Updated definitions of healthy ranges for serum alanine aminotransferase levels
Updated definitions of healthy ranges for serum alanine aminotransferase levels
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DOI：
10.7326/0003-4819-137-1-200207020-00006
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发表时间：
2002-07-02
影响因子：
39.2
通讯作者：
Sirchia, G
中科院分区：
文献类型：
--
作者：
Prati, D;Taioli, E;Sirchia, G
背景资料：血清丙氨酸氨基转移酶（ALT）活性是评估肝脏疾病最常用的指标，但无法识别许多肝损伤患者。当前“正常”ALT水平的标准是通过使用包括亚临床肝病患者的人群来定义的。目的：更新血清ALT水平健康范围的定义。设计：回顾性队列研究。设置：意大利米兰的一所大学医院。参与者：1995年至1999年首次献血的6835人，抗丙型肝炎病毒（HCV）阴性，1990年至1999年期间，有209人试图献血，但发现有抗-HCV抗体。后一组中，131人有HCV病毒血症。测量：单变量和多变量分析研究临床和实验室因素和ALT水平之间的关联。从肝病风险最低的人群中计算ALT的健康范围。健康的ALT范围的灵敏度和特异性进行了评估，在与HCV抗体的捐助者，其中133肝biopsiz.Results：血清ALT活性是独立相关的体重指数和实验室指标异常的脂质或碳水化合物代谢。更新上限（男性为500 nkat/L [30 U/L];女性为317 nkat/L [19 U/L]）（男性：667 nkat/L [40 U/L];女性为500 nkat/L [30 U/L]），在6个月的随访中，在识别HCV病毒血症参与者方面显示出优越的上级灵敏度（灵敏度，76.3% [95% CI，69.1%至83.6%] vs. 55% [CI，46.4%至63.5%]）。特异性的相关权衡是可接受的（88.5% [CI，79.2%至94.6%] vs. 97.4% [91%至99.7%]）。增加的敏感性针对患者的最小到轻度的组织学lesions.Conclusion：在慢性HCV感染或非酒精性脂肪肝疾病的患者，修改ALT水平的正常范围是可取的。
Background: Serum alanine aminotransferase (ALT) activity, the variable most commonly measured to assess hepatic disease, fails to identify many patients with hepatic injury. Current standards for "normal" ALT level were defined by using populations that included persons with subclinical liver disease.Objective: To update definitions of healthy ranges for serum ALT level.Design: Retrospective cohort study.Setting: A university hospital in Milan, Italy.Participants: 6835 persons who were first-time blood donors from 1995 through 1999, were negative for anti-hepatitis C virus (HCV), and had no contraindications to donation and 209 persons who attempted to donate blood from 1990 through 1999 but were found to have anti-HCV antibodies. Of the latter group, 131 had HCV viremia.Measurements: Univariate and multivariate analyses examined associations between clinical and laboratory factors and ALT levels. Healthy ranges for ALT were computed from the population at lowest risk for liver disease. Sensitivity and specificity of healthy ALT ranges were evaluated in the donors with HCV antibodies, of whom 133 had liver biopsy.Results: Serum ALT activity was independently related to body mass index and to laboratory indicators of abnormal lipid or carbohydrate metabolism. Updated upper limits (for men, 500 nkat/L [30 U/L]; for women, 317 nkat/L [19 U/L]) were lower than current limits (for men, 667 nkat/L [40 U/L]; for women, 500 nkat/L [30 U/L]) and, during 6-month follow-up, showed superior sensitivity in identifying participants with HCV viremia (sensitivity, 76.3% [95 % Cl, 69.1% to 83.6%] vs. 55% [Cl, 46.4% to 63.5%]). The related tradeoff in specificity was acceptable (88.5% [Cl, 79.2% to 94.6%] vs. 97.4% [91% to 99.7%]). The increased sensitivity targeted patients with minimal to mild histologic lesions.Conclusion: In patients with chronic HCV infection or nonalcoholic fatty liver disease, revision of normal limits for ALT level is advisable.