Diagnostica e Ricerca S. Raffaele, Istituto Scientifico Universitario S. Raffaele, Milano, Italy.
Clin Chem Lab Med. 2010 Nov;48(11):1593-601. doi: 10.1515/CCLM.2010.315. Epub 2010 Oct 29.
Aspartate aminotransferase (AST), alanine aminotransferase (ALT) and γ-glutamyl transferase (GGT) measurements are important for the assessment of liver damage. The aim of this study was to define the reference intervals (RIs) for these enzymes in adults, paying attention to standardization of the methods used and careful selection of the reference population.
AST, ALT and GGT were measured with commercial analytical systems standardized to the IFCC-recommended reference measurement systems. Three centers (two in Italy and one in China) measured their own freshly collected samples; one of these centers also measured frozen samples from the Nordic Countries RI Project and from a Turkish center. RIs were generated using non-parametric techniques from the results of 765 individuals (411 females and 354 males, 18-85 years old) selected on the basis of the results of other laboratory tests and a specific questionnaire.
AST results from the four regions (Milan, Beijing, Bursa and Nordic Countries) were statistically different, but these differences were too small to be clinically relevant. Likewise, differences between the upper reference limits for genders was only 1.7 U/L (0.03 μkat/L), allowing a single RI of 11-34 U/L (0.18-0.57 μkat/L) to be defined. Interregional differences were not statistically significant for ALT, but partitioning was required due to significant gender differences. RIs for ALT were 8-41 U/L (0.13-0.68 μkat/L) for females and 9-59 U/L (0.15-0.99 μkat/L) for males, respectively. The upper reference limits for GGT from the Nordic Country population were higher than those from the other three regions and results from this group were excluded from final calculations. The GGT RIs were 6-40 U/L (0.11-0.66 μkat/L) for females and 12-68 U/L (0.20- 1.13 μkat/L) for males, respectively.
For AST and ALT, the implementation of common RIs appears to be possible, because no differences between regions were observed. However, a common RI for GGT that is applicable worldwide appears unlikely due to differences among populations.
天门冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）和γ-谷氨酰转移酶（GGT）的测定对于评估肝损伤很重要。本研究的目的是为成年人定义这些酶的参考区间（RI），并注意所用方法的标准化和参考人群的精心选择。
AST、ALT 和 GGT 采用与 IFCC 推荐的参考测量系统标准化的商业分析系统进行测量。三个中心（两个在意大利，一个在中国）测量了自己收集的新鲜样本；其中一个中心还测量了来自北欧国家 RI 项目和来自土耳其中心的冷冻样本。RI 使用来自基于其他实验室测试和特定问卷结果选择的 765 个人（411 名女性和 354 名男性，年龄 18-85 岁）的结果使用非参数技术生成。
来自四个地区（米兰、北京、布尔萨和北欧国家）的 AST 结果存在统计学差异，但这些差异太小，临床上无关紧要。同样，性别之间的上参考限值差异仅为 1.7 U/L（0.03 μkat/L），允许定义一个单一的 RI 为 11-34 U/L（0.18-0.57 μkat/L）。ALT 的区域间差异无统计学意义，但由于性别差异显著，需要分区。女性的 ALT RI 为 8-41 U/L（0.13-0.68 μkat/L），男性为 9-59 U/L（0.15-0.99 μkat/L）。来自北欧国家人群的 GGT 上参考限值高于其他三个地区，因此从最终计算中排除了该组的结果。女性的 GGT RI 为 6-40 U/L（0.11-0.66 μkat/L），男性为 12-68 U/L（0.20-1.13 μkat/L）。
对于 AST 和 ALT，似乎可以实施共同的 RI，因为没有观察到区域之间的差异。然而，由于人群之间的差异，全球范围内适用的 GGT 共同 RI 似乎不太可能。
