Burra Patrizia, Cammà Calogero, Invernizzi Pietro, Marra Fabio, Pompili Maurizio
Gastroenterology, Department of Surgery, Oncology, and Gastroenterology, Padua University Hospital, Padua, Italy.
Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy.
Ann Hepatol. 2025 Jan-Jun;30(1):101900. doi: 10.1016/j.aohep.2025.101900. Epub 2025 Mar 13.
Aminotransferases, particularly alanine aminotransferase (ALT), are commonly used in the detection, diagnosis, and management of chronic liver diseases. ALT, a sensitive and cost-effective marker of liver injury, remains pivotal in predicting clinical outcomes and guiding interventions in several chronic liver diseases including metabolic dysfunction-associated steatotic liver disease, and chronic viral hepatitis. This study aims to explore the evolving role of ALT as a biomarker. A comprehensive review of evidence was conducted, focusing on studies evaluating ALT thresholds, diagnostic accuracy, and integration with non-invasive liver assessment tools. Special emphasis was given to novel approaches, including artificial intelligence-driven algorithms. Expert opinions from hepatology care perspectives were considered to assess the practical implications of refining ALT-based diagnostic strategies. ALT levels are influenced by diverse factors such as age, gender, and metabolic risks, challenging the use of specific thresholds as biomarker of disease and prognosis. Emerging evidence suggests redefining ALT ranges to enhance sensitivity and accuracy in detecting liver abnormalities. The integration of ALT with advanced non-invasive diagnostic tools, artificial intelligence, and comprehensive patient assessments can optimize early detection of liver disease, thus reducing underdiagnosis, particularly in asymptomatic or vulnerable populations. This work highlights the urgency to tailor the diagnostic approaches in primary and specialised care, ensuring timely and targeted intervention to effectively address the global burden of liver diseases.
转氨酶，尤其是丙氨酸转氨酶（ALT），常用于慢性肝病的检测、诊断和管理。ALT作为一种敏感且经济高效的肝损伤标志物，在预测包括代谢功能障碍相关脂肪性肝病和慢性病毒性肝炎在内的多种慢性肝病的临床结局及指导干预措施方面仍起着关键作用。本研究旨在探讨ALT作为生物标志物不断演变的作用。我们对相关证据进行了全面综述，重点关注评估ALT阈值、诊断准确性以及与非侵入性肝脏评估工具整合的研究。特别强调了包括人工智能驱动算法在内的新方法。我们考虑了肝病护理领域专家的意见，以评估完善基于ALT的诊断策略的实际意义。ALT水平受年龄、性别和代谢风险等多种因素影响，这对将特定阈值用作疾病和预后生物标志物提出了挑战。新出现的证据表明，重新定义ALT范围可提高检测肝脏异常的敏感性和准确性。将ALT与先进的非侵入性诊断工具、人工智能以及全面的患者评估相结合，可以优化肝病的早期检测，从而减少漏诊，尤其是在无症状或易患人群中。这项工作凸显了在初级和专科护理中调整诊断方法的紧迫性，确保及时进行有针对性的干预，以有效应对全球肝病负担。
