 센터 후향적 연구

한아람,금창열,윤채림,최수현,정다희,정나현,정해인,하나연,김진성 대한한방내과학회 2023 大韓韓方內科學會誌 Vol.44 No.4

Objectives: This study analyzed laboratory serum data results before and after patients took herbal medicine to confirm the clinical safety of herbal medicine. In addition, in the event of liver damage, the case was analyzed to confirm the characteristics of liver damage and the possibility of liver damage caused by herbal medicine. Methods: A retrospective chart review of the effects of herbal medicine on liver function in patients diagnosed with functional dyspepsia was conducted. The electronic medical records of 128 patients in a single hospital were reviewed. Results: The statistical analysis revealed a statistically significant decrease in liver function-related laboratory serum data after taking herbal medicine (p<0.05). In addition, among 128 patients, there were two cases of drug-induced liver injury (DILI) (1.56%). Conclusion: Taking herbal medicine prescribed by experts does not significantly affect liver function in patients with functional dyspepsia. Rather, the liver levels of the subjects showed a significant decrease after taking herbal medicine. To support these results, further large-scale multicenter prospective studies are necessary.

Distribution of Diseases Causing Liver Function Test Abnormality in Children and Natural Recovery Time of the Abnormal Liver Function

장미리내,오민수,오세철,강기수 대한의학회 2016 Journal of Korean medical science Vol.31 No.11

Although liver function test abnormality is frequently noted in children, there is no report about the distribution of the etiology and natural recovery time of the abnormal liver function. From March 2005 to February 2014, clinical information was retrospectively collected from 559 children who had abnormal liver function and were hospitalized or visited the outpatient clinic at the Jeju National University Hospital. The etiology of abnormal liver function was classified into groups and the natural recovery time of abnormal liver function was analyzed. The etiological groups of 559 patients included ‘nonspecific hepatitis’ in 42 (7.5%), ‘infection’ in 323 (57.8%), ‘rheumatologic and autoimmune’ in 66 (11.8%), ‘nonalcoholic fatty liver disease’ in 57 (10.2%), ‘anatomic’ in 12 (2.1%), ‘toxic’ in 13 (2.1%), ‘metabolic’ in 8 (1.4%), ‘hematologic’ in 7 (1.3%), ‘hemodynamic’ in 4 (0.7%), and ‘others’ in 27 (4.8%). Among the ‘infection’ group (57.8%), the ‘viral infection in the respiratory tract’ subgroup, which had 111 patients (19.8%), was the most common. The natural recovery time of the abnormal liver function was 27 days (median) in ‘nonspecific hepatitis’, 13 days (median) in ‘viral respiratory tract disease’, 16 days (median) in ‘viral gastroenteritis’, 42 days (median) in ‘viral febrile illness”, and 7 days (median) in “Kawasaki disease”. The information on the natural recovery time of abnormal liver function may help the physician to perform good clinical consultation for patients and their parents.

Atorvastatin이 주요 원인으로 추정되는 간 기능 장애에 대한 생간건비탕 가미방 치험 1례

권정연,김영지,박장경,공경환,고호연,Kwon, Jung-yeon,Kim, Young-ji,Park, Jang-kyung,Kong, Kyung-hwan,Go, Ho-yeon 대한한방내과학회 2017 大韓韓方內科學會誌 Vol.38 No.5

Objective: A general prejudice exists that all herbal medicines are not good for liver. We report that herbal medicine can have positive effects on the liver, based on the improved liver function test levels observed in one patient. We also suggest the effectiveness of co-administration of herbal and western medicines. Methods: We checked the liver function test levels of one patient measured on 12 July at another hospital. We identified worse levels on 7 August, when he was first admitted to Semyung University Hospital. We measured liver function test levels of the same patient after treatment with Korean herbal medicine on 14 and 21 August during hospitalization at Semyung Hospital. We compared the figures and evaluated the effectiveness of 'Saenggangeonbi-tang' herbal medicine in the liver. Results: The patient's liver function test levels were normal on 12 July, but had become abnormal by 7 August, when he was admitted to Semyung Hospital. The cause of liver dysfunction was suggested as Atorvastatin, one of the western drugs he had started to take. Continuous treatment with Korean herbal medicine resulted in a definite improvement in liver function. Conclusion: Korean herbal medicine can provide positive improvements in liver function test levels.

부산지역 근로자들에서 Alcohol Use Disorders Identification Test (AUDIT)와 간기능 검사와의 연관성 조사

손진군,송혜란,이광영,김진하,김호찬 大韓産業醫學會 2003 대한직업환경의학회지 Vol.15 No.3

목적: 세계보건기구에서 알코올의존 이전 단계인 위험 및 유해음주를 조기에 선별하기 위해 개발한 AUDIT와 근오자 정기 건강 진단시 간기능 수치를 조사하여 집단검진에서 AUDIT의 유용ㅇ성과 AUDIT점수와 간기능 이상과의 연관성을 확인 하고자 하였다. 방법: 생산직 근로자 440명을 대상으로 AUDIT설문을 시행하고 이들의 간기능 수치를 측정하여 세계보건기구 기준에 따른 정상, 우험음주와 김종성등(1999)의 기준에 따른 정상, 위험, 유해음주 사이의 간기능의 차이를 비교하고 비정상 간기능에 영향을 미치는 요인들을 비교 하였다. 결과: 체질량지수가 정상인 군에서 세계보건기구 기준에 의한 정상, 위험음주의 비정상 간기능에 대한 단순분석시 교차비는 위험음주가 2.81로 통계적으로 유의하게 높았고, 김종성 등(1999)의 기준에 의한 정상, 위험, 유해음주간의 비정상 간기능에 대한 chi-square test for linear trend 분석시 교차비는 위험, 유해음주에서 각각 1.23, 2.14로 통계적으로 유의하게 높았다. 비정상 간기능에 영향을 미치는 요인들을 다중 로지스틱 희귀분석을 구한 교차비는 AUDIT문항 No. 1-3(고위험군- 2.39), 연령(30대-1.95, 40대-2.40, 50대-3.85), 체질량지수(과체중-1.66, 비만-4.53), 세계보건기구 기준(위험음주-2.10), 김종성 등 기준(유해음주-2.20) 모두에서 통계적으로 유의하였다. 결론: AUDIT를 이용한 음주문제의 선별기준은 간기능 장애와 유의한 연관을 보여 향후 집단 검진시 음주로 인한 간기능 장애의 예측검사와 위험 및 유해음주의 선별검사로 AUDIT활용이 가능 할 것으로 생각된다. Objects: The purpose of this study was to investigate the usefulness of the Alcohol Use Disorders Identification Test (AUDIT) and the relationship between AUDIT score and liver function test. Methods: AUDIT questionnaires were distributed to 440 blue-collar workers. We compared liver function test with firstly, normal and hazardous drinking as measured by Kim et al.(1999). We also compared influencing factors on abnormal liver function. Results: By simple analsis in the normal BMI group, abnormal liver function was significantly affected by hazardous drinking (odds ratio 2.81) based on the guideline of WHO. By chisquare test for linear trend in the normal BMI froup, abnormal liver function was significantly affected by hazhrdous drinking (odds ratio 1.23) and harmful drinking (odds ratio 2.14) based on the guideline of Kim et al. By multiple logistic regression analysis, abnormal liver function was significantly affected by AUDIT questionnaires No. 1-3 (odds ratio risk 2.39), age (odds ratio-thirties 1.95, forties 2.40, fifties 3.85), BMI (odds ratio- overweight 1.66, obesity 4.53), guideline by WHO (odds ratio- hazardous drinking 2.10), and guideline by Kim et al (odds ratio-harmful drinking 2.20) Conclusions: We found that the problem of alcohol drinking as meadured by AUDIT was significantly associated with abnormal liver function. Therefore we suggest that AUDIT will be useful for the predictive test of abnormal liver function and screening test of hazardous and harmful drinking.

Correlation between Sarcopenia and Liver Function or Fibrosis in Alcoholic Liver Cirrhosis

( Myung Jin Oh ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: Sarcopenia is characterized by the loss of skeletal muscle mass, and is reported to be associated with impaired prognosis in patients with liver cirrhosis. To date, several indicators for prognostication in liver cirrhosis were investigated. Generally, Child-Pugh score, MELD score, and MELD-sodium score for liver function and AST to platelet ratio index (APRI) score, and fibrosis-4 (FIB-4) index for hepatic fibrosis were included in the indicators. Studies for association between these indicators and sarcopenia were seldom. In alcoholics, sarcopenia is more problematic due to serious lack of the intake of nutrients. The aim of this study was to analyze the correlation between sarcopenia and residual liver function or hepatic fibrosis in alcoholic liver cirrhosis. Methods: A total of 39 cirrhotic patients who had consumed alcohol over 60 g/day in men or 40 g/day in women and underwent abdominal CT scan from Jan. 2014 to Dec. 2015 were enrolled. As parameters of sarcopenia, ratio of psoas muscle thickness at umbilicus level and height [PMTH (mm/m)] was measured, and ratio of area of psoas muscle at the same level and the square of height as psoas index [PI (㎟/㎡)] was investigated through review of CT scans. Child-Pugh score, MELD score, serum sodium level, and MELD-Na score were evaluated as indicators of residual liver function. APRI score and FIB-4 index as non-invasive biomarkers for hepatic fibrosis were measured. Parameters of sarcopenia and indicators of liver function or fibrosis were analyzed retrospectively. To investigate the correlation, Pearson’s correlation analysis and simple linear regression analysis were used. Results: Of enrolled patients, male was predominant (89.7%), and mean age was 60.7 years. 26 patients had ascites (66.7%), and hepatic decompensation was observed in 16 patients (41.0%). PMTH and PI were measured as 18.1 ± 4.1 mm/m, and 464.0 ± 132.5 ㎟/㎡ on average. Mean Child-Pugh score, MELD score, serum Na level, and MELD-Na score were 6.4 points, 7.2 points, 138.3 mEq/mL, and 11.9 points, respectively. Average of APRI score and FIB-4 index were 3.1 ± 5.9 points and 9.72 ± 12.35 points. Child-Pugh score significantly showed inverse correlation with PMTH and PI (p=0.007 and p=0.001, respectively). On simple linear regression analysis, PMTH and PI presented significant correlation with Child-Pugh score (p=0.011 and p=0.001, respectively). Conclusions: This study showed that sarcopenia in alcoholic cirrhosis might be inversely correlated with Child-Pugh score as an indicator of liver function.