Am J Gastroenterol. 2018 Oct 23. doi: 10.1038/s41395-018-0248-8. [Epub ahead of print]
An Assessment of Upper Limits of Normal for ALT and the Impact on Evaluating Natural Course of Chronic Hepatitis B Virus Infection in Chinese Children.
Pan XB1,2, Lu YQ3, Lin SZ4, Ye J5, Wu N3, Lou YY6, Ni L6, Han JC3, Zheng XQ7, Wei L3.
Author information
1
Hangzhou Key Laboratory of Inflammation and Immunoregulation, Department of Basic Medical Science, School of Medicine, Hangzhou Normal University, Hangzhou, Zhejiang, China. [email protected].
2
Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Peking University People's Hospital, Peking University Hepatology Institute, Beijing, China. [email protected].
3
Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Peking University People's Hospital, Peking University Hepatology Institute, Beijing, China.
4
Department of Hepato-Biliary-Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
5
Department of Surgery Intensive Care Unit, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
6
Department of Clinical Laboratory, The Yuying Children's Hospital of Wenzhou Medical University and The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
7
Department of Clinical Laboratory, The Yuying Children's Hospital of Wenzhou Medical University and The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China. [email protected].
Abstract
BACKGROUND:
The current upper limits of normal (ULN) for serum alanine aminotransferase (ALT) are increasingly challenged. We aimed to re-evaluate the ULN for ALT and assess the potential impact on the classification of natural course of chronic hepatitis B virus (HBV) infection in children.
METHODS:
Laboratory data obtained from three hospitals in China were retrospectively analysed. In total, 2054 children with chronic HBV infection and 8149 healthy children at age ≤18 years were included in the study.
RESULTS:
Age-specific and gender-specific ULNs for ALT, at averages of 30 U/L for boys and 24 U/L for girls, were calculated from the data of healthy children. Using the revised ULNs vs. the current ULNs (40-50 U/L), 31-60% vs. 9-17% of the 2054 HBV-infected children had an abnormal result as seen in their ALT baseline analysis, and the highest abnormality rate was seen in the infants. Data of 516 HBV-infected children were applied for the classification of clinical phase, 28.8% vs. 19.8% of the children were classified into the phases of hepatitis B e antigen (HBeAg-)positive/negative hepatitis. During a median follow-up of 62 months, 39 of 153 children underwent HBeAg seroconversion, whereas 3 of them had persistently "normal" ALT, according to the current ULN.
CONCLUSIONS:
The revision of ULN for ALT in children substantially impacts the classification of the natural course of chronic HBV infection. Mild ALT fluctuation is common during the stage childhood, suggesting a need to rethink the current conceptions of immune tolerance and natural course of chronic HBV infection in the children.
根据健康儿童的数据计算ALT的年龄特异性和性别特异性ULN，男孩平均为30 U / L，女孩平均为24 U / L.使用修订的ULNs与当前的ULNs（40-50 U / L），在2054例HBV感染的儿童中，31-60％与9-17％的患者的ALT基线分析结果异常，且最高婴儿出现异常率。 516名HBV感染儿童的数据用于临床分期，28.8％对比19.8％的儿童被分为乙型肝炎e抗原（HBeAg-）阳性/阴性肝炎阶段。根据目前的ULN，在中位随访62个月期间，153名儿童中有39名接受了HBeAg血清学转换，而其中3名患者持续“正常”ALT。
结论：