An Assessment of Upper Limits of Normal for ALT and the Impact on Evaluating Natural Course of Chronic Hepatitis B Virus Infection in Chinese Children
| Autor: | Li Ni, Sheng-Zhang Lin, Lai Wei, Yu-Qing Lu, Jing Ye, Nan Wu, Jin-Chao Han, Xiao-Ben Pan, Yun-Yan Lou, Xiao-Qun Zheng |
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| Rok vydání: | 2018 |
| Předmět: |
Male
0301 basic medicine China Hepatitis B virus medicine.medical_specialty Adolescent Virus 03 medical and health sciences Hepatitis B Chronic Sex Factors 0302 clinical medicine Liver Function Tests Chronic hepatitis Reference Values Internal medicine medicine Humans Hepatitis B e Antigens Child Retrospective Studies Hepatitis Natural course Hepatology business.industry Age Factors Gastroenterology Infant Alanine Transaminase Retrospective cohort study Hepatitis B medicine.disease digestive system diseases 030104 developmental biology HBeAg Child Preschool Female 030211 gastroenterology & hepatology Abnormality business |
| Zdroj: | American Journal of Gastroenterology. 113:1660-1668 |
| ISSN: | 0002-9270 |
| DOI: | 10.1038/s41395-018-0248-8 |
| Popis: | The current upper limits of normal (ULN) for serum alanine aminotransferase (ALT) are increasingly challenged. We aimed to re-evaluate the ULN for ALT and assess the potential impact on the classification of natural course of chronic hepatitis B virus (HBV) infection in children. Laboratory data obtained from three hospitals in China were retrospectively analysed. In total, 2054 children with chronic HBV infection and 8149 healthy children at age ≤18 years were included in the study. Age-specific and gender-specific ULNs for ALT, at averages of 30 U/L for boys and 24 U/L for girls, were calculated from the data of healthy children. Using the revised ULNs vs. the current ULNs (40–50 U/L), 31–60% vs. 9–17% of the 2054 HBV-infected children had an abnormal result as seen in their ALT baseline analysis, and the highest abnormality rate was seen in the infants. Data of 516 HBV-infected children were applied for the classification of clinical phase, 28.8% vs. 19.8% of the children were classified into the phases of hepatitis B e antigen (HBeAg-)positive/negative hepatitis. During a median follow-up of 62 months, 39 of 153 children underwent HBeAg seroconversion, whereas 3 of them had persistently “normal” ALT, according to the current ULN. The revision of ULN for ALT in children substantially impacts the classification of the natural course of chronic HBV infection. Mild ALT fluctuation is common during the stage childhood, suggesting a need to rethink the current conceptions of immune tolerance and natural course of chronic HBV infection in the children. |
| Databáze: | OpenAIRE |
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