Misclassification of chronic hepatitis B natural history phase: Insight from new ALT, AST, AKP, and GGT reference intervals in Chinese children.

The age- and sex-specific reference intervals (RIs) for liver chemistry in children are not available in China. Our study aimed to establish age and gender related RIs for ALT, AST, AKP, and GGT in China, and apply the new RI for ALT in children with chronic hepatitis B to use as a biochemical marker for disease progression. Data were collected from the Children's Healthcare Center. The measurements of ALT, AST, AKP and GGT were performed on a Hitachi 7600 Chemistry Analyzer. Age- and sex-specific RIs were determined using a percentile (3rd-97th) method. The sensitivity and specificity were determined to test the ability of the newly proposed ALT thresholds to classify children with chronic HBV infection. The age- and sex-specific RIs of ALT, AST, AKP and GGT were established based on 4232 Chinese healthy children. Using the new median ALT threshold, the sensitivity was higher. The detection of chronic HBV infection was 31.2% in boys and 35.5% in girls, while a very slight decrease in specificity was found. Based on the newly proposed RIs of ALT, approximately 16.1% boys and 19.0% girls would be classified in the HBeAg-positive chronic hepatitis phase, but using the current ALT threshold of children's hospitals they were in HBeAg-positive chronic infection phase. Based on a large healthy population, we established the sex- and age-specific RIs of ALT, AST, AKP and GGT serum activities for Chinese children. Meanwhile, newly proposed liver chemistry RIs will benefit the understanding of liver function and the natural history of chronic HBV infection in children.

Chang Y ，Li H ，Ren H ，Xu H ，Hu P ... -  《-》

Common reference intervals for aspartate aminotransferase (AST), alanine aminotransferase (ALT) and γ-glutamyl transferase (GGT) in serum: results from an IFCC multicenter study.

Ceriotti F ，Henny J ，Queraltó J ，Ziyu S ，Özarda Y ，Chen B ，Boyd JC ，Panteghini M ，IFCC Committee on Reference Intervals and Decision Limits (C-RIDL) ，Committee on Reference Systems for Enzymes (C-RSE) ... -  《-》

Establishing reference intervals for ALT, AST, UR, Cr, and UA in apparently healthy Chinese adolescents.

The current child-specific reference intervals (RIs) are inadequate or even unavailable for many analyses in China. Many of the RIs used in Chinese laboratories were derived from Chinese adult standards or from foreign studies. The aim of this study was to establish specific RIs for alanine aminotransferase (ALT), aspartate aminotransferase (AST), urea (UR), creatinine (Cr) and uric acid (UA) for apparently healthy Chinese adolescents. Overall, 1682 apparently healthy adolescents were enrolled. Serum ALT, AST, UR, Cr and UA were measured by an ARCHITECT C-8000 automated chemistry analyzer. The 2.5th and 97.5th percentile RIs were determined using non-parametric methods. The established reference intervals for ALT, AST, UR, CR and UA were 7.5-42.8 U/L, 12.8-40.2 U/L, 3.12-6.38 mmol/L, 42.7-91.2 μmol/L, and 180.2-409.6 μmol/L in boys and 6.5-32.8 U/L, 10.4-32.5 U/L, 3.05-6.47 mmol/L, 40.2-88.8 μmol/L and 176.5-394.0 μmol/L in girls, respectively. The median and upper and lower limits for the RIs of ALT, AST, Cr and UA were higher in boys than they were in girls (P < 0.05). RIs based on adult criteria are not applicable to adolescents. It was necessary to establish specific, accurate and suitable RIs for Chinese adolescents. We have established reference intervals of ALT, AST, UR, Cr and UA that are defined specifically for Chinese adolescents and are appropriate for universal use among Chinese laboratories.

Li Y ，Mussa AE ，Tang A ，Xiang Z ，Mo X ... -  《-》

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.

Pan XB ，Lu YQ ，Lin SZ ，Ye J ，Wu N ，Lou YY ，Ni L ，Han JC ，Zheng XQ ，Wei L ... -  《-》

New pediatric percentiles of liver enzyme serum levels (alanine aminotransferase, aspartate aminotransferase, γ-glutamyltransferase): Effects of age, sex, body mass index, and pubertal stage.

The present study aims to clarify the effects of sex, age, body mass index (BMI), and puberty on transaminase serum levels in children and adolescents and to provide new age- and sex-related percentiles for alanine aminotransferase (ALT), aspartate aminotransferase (AST), and γ-glutamyltransferase (GGT). Venous blood and anthropometric data were collected from 4,126 cases. Excluded were cases of participants with potential hepatotoxic medication, with evidence of potential illness at the time of blood sampling and non-normal BMI (BMI <10th or >90th). The resulting data (N = 3,131 cases) were used for the calculations of ALT, AST, and GGT percentiles. Age- and sex-related reference intervals were established by using an LMS method of Cole-type method. Serum levels of transaminases follow age-specific patterns and relate to the onset of puberty. This observation is more pronounced in girls than in boys. ALT percentiles showed similar-shaped patterns in both sexes. Multivariate regression confirmed significant effects of puberty and BMI-SDS (β = 2.21) on ALT. Surprisingly, AST serum levels were negatively influenced by age (β = -1.42) and BMI-SDS (β = -0.15). GGT percentiles revealed significant sex-specific differences, correlated positively with age (β = 0.37) and showed significant association with BMI-SDS (β = 1.16). Current reference values of ALT, AST, and GGT serum levels were calculated for children between 11 months and 16.0 years, using modern analytical and statistical methods. This study extends the current knowledge about transaminases by revealing influences of age, sex, BMI, and puberty on serum concentrations of all three parameters and has for these parameters one of the largest sample sizes published so far. (Hepatology 2017).

Bussler S ，Vogel M ，Pietzner D ，Harms K ，Buzek T ，Penke M ，Händel N ，Körner A ，Baumann U ，Kiess W ，Flemming G ... -  《-》