Department of Internal Medicine, Sanggye Paik Hospital, Inje University School of Medicine, Seoul 139-707, South Korea.
World J Gastroenterol. 2013;19(14):2256-61. doi: 10.3748/wjg.v19.i14.2256.
To investigate whether the disease progression of chronic hepatitis C patients with normal alanine aminotransferase (ALT) levels differs by ALT levels.
A total of 232 chronic hepatitis C patients with normal ALT (< 40 IU/L) were analyzed. The patients were divided into "high-normal" and "low-normal"ALT groups after determining the best predictive cutoff level associated with disease progression for each gender. The incidence of disease progression, as defined by the occurrence of an increase of ≥ 2 points in the Child-Pugh score, spontaneous bacterial peritonitis, bleeding gastric or esophageal varices, hepatic encephalopathy, the development of hepatocellular carcinoma, or death related to liver disease, were compared between the two groups.
Baseline serum ALT levels were associated with disease progression for both genders. The best predictive cutoff baseline serum ALT level for disease progression was 26 IU/L in males and 23 IU/L in females. The mean annual disease progression rate was 1.2% and 3.9% for male patients with baseline ALT levels ≤ 25 IU/L (low-normal) and > 26 IU/L (high-normal), respectively (P = 0.043), and it was 1.4% and 4.8% for female patients with baseline ALT levels ≤ 22 IU/L (low-normal) and > 23 IU/L (high-normal), respectively (P = 0.023). ALT levels fluctuated during the follow-up period. During the follow-up, more patients with "high-normal" ALT levels at baseline experienced ALT elevation (> 41 IU/L) than did patients with "low-normal" ALT levels at baseline (47.7% vs 27.9%, P = 0.002). The 5 year cumulative incidence of disease progression was significantly lower in patients with persistently "low-normal" ALT levels than "high-normal" ALT levels or those who exhibited an ALT elevation > 41 U/L during the follow-up period (0%, 8.3% and 34.3%, P < 0.001).
A "high normal" ALT level in chronic hepatitis C patients was associated with disease progression, suggesting that the currently accepted normal threshold of serum ALT should be lowered.
研究丙型肝炎慢性患者正常丙氨酸氨基转移酶（ALT）水平的疾病进展是否因 ALT 水平而异。
共分析了 232 例 ALT（<40IU/L）正常的丙型肝炎慢性患者。在确定每个性别与疾病进展相关的最佳预测截止值后，将患者分为“高正常”和“低正常”ALT 组。比较两组间疾病进展的发生率，定义为：Child-Pugh 评分增加≥2 分、自发性细菌性腹膜炎、胃或食管静脉曲张出血、肝性脑病、肝细胞癌发展或与肝病相关的死亡。
男女患者的基线血清 ALT 水平均与疾病进展相关。预测疾病进展的最佳预测基线血清 ALT 水平为男性 26IU/L，女性 23IU/L。男性基线 ALT 水平≤25IU/L（低正常）和>26IU/L（高正常）的患者年疾病进展率分别为 1.2%和 3.9%（P=0.043），女性基线 ALT 水平≤22IU/L（低正常）和>23IU/L（高正常）的患者年疾病进展率分别为 1.4%和 4.8%（P=0.023）。随访期间 ALT 水平波动。在随访期间，基线时 ALT 水平较高的患者中，有更多的患者出现 ALT 升高（>41IU/L），而基线时 ALT 水平较低的患者中，有更多的患者出现 ALT 升高（47.7% vs 27.9%，P=0.002）。在随访期间持续“低正常”ALT 水平的患者、“高正常”ALT 水平的患者或 ALT 升高>41U/L 的患者中，5 年疾病进展累积发生率显著降低（0%、8.3%和 34.3%，P<0.001）。
丙型肝炎慢性患者的“高正常”ALT 水平与疾病进展相关，表明目前接受的血清 ALT 正常阈值应降低。
