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alanine aminotransferase as the First Test Parameter for Wilson's Disease

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Journal of Clinical and Translational Hepatology 2019年第4期7卷 293-296页

作者： Hisao Hayashi Kazumasa Watanabe Ayano Inui Ayako Kato Yasuaki Tatsumi Akihiko Okumura Tomoo Fujisawa Koichi Kato Department of Medicine Aichi Gakuin University School of PharmacyChikusa-kuNagoyaJapan Department of Gastroenterology Kainan HospitalYatomiJapan Department of Pediatric Gastroenterology and Hepatology Saiseikai Yokohama Toub HospitalYokohamaKanagawaJapan

Background and Aims: The liver is the first organ affected by toxic copper in the classical and severe hepatic forms of Wilson's disease(WD).Because their associated chronic liver damage is mostly asymptomatic,an intervention using a special test including serum alanine aminotransferase(ALT)activity is needed for detecting ***: Using the modified international criteria for the diagnosis of WD,45 patients were selected from the collective databases of our institutions,and 7 infants were reviewed from the *** patients had the severe hepatic form,with nor-moceruloplasminemia and no mutations in *** rapid ALT change during hemolytic anemia was adjusted for a *** diagnostic potential of the ALT test was assessed from the age-dependent natural course of the liver damage of ***: The natural course had three *** were still low in some infants younger than 4 *** were high in all children between the ages of 4 and 8 years-old;then,they reduced to low levels in some patients over 9 years of *** high ALT stage represents chronic active hepatitis,and the sub-sequent low ALT stage is due to silent *** hepatic cop-per content is a reliable but invasive test,while urinary copper secretion is an alternative,non-invasive test for copper toxicosis of *** serum ceruloplasmin and ATP7B analyses are sub-type tests of *** response to anti-copper regimens is the final test ***: ALTcould be the first parameter to test to detect WD in children between the ages of 4 and 8 years.

关键词： alanine aminotransferase ATP7B Ceruloplasmin Chronic active hepatitis Wilson's disease

alanine aminotransferase predicts incident steatotic liver disease of metabolic etiology: Long life to the old biomarker!

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World Journal of Gastroenterology 2024年第24期30卷 3016-3021页

作者： Amedeo Lonardo Department of Internal Medicine Azienda Ospedaliero-Universitaria of Modena(2023)Modena 41126Italy

alanine aminotransferase(ALT)serum levels increase because of hepatocellular *** dysfunction-associated fatty liver disease(MAFLD),which identifies steatotic liver disease(SLD)associated with≥2 metabolic abnormalities,has prominent sexual *** Metabolic Syndrome defines a cluster comprising abdominal obesity,altered glucose metabolism,dyslipidemia,and *** sex,body mass index,glucose,lipids,ferritin,hypertension,and age independently predict ALT levels among blood *** the last few decades,the reference range of ALT levels has been animatedly debated owing to attempts to update sex-specific reference *** this backset,Chen et al have recently published a study which has two main ***,>80%of indi-viduals with MAFLD had normal ALT ***,there was a linear increa-sing trend in the association between cumulative excess high-normal ALT levels and the rate of incident *** study has biologically credible ***,it inaccurately considered sex differences in the MAFLD ***,future studies on SLD owing to metabolic dysfunction should adopt locally determined and prospectively validated reference ranges of ALT and carefully consider sex differences in liver enzymes and MAFLD pathobiology.

关键词： alanine aminotransferase Biomarker History of medicine Metabolic dysfunction-associated fatty liver disease Metabolism Nonalcoholic fatty liver disease Reference range Sex differences Steatotic liver disease

A better parameter in predicting insulin resistance:Obesity plus elevated alanine aminotransferase

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World Journal of Gastroenterology 2009年第44期15卷 5598-5603页

作者： Ping-Hao then Jong-Dar Chen Yu-Cheng Lin Department of family practice Lo-Sheng Sanatorium Department of Health Taipei County 242 Taiwan China Department of family medicine Shin Kong Wu Ho-Su Memorial Hospital Taipei 111 Taiwan China Department of Occupational Medicine Tao- Yuan General Hospital Department of Health Tao-Yuan 330 Taiwan China

AIM:To investigate the association of obesity and elevated alanine aminotransferase with insulin resistance and compare these factors with metabolic syndrome. METHODS:We enrolled a total of 1308 male workers aged from 22 to 63 *** was extracted from the workers'periodic health check-ups in *** cases were from the community of northern Taiwan. This was a cross-sectional observational study from July to September in *** grouped all cases into four groups,based on the quartile of homeostasis model *** top fourth quartile group was defined as the group with insulin *** performed multivariate logistic regression analysis for the odds ratio of the risk factors for insulin resistance. RESULTS:Compared with metabolic syndrome,the coexistence of both factors had a 4.3-fold(95%CI: 2.7-6.8)increased risk,which was more than metabolic syndrome with a 3.6-fold(95%CI:2.6-5.0)increased *** two factors had a synergistic *** synergistic index of obesity and elevated alanine aminotransferase(ALT)was 2.1(95%CI:1.01-4.3).CONCLUSION:Obesity and elevated ALT are associatedwith insulin *** effects are synergistic. Coexistence of them is better than metabolic syndrome in predicting insulin resistance.

关键词： alanine aminotransferase Transaminase Overweight Obesity Insulin resistance

Association of body mass index with serum alanine aminotransferase in Chinese adolescents:a school-based cross-sectional study

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Gastroenterology Report 2020年第2期8卷 119-124,I0002页

作者： Zan Ding Jing Zhang Chang-Yu Deng Ying-Bin You Hua Zhou Institute of Low Carb Medicine Baoan Central Hospital of Shenzhenthe Fifth Affiliated Hospital of Shenzhen UniversityShenzhenGuangdongP.R.China Department of Nursing Baoan Central Hospital of Shenzhenthe Fifth Affiliated Hospital of Shenzhen UniversityShenzhenGuangdongP.R.China Department of Preventive Medicine Shantou University Medical CollegeShantouGuangdongP.R.China

Background:Numerous studies have consistently demonstrated that high body mass index(BMI)is related to elevated serum alanine aminotransferase(ALT)among adults,but little is known about the association regarding adolescents,especially in *** this study,we aimed to investigate the association between BMI and ALT activity among Chinese ***:A school-based cross-sectional study was performed among nine high schools in Shenzhen,China between February 2017 and June 2018.A generalized linear-regression model adjusting for age and gender was conducted,and bivariate correlation analysis between ALT and BMI was also ***:A total of 7,271 adolescents aged from 9 years to 17 years were ***,weight,BMI,and ALT were higher among boys than among girls(all P<0.001).The mean(standard deviation)of serum ALT levels was 14.26(14.77)U/*** the entire BMI range,the BMIALT correlation was stronger for boys(Spearman’s r=0.396,P<0.001)and adolescents of 14 years17 years(r=0.356,P<0.001)than for girls(r=0.203,P<0.001)and adolescents of 9 years13 years(r=0.221,P<0.001),*** ALT increased rapidly and followed a linear pattern from the point of BMI20.5 kg/m^(2),and each increase of 1 kg/m^(2)in BMI range above 20.5 kg/m^(2)was averagely correlated with an increase of 2.71 U/L in ALT levels(P<0.001).Conclusions:We found a significant BMIALT *** at 20.5 kg/m^(2)may be a cut-off for evaluating serum ***27.1 kg/m^(2)for boys and24.9 kg/m^(2)for girls were linked to an elevated ALT activity for Shenzhen adolescents.

关键词： adolescent alanine aminotransferase association body mass index cut-off point

Persistent alanine aminotransferase elevation among the general Iranian population: Prevalence and causes

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World Journal of Gastroenterology 2008年第18期14卷 2867-2871页

作者： Raika Jamali Mahmoodreza Khonsari Shahin Merat Masoud Khoshnia Elham Jafari Alireza Bahram Kalhori Hassan Abolghasemi Sedighe Amini Mahtab Maghsoudlu Mohammad Reza Deyhim Houri Rezvan Akram Pourshams Digestive Disease Research Center Shariati Hospital Medical Sciences/University of Tehran Tehran 14117 Iran Department of Internal Medicine Hamadan Hamadan University of Medical Sciences Iran Department of Radiology Gonbad Social Insurance Organization Khatam Hospital Golestan Iran Iranian Blood Transfusion Research Center Tehran 14117 Iran

AIM: To determine the prevalence and causes of persistently elevated alanine aminotransferase (ALT) levels among the general population in northern Iran. METHODS: A total of 2292 (1376 female, aged 18-75 year), were selected by systematic clustered random sampling from the cities and villages of Gonbad and Kalaleh in Golestan Province and invited to participate in the study. A comprehensive history regarding alcohol drinking and medication was taken. Body mass index (BMI), viral markers and ALT levels were measured. If ALT level was ≥ 40 U/L, it was rechecked twice within 6 mo. Those with ≥ 2 times elevation of ALT were considered as having persistently elevated ALT level. Non-alcoholic fatty liver disease (NAFLD) was diagnosed based on evidence of fatty liver upon sonography and excluding other etiology. RESULTS: A total of 2049 (1351 female) patients participated in the study, 162 (7.9%) had elevated ALT level at the first measurement. Persistently elevated ALT level was detected in 64 (3.1%) participants, with51 (79.6%) with no obvious etiology, six (9.3%) with Hepatitis B, four (6.2%) with Hepatitis C virus (HCV) infection and three (4.6%) with alcoholic hepatitis. The prevalence of NAFLD and alcoholic hepatitis was 2.04% (42 patients) and 0.1% (three), respectively. There was correlation between NAFLD and male gender, overweight, diabetes and living in an urban area [odds ratio = 3.03 (95% CI: 1.6-5.72), 4.21 (95% CI: 1.83-9.68), 2.86 (95% CI: 1.05-7.79) and 2.04 (95% CI: 1.00-4.16) respectively]. CONCLUSION: NAFLD is the most common cause of persistently elevated serum ALT level among the general population of Iran.

关键词： alanine aminotransferase Iran Non-alcoholic fatty liver disease Viral hepatitis

Diagnostic value of FIB-4, aspartate aminotransferaseto-platelet ratio index and liver stiffness measurement in hepatitis B virus-infected patients with persistently normal alanine aminotransferase

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World Journal of Gastroenterology 2017年第31期23卷 5746-5754页

作者： You-Wen Tan Xing-Bei Zhou Yun Ye Cong He Guo-Hong Ge Department of Hepatology the Third Hospital of Zhenjiang Affiliated Jiangsu University

AIM To assess the diagnostic value of FIB-4, aspartate aminotransferase-to-platelet ratio index(APRI), and liver stiffness measurement(LSM) in patients with hepatitis B virus infection who have persistently normal alanine transaminase(PNALT).METHODS We enrolled 245 patients with chronic hepatitis B: 95 in PNALT group, 86 in intermittently elevated alanine transaminase(PIALT1) group [alanine transaminase(ALT) within 1-2 × upper limit of normal value(ULN)], and 64 in PIALT2 group(ALT > 2 × ULN). All the patients received a percutaneous liver biopsy guided by ultrasonography. LSM, biochemical tests, and complete blood cell counts were *** The pathological examination revealed moderate inflammatory necrosis ratios of 16.81%(16/95), 32.56%(28/86), and 45.31%(28/64), and moderate liverfibrosis of 24.2%(23/95), 33.72%(29/86), and 43.75%(28/64) in the PNALT, PIALT1, and PIALT2 groups, respectively. The degrees of inflammation and liver fibrosis were significantly higher in the PIALT groups than in the PNALT group(P 0.05) was found in AUCs for all comparisons(P > 0.05 for all). In the overall patients, a significant difference in the AUCs was found only between LSM and APRI(P < 0.05).CONCLUSION APRI and FIB-4 are not the ideal noninvasive hepatic fibrosis markers for PNALT patients. LSM is superior to APRI and FIB-4 in PNALT patients because of the influence of liver inflammation and necrosis.

关键词： Liver stiffness measurement Hepatitis B virus FIB-4 Aspartate aminotransferase-to-platelet ratio index Normal alanine aminotransferase

Drug-induced liver injury in hospitalized patients with notably elevated alanine aminotransferase

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World Journal of Gastroenterology 2012年第41期18卷 5972-5978页

作者： Hui-Min Xu Yan Chen Jie Xu Quan Zhou Department of Pharmacy the 2nd Af-filiated Hospital School of Medicine Zhejiang University Hang-zhou 310009 Zhejiang Province China Department of Gastroenterology the 2nd AffiliatedHospital School of Medicine Zhejiang University Hangzhou310009 Zhejiang Province China Department of Information Technology the 2nd AffiliatedHospital School of Medicine Zhejiang University Hangzhou310009 Zhejiang Province China

AIM： To identify the proportion, causes and the nature of drug-induced liver injury （DILI） in patients with no- tably elevated alanine aminotransferase （ALT）. METHODS： All the inpatients with ALT levels above 10 times upper limit of normal range （ULN） were ret- rospectively identified from a computerized clinical laboratory database at our hospital covering a 12-mo period. Relevant clinical information was obtained from medical records. Alternative causes of ALT eleva- tions were examined for each patient, including bili- ary abnormality, viral hepatitis, hemodynamic injury, malignancy, DILI or undetermined and other causes. All suspected DILI cases were causality assessed usingthe Council for International Organizations of Medical Sciences scale, and only the cases classified as highly probable, probable, or possible were diagnosed as DILI. Comments related to the diagnosis of DILI in the medical record and in the discharge letter for each case were also examined to evaluate DILI detection by the treating doctors. RESULTS： A total of 129 cases with ALT 〉 i0 ULN were identified. Hemodynamic injury （n = 46, 35.7%）, DILl （n = 25, 19.4%） and malignancy （n = 21, 16.3%） were the top three causes of liver injury. Peak ALT val- ues were lower in DILI patients than in patients with hemodynamic injury （14.5 5.6 ULN vs 32.5 ：I： 30.7 ULN, P = 0.001）. Among DILI patients, one （4%） case was classified as definite, 19 （76%） cases were clas- sified as probable and 5 （20%） as possible according to the ClOMS scale. A hepatocellular pattern was ob- served in 23 （92%） cases and mixed in 2 （8%）. The extent of severity of liver injury was mild in 21 （84%） patients and moderate in 4 （16%）. Before discharge, 10 （40%） patients were recovered and the other 15 （60%） were improved. The improved patients tended to have a higher peak ALT （808 ＋ 348 U/L vs 623 ＋ 118 U/L, P = 0.016） and shorter treatment duration before discharge （8 ＋ 6 d vs 28 ~ 12 d, P = 0.008） compared with the recovered pati

关键词： Drug-induced liver injury Abnormal liverenzyme alanine aminotransferase Underdiagnosis Adjunctive drugs

Postoperative day one serum alanine aminotransferase does not predict patient morbidity and mortality after elective liver resection in non-cirrhotic patients

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Hepatobiliary & Pancreatic Diseases International 2016年第6期15卷 655-659页

作者： Ricky Harminder Bhogal Amit Nair Davide Papis Zaed Hamady Jawad Ahmad For Tai Lam Saboor Khan Gabriele Marangoni Department of Hepato-pancreatico-biliary Surgery University Hospitals of Coventry and Warwickshire University of Birmingham Centre for Liver ResearchInstitute for Biomedical ResearchThe Medical School

ABSTRACT： Serum aminotransferases have been used as surrogate markers for liver ischemia-reperfusion injury that follows liver surgery. Some studies have suggested that rises in serum alanine aminotransferase （ALT） correlate with patient outcome after liver resection. We assessed whether postoperative day 1 （POD 1） ALT could be used to predict patient morbidity and mortality following liver resection. We reviewed our prospectively held database and included consecutive adult patients undergoing elective liver resection in our institution between January 2013 and December 2014. Primary outcome assessed was correlation of POD 1 ALT with patient＇s morbidity and mortality. We also assessed whether concurrent radiofrequency ablation, neoadjuvant chemotherapy and use of the Pringle maneuver significantly affected the level of POD 1 ALT. A total of 110 liver resections were included in the study. The overall in-hospital patient morbidity and mortality were 31.8% and 0.9%, respectively. The median level of POD 1 ALT was 275 IU/L. No correlation was found between POD 1 serum ALT levels and patient morbidity after elective liver resection, whilst correlation with mortality was not possible because ofthe low number of mortalities. Patients undergoing concurrent radiofrequency ablation were noted to have an increased level of POD 1 serum ALT but not those given neoadjuvant chemotherapy and those in whom the Pringle maneuver was used. Our study demonstrates POD 1 serum ALT does not correlate with patient morbidity after elective liver resection.

关键词： alanine aminotransferase hepatectomy reperfusion injury aminotransferases postoperative complications

Propylthiouracyl-induced severe liver toxicity:An indication for alanine aminotransferase monitoring?

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World Journal of Gastroenterology 2006年第38期12卷 6232-6234页

作者： M Benyounes C Sempoux C Daumerie J Rahier AP Geubel Departments of Gastroenterology Endocrinology and Pathology St Luc University Hospital Université Catholique de Louvain Brussels 1200 Belgium

Propylthiouracyl (PTU)-related liver toxicity is likely to oc- cur in about 1% of treated patients. In case of acute or subacute hepatitis, liver failure may occur in about one third. We report two further cases of PTU-induced sub- acute hepatitis, in whom the delay between occurrence of liver damage after the initiation of treatment, the un- derestimation of its severity and the delayed withdrawal of the drug were all likely responsible for liver failure. The high incidence of liver toxicity related to PTU, its potential severity and delayed occurrence after initiation of treatment are in favor of monthly alanine aminotrans- ferase monitoring, at least during the first six months of therapy.

关键词： Hepatitis Drug-induced liver toxicity Propylthiouracil alanine aminotransferase