ALT正常上限评估及对中国儿童慢性乙型肝炎病毒感染自然疗

StephenW

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.

PMID:
    30353056
DOI:
    10.1038/s41395-018-0248-8

StephenW

Am J Gastroenterol。 2018年10月23日doi：10.1038 / s41395-018-0248-8。 [提前打印]
ALT正常上限评估及对中国儿童慢性乙型肝炎病毒感染自然疗程评估的影响。
Pan XB1,2，Lu YQ3，Lin SZ4，Ye J5，Wu N3，Lou YY6，Ni L6，Han JC3，Zheng XQ7，Wei L3。
作者信息

1
    杭州师范大学医学院基础医学系杭州市炎症与免疫调节重点实验室，浙江杭州[email protected]。
2
    北京大学人民医院北京市肝病与肝病免疫治疗重点实验室，北京大学肝病研究所，北京[email protected]。
3
    北京大学人民医院北京市肝病与肝病免疫治疗重点实验室，北京大学肝病研究所，北京
4
    浙江大学医学院附属第一医院肝胆胰外科，浙江杭州
五
    浙江大学医学院附属儿童医院重症监护室，浙江杭州
6
    温州医科大学育英儿童医院和温州医科大学附属第二医院临床实验室，浙江温州
7
    温州医科大学育英儿童医院和温州医科大学附属第二医院临床实验室，浙江温州[email protected]。

抽象
背景：

目前血清丙氨酸氨基转移酶（ALT）的正常上限（ULN）受到越来越多的挑战。我们的目的是重新评估ALT的ULN，并评估儿童慢性乙型肝炎病毒（HBV）感染自然病程分类的潜在影响。
方法：

回顾性分析了中国三家医院的实验室数据。总共有2054名患有慢性HBV感染的儿童和8149名年龄≤18岁的健康儿童被纳入该研究。
结果：

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：

儿童ALT的ULN修订显着影响慢性HBV感染的自然病程分类。轻微的ALT波动在儿童期阶段很常见，这表明需要重新思考当前儿童免疫耐受和慢性HBV感染自然过程的概念。

结论：
    30353056
DOI：
    10.1038 / s41395-018-0248-8