Upper limits of normal for serum alanine aminotransferase levels in chinese han population

    本研究团队对我院体检人群进行长期调研，收集53037例成年人相关资料进行分析，严格入选标准，对确定或疑似或可能存在肝病基础的人群进行剔除，筛选出13637例目前观点认为是正常的人群。温州医学院附属第一医院感染内科郑明华

    通过严密统计学分析，结果发现：目前各大单位在使用的谷丙转氨酶的正常高限值定的过高（40-60 IU/L）。

    我们认为，对不同性别（男女），谷丙转氨酶的正常高限值也应该存在差异，我们的结果支持该假想（男：35 IU/L，而女性则应该更低，为23 IU/L）。

    该研究为亚太地区第一次对亚洲人群，尤其是中国汉族人群的系统研究，同时与国际上的专家推荐一致。为制定临床指南提供了有力依据。

 

PLoS One. 2012;7(9):e43736. Epub 2012 Sep 4.
Upper limits of normal for serum alanine aminotransferase levels in chinese han population.
Zheng MH, Shi KQ, Fan YC, Liu WY, Lin XF, Li LF, Chen YP.
Source
Department of Infection and Liver Diseases, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China.

Abstract
BACKGROUND AND OBJECTIVES:
Serum alanine aminotransferase (ALT) activity is the most common tool for the assessment of liver diseases. However, it is not clear whether the current normal ALT range really discriminate patients with or without liver diseases. The present study was to establish a new normal range of ALT and examine its ability to identify patients with hepatitis B or nonalcoholic fatty liver disease (NAFLD) in Chinese Han population.

METHODS:
53037 adults were included in this study from January 1st 2008 to August 31st 2010. The 95th percentile of ALT in population with relative low risk factors for liver diseases was set as the new upper limits of normal ALT in gender-specific manner.

RESULTS:
The 95(th) percentile levels at low risk factors for liver diseases were achieved at 35 U/L for men and 23 U/L for women. The concordance statistics for detection were 0.873 (95%CI: 0.865-0.881) for HBV and 0.932 (95%CI: 0.927-0.937) for NAFLD in men while 0.857 (95%CI: 0.850-0.864) for HBV and 0.909 (95%CI: 0.903-0.915) for NAFLD in women. The median sensitivity of the current used ALT upper limit (40 U/L) was 6.6% for HBV and 29.7% for NAFLD and median specificity was 98.7% for men and 99.4% for women. Using our new-derived thresholds, the sensitivities ranged from 35.3% to 61.1% and the specificities were 94.8% for men and 94.6% for women.

CONCLUSIONS:
Our results suggest that upper limits of ALT 35 U/L for men and 23 U/L for women in Chinese Han population. Re-consideration of normal limits of ALT should be recommended.

TRIAL REGISTRATION:
ChiCTR.org ChiCTR-OCS-11001173.