ระดับเอนไซม์ aspartate and alanine aminotransferase และการติดเชื้อไวรัสตับอักเสบชนิดบี ในผู้ป่วยไตวายระยะสุดท้ายที่ได้รับการฟอกเลือดที่โรงพยาบาลราชบุรี

บทคัดย่อ

Objective : To evaluate host factor and virologic factor on serum aspartate aminotransferase (AST) and alanine aminotransferase among ESRD patients on maintenance hemodialysis compared to healthy control subjects

Design : A cross-sectional study were done on 69 chronic hemodialysis patients and 93 healthy controlled subjects.

Material and method : Blood samples was collected for AST, ALT, HBsAg and antiHBsAb. In blood samples that HBsAg showed positive result will send to determine HBeAg and antiHBeAb.

Results : ESRD hemodialysis patients had serum aminotransferase activity significantly lower than healthy control group ; AST 19.87 ± 13.24 IU/L vs. 28.09 ± 26.63 IU/L (p = 0.001) and ALT 28.88 ± 17.44lU/L vs. 50.27 ± 34.11 IU/L (p = 0.000). In the subset of ESRD hemodialysis patients, we had nine patients who were HBsAg positive and two patients who had both HBsAg and HBeAg positive. HBsAg positive hemodialysis group had mean AST and ALT higher than HBsAg negative hemodialysis group ; AST 26.22 ± 12.39lU/L vs. 18.92 ± 13.20 IU/L and ALT 36.89 z 22.58 lU/L vs. 27.68 ± 16.44 IU/L respectively. HBsAg positive and HBeAg positive hemodialysis group had mean AST and ALT higher than HBsAg positive and HBeAg negative hemodialysis group ; AST 34 ± 31.11IU/L vs 24 ± 4.1 6lU/L and ALT 60 : 42.43 IU/L vs. 30.29 ± 12.28 IU/L.

conclusion : ESRD patients that on maintenance hemodialysis have decreased aminotransferase activity compared with the general population. AST and ALT levels in ESRD patients were highest in HBsAg positive and HBeAg positive group. Because serum aminotransferase levels are commonly used to screen for liver disease in the dialysis population, recognition of liver damage may be hampered by the reduction in aminotransferase values in these patients.