Department of Pediatrics, Hallym University College of Medicine, Seoul, Republic of Korea.
J Pediatr Gastroenterol Nutr. 2013 Jun;56(6):686-91. doi: 10.1097/MPG.0b013e31828b4e67.
Serum alanine aminotransferase (ALT) is not only a surrogate marker of chronic liver disease but also predictive of future development of cardiovascular disease (CVD) in adults; however, pediatric reference data are rare, and "healthy-range ALT limits" have not been assessed to predict cardiovascular risk in children and adolescents.
Data from 2242 examinees (1171 boys and 1071 girls; 10-18 years of age) in the Korea National Health and Nutrition Examination Survey IV (2007-2009) were analyzed. The reference values of ALT levels were determined according to age and sex. Multiple logistic regressions were used to assess the association between healthy-range ALT limits (ALT level >30 IU/L for boys and >19 IU/L for girls) and each cardiovascular risk factor.
The 50th, 90th, and 95th percentiles of ALT levels were respectively 14, 27, and 35 IU/L in boys and 11, 19, and 24 IU/L in girls. Subjects with ALT levels higher than healthy-range ALT limits not only exhibited higher odds ratios for metabolic syndrome but also showed higher each cardiovascular risk related to obesity, hypertension, and dyslipidemia compared with subjects whose ALT levels were within the healthy range (P < 0.001).
The present study shows normal ALT reference data of Korean children and adolescents. The present study also showed the effectiveness of healthy-range ALT limits in predicting each cardiovascular risk factor in a national representative population.
血清丙氨酸氨基转移酶（ALT）不仅是慢性肝病的替代标志物，而且可预测成年人未来发生心血管疾病（CVD）的风险；然而，儿科参考数据很少，并且尚未评估“正常 ALT 范围”限制来预测儿童和青少年的心血管风险。
分析了韩国国家健康和营养检查调查 IV（2007-2009 年）中 2242 名受检者（1171 名男孩和 1071 名女孩；10-18 岁）的数据。根据年龄和性别确定 ALT 水平的参考值。采用多因素 logistic 回归评估正常 ALT 范围（男孩 ALT 水平＞30IU/L，女孩 ALT 水平＞19IU/L）与每个心血管危险因素之间的关联。
男孩的 ALT 水平第 50、90 和 95 百分位数分别为 14、27 和 35IU/L，女孩的 ALT 水平第 50、90 和 95 百分位数分别为 11、19 和 24IU/L。ALT 水平高于正常 ALT 范围的受试者不仅表现出更高的代谢综合征比值比，而且与 ALT 水平在正常范围内的受试者相比，还表现出与肥胖、高血压和血脂异常相关的每个心血管风险更高（P＜0.001）。
本研究显示了韩国儿童和青少年正常 ALT 的参考数据。本研究还表明，正常 ALT 范围在预测全国代表性人群的每个心血管危险因素方面是有效的。
