Wedemeyer H, Hofmann W P, Lueth S, Malinski P, Thimme R, Tacke F, Wiegand J
Klinik für Gastroenterologie, Hepatologie and Endokrinologie, Medizinische Hochschule Hannover.
Z Gastroenterol. 2010 Jan;48(1):46-55. doi: 10.1055/s-0028-1109980. Epub 2010 Jan 13.
Elevated serum amino-transferase levels may be associated with liver injury. Testing for aspartate aminotransferase (AST) or alanine aminotransferase (ALT) is part of many routine screening approaches. The aim of this manuscript was to scrutinize the evidence for using ALT testing as a primary screening parameter for liver diseases. We conclude that (i) elevated serum ALT levels indicate a high specificity and a reasonable sensitivity liver injury, (ii) 10 - 25 % of German adults have elevated ALT levels, (iii) ALT values are increased in the majority but not all patients with acute and chronic liver disease (iv) elevated ALT-values are associated with an increased risk of liver-specific mortality, (v) elevated ALT values are also a risk factor for non-hepatic diseases including diabetes mellitus type 2, metabolic syndrome, cardiovascular diseases and malignancies, (vi) many liver diseases identified by an ALT screening can be treated successfully including prevention of development of clinical endpoints, (vii) an ALT-screening is very likely to be cost-effective although studies are needed for Germany to support this conclusion.
血清氨基转移酶水平升高可能与肝损伤有关。检测天冬氨酸氨基转移酶（AST）或丙氨酸氨基转移酶（ALT）是许多常规筛查方法的一部分。本手稿的目的是仔细审查将ALT检测用作肝病主要筛查参数的证据。我们得出以下结论：（i）血清ALT水平升高表明肝损伤具有高特异性和合理的敏感性，（ii）10% - 25%的德国成年人ALT水平升高，（iii）大多数但并非所有急慢性肝病患者的ALT值都会升高，（iv）ALT值升高与肝脏特异性死亡率增加有关，（v）ALT值升高也是包括2型糖尿病、代谢综合征、心血管疾病和恶性肿瘤在内的非肝脏疾病的危险因素，（vi）通过ALT筛查发现的许多肝病可以成功治疗，包括预防临床终点的出现，（vii）ALT筛查很可能具有成本效益，尽管德国需要开展研究来支持这一结论。
