Upper limits of normal for alanine aminotransferase activity in the United State

StephenW

Ruhl, C. E. and Everhart, J. E. (2012), Upper limits of normal for alanine aminotransferase activity in the United States population. Hepatology, 55: 447–454. doi: 10.1002/hep.24725

Author Information

• 1Social and Scientific Systems, Inc., Silver Spring, MD
  
• 2National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
  
  

AbstractAlanine aminotransferase (ALT) is an important test for liver disease, yet there is no generally accepted upper limit of normal (ULN) in the United States. Furthermore, the ability of ALT to differentiate persons with and without liver disease is uncertain. We examined cut-offs for ALT for their ability to discriminate between persons with positive hepatitis C virus (HCV) RNA and those at low risk for liver injury in the U.S. population. Among adult participants in the 1999-2008 U.S. National Health and Nutrition Examination Survey, 259 were positive for serum HCV RNA and 3,747 were at low risk for liver injury (i.e., negative HCV RNA and hepatitis B surface antigen, low alcohol consumption, no evidence of diabetes, and normal body mass index and waist circumference). Serum ALT activity was measured centrally. Maximum correct classification was achieved at ALT = 29 IU/L for men (88% sensitivity, 83% specificity) and 22 IU/L (89% sensitivity, 82% specificity) for women. The cut-off for 95% sensitivity was an ALT = 24 IU/L (70% specificity) for men and 18 IU/L (63% specificity) for women. The cut-off for 95% specificity was ALT = 44 IU/L (64% sensitivity) for men and 32 IU/L (59% sensitivity) for women. The area under the curve was 0.929 for men and 0.915 for women. If the cut-offs with the best correct classification were applied to the entire population, 36.4% of men and 28.3% of women would have had abnormal ALT. Conclusion: ALT discriminates persons infected with HCV from those at low risk of liver disease, but would be considered elevated in a large proportion of the U.S. population. (HEPATOLOGY 2012)

StephenW

摘要

丙氨酸转氨酶（ALT）是肝脏疾病的一个重要考验，但有没有普遍接受的正常值上限（ULN）的在美国。此外，ALT的分化和无肝脏疾病的人的能力是不确定的。我们检查ALT自己的能力来区分积极丙型肝炎病毒（HCV）RNA和那些在美国总人口的肝损伤的低风险的人的削减权衡。在1999-2008年美国全国健康和营养调查的成年参与者当中，有259人阳性血清HCV RNA和3747肝损伤的低风险（即负的丙型肝炎病毒RNA和乙肝表面抗原，低酒精消费，没有证据糖尿病，和正常体重指数和腰围）。集中血清ALT活性测定。在ALT键实现最大的正确分类男性（88％的敏感性，特异性83％）和22 IU / L，为妇女（89％的敏感性，特异性82％）= 29 IU/ L;截止为95％的敏感性是一个ALT= 24 IU / L，（特异性70％）的男性和18 IU / L，女性（63％特异性）。截止为95％，特异性为ALT= 44 IU / L，（64％的敏感性）的男性和32 IU / L，女性（59％的敏感性）。曲线下面积为0.929男子和妇女的0.915。如果切的平衡最好的正确分类，适用于整个人口，36.4％的男性和28.3％的女性将有ALT异常。结论：ALT键的歧视与丙型肝炎病毒感染的人从那些在低风险的肝病，但将被视为在美国总人口的很大比例升高。 （2012年肝病）