Magen-Rimon Ramit, Shaoul Ron
Pediatric Gastroenterology & Nutrition institute, Faculty of Medicine, Ruth Children's Hospital of Haifa, Rambam Medical Center, Technion, Haifa, Israel.
Acta Paediatr. 2021 Feb;110(2):668-672. doi: 10.1111/apa.15446. Epub 2020 Sep 2.
Hypertransaminasaemia is a common incidental finding in children. It has been demonstrated that even prolonged elevation usually resolves spontaneously without clear aetiology. The aim of this study was to evaluate whether a longer follow-up period, on a larger group, supports the previous findings.
We retrospectively reviewed medical charts of children diagnosed with prolonged idiopathic hypertransaminasaemia, which spontaneously resolved over the follow-up period.
Of the 468 patients screened for elevated transaminases levels, 87 patients younger than 5 years of age were included in the study. An aetiology was found in half of the patients, and the most common aetiologies were fatty liver and cytomegalovirus (CMV) infection. Aminotransferase abnormality persisted for a median of 10 months, and alanine aminotransferase (ALT) levels ranged from 1.5 to 15.9-fold of the upper limit of normal (ULN). After normalisation of transaminase levels, the values remained normal for a documented mean period of 6.4 ± 3.0 years.
Although idiopathic asymptomatic aminotransferase elevation in healthy children resolves spontaneously in most children, the abnormality may be prolonged. Comprehensive workup finds aetiology only in half of the patients, and the most common aetiologies are fatty liver and CMV hepatitis, which can be diagnosed by non-invasive methods.
高转氨酶血症是儿童常见的偶然发现。已经证明，即使转氨酶长时间升高通常也会在没有明确病因的情况下自发缓解。本研究的目的是评估在更大的群体中进行更长时间的随访是否支持先前的研究结果。
我们回顾性分析了被诊断为特发性转氨酶长时间升高且在随访期间自发缓解的儿童的病历。
在筛查转氨酶水平升高的468例患者中，87例5岁以下儿童被纳入研究。一半患者发现了病因，最常见的病因是脂肪肝和巨细胞病毒（CMV）感染。转氨酶异常持续的中位数为10个月，丙氨酸转氨酶（ALT）水平为正常上限（ULN）的1.5至15.9倍。转氨酶水平正常化后，记录的平均正常时间为6.4±3.0年。
尽管健康儿童特发性无症状转氨酶升高在大多数儿童中会自发缓解，但异常情况可能会持续较长时间。全面检查仅在一半患者中发现病因，最常见的病因是脂肪肝和CMV肝炎，可通过非侵入性方法诊断。
