肝功能检查异常的解释,尤其是无症状儿童,是临床医生面临的常见问题。天冬氨酸转氨酶的单独升高可能会进一步困扰医生。大天冬氨酸氨基转移酶(AST)由AST与其他血浆成分产生的复合物产生,如免疫球蛋白。据我们所知,这是首例宏观AST相关不完全川崎病(KD)病例的报告.这是为了让医生意识到这种良性状况,并帮助防止广泛的,不必要的调查和侵入性检查。
一名16个月大的男孩,有7天的发热史,被送进儿科病房接受发热检查。经过全面调查,KD由儿科风湿病学家证实。在他的入院和连续随访测试中,注意到孤立的AST升高。进行了综合测试,并使用聚乙二醇(PEG)沉淀法,宏观AST得到确认。患者已随访3年,到目前为止,这种情况的良性性质已经得到证实。
当AST升高是唯一的异常实验室发现时,临床医生应考虑检测宏观AST。虽然一个不寻常的发现,宏AST可以在儿童和成人中看到。造成这种现象的原因有很多,包括已解决的急性肝炎或在某些情况下,炎症性肠病,肝脏恶性肿瘤,单克隆gammapathy,乳糜泻,或KD;然而,在无症状的健康儿童中也可以观察到。使用PEG沉淀法,可以做出明确的诊断。在这些条件中,宏观-AST均不具有任何预后意义。对宏AST的了解可能会阻止对患者不必要地进行更多侵入性检查的需要。重要的是要认识到这种情况是良性的,并确保患者不需要特殊的治疗。
Interpretation of abnormalities in liver function tests, especially in asymptomatic children, is a common problem faced by clinicians. Isolated elevation of aspartate aminotransferase may further puzzle physicians. Macro-aspartate aminotransferase (AST) results from complexes AST produces with other plasma components, such as immunoglobulin. To our knowledge, this is the first report on a
case of macro-AST-associated incomplete Kawasaki disease (KD). It is to make physicians aware of this benign condition and help to prevent extensive, unnecessary investigations and invasive workups.
A 16-month old boy with a 7-day history of fever was admitted to our pediatric ward for pyrexia workup. After complete investigations, KD was confirmed by a pediatric rheumatologist. During his admission and serial follow-up tests, an isolated AST elevation was noted. Comprehensive tests were performed and using the polyethylene glycol (PEG) precipitation method, macro-AST was confirmed. The patient has been followed up for 3 years, and so far, the benign nature of this condition has been confirmed.
Clinicians should consider testing for macro-AST when elevated AST is the only abnormal lab finding. Although an uncommon finding, macro-AST may be seen in both children and adults. There are many reasons for this phenomenon, including resolved acute hepatitis or in some cases, inflammatory bowel disease, hepatic malignancy, monoclonal gammapathy, celiac disease, or KD; however, it may be observed in asymptomatic healthy children as well. Using the PEG precipitation method, a definitive diagnosis can be made. In none of these conditions does macro-AST have any prognostic significance. An appreciation of macro-AST may prevent the need for more invasive investigations to which patients may be unnecessarily subjected. It is important to recognize this condition as benign and assure patients that no specific treatment is required.