Department of Pediatric Gastroenterology, Children's Hospital, University of Helsinki, P.O. Box 281, FI-00029, Helsinki, Finland.
Department of Clinical Laboratory, HUSLAB, Children's Hospital, University of Helsinki, Helsinki, Finland.
Eur J Pediatr. 2023 Dec;182(12):5707-5711. doi: 10.1007/s00431-023-05248-x. Epub 2023 Oct 9.
The purpose is to study liver biochemistry in a well-defined cohort of term infants. The methods include healthy term infants (n = 619) provided blood samples at 3 and 6 months of age when participating to the DIABIMMUNE study. The infants were followed up at clinical study visits 3, 6, 12, 18, 24, and 36 months the participation rate being 88.6% at the end of follow-up, while none disclosed any signs of a liver disease. The serum levels of serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), total bilirubin (BIL), and conjugated bilirubin (BIL-conj) were determined using Siemens Atellica CH 930 analyzers. The results are at 3 months of age, the upper 90% CI for ALT, AST, ALP, GGT, BIL, and BIL-conj were higher than the current upper reference limits in our accredited hospital laboratory. At 6 months, the upper 90% CIs for ALT had declined but was still higher than the cut-offs for a raised value. The upper 90% CI for AST remained as high as at 3 months, whereas ALP, BIL-conj, and GGT had decreased close to the current cut-offs. The type of feeding was associated with the levels of liver biochemistry. Exclusively or partially breastfed infants showed higher ALT, AST, BIL, and BIL-conj values at 3 months than formula-fed. Breastfed infants had higher AST, Bil, and Bil-conj values also at 6 months. Conclusion: We encourage setting appropriate reference ranges for liver biochemistry for the first year of life and to note the type of feeding. What is Known: • Healthy infants may show higher values of liver biochemistry during their first year of life than in later life. • It has been speculated that type of feeding may play a role in liver biochemistry levels among infants. What is New: • In a cohort of healthy infants, several analytes of liver biochemistry were higher than the currently used upper reference limits at 3 and 6 months of age, and exclusively or partially breastfed infants showed higher values than formula-fed. • The findings address the importance of setting appropriate reference ranges for liver biochemistry for the first year of life.
目的是研究足月婴儿中明确定义的队列的肝生化。方法包括在参与 DIABIMMUNE 研究时，健康的足月婴儿（n=619）在 3 个月和 6 个月时提供血液样本。在参与研究的随访结束时，婴儿接受了临床研究访问 3、6、12、18、24 和 36 个月，随访率为 88.6%，而没有任何婴儿显示出任何肝脏疾病的迹象。使用 Siemens Atellica CH 930 分析仪测定血清丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、碱性磷酸酶（ALP）、γ-谷氨酰转移酶（GGT）、总胆红素（BIL）和结合胆红素（BIL-conj）的血清水平。结果显示，在 3 个月时，ALT、AST、ALP、GGT、BIL 和 BIL-conj 的上 90%CI 高于我们认可的医院实验室目前的上参考限值。在 6 个月时，ALT 的上 90%CI 有所下降，但仍高于升高值的截止值。AST 的上 90%CI 仍如 3 个月时那样高，而 ALP、BIL-conj 和 GGT 则接近目前的截止值。喂养类型与肝生化水平有关。纯母乳喂养或部分母乳喂养的婴儿在 3 个月时的 ALT、AST、BIL 和 BIL-conj 值高于配方奶喂养的婴儿。纯母乳喂养的婴儿在 6 个月时的 AST、BIL 和 BIL-conj 值也较高。结论：我们鼓励为生命的头一年制定适当的肝生化参考范围，并注意喂养类型。已知内容：•健康婴儿在生命的头一年可能比以后的生命阶段显示出更高的肝生化值。•有人推测，喂养类型可能在婴儿的肝生化水平中起作用。新内容：•在一个健康婴儿队列中，一些肝生化指标在 3 个月和 6 个月时高于目前使用的上参考限值，纯母乳喂养或部分母乳喂养的婴儿比配方奶喂养的婴儿值更高。•这些发现强调了为生命的头一年制定适当的肝生化参考范围的重要性。
