关于丙氨酸氨基转移酶的参考范围

丙氨酸氨基转移酶(ALT)是肝脏疾病实验室检测的一项重要项目,检测方法有多种,不同方法所测得的参考范围各不相同。上海市曾于1975年组织临床肝病学专家、临床检验专家和流行病学专家共同进行了上海市居民的Reitman法(赖氏法)检测ALT参考范围的调查。调查结果显示第95百分位值为25赖氏单位,和国外报道一致。考虑肝炎防治工作的需要并结合当时的情况,决定以40赖氏单位(第99百分位值)为赖氏法检测ALT的参考范围上限。手工操作检测ALT的赖氏法因操作简便,成本低廉,得以广泛应用。卫生部确定全国测定ALT活力统一使用赖氏法,并且将40赖氏单…     

戊型肝炎及重叠乙型肝炎感染患者丙氨酸转氨酶变化

目的　观察戊型肝炎及重叠乙型肝炎感染患者丙氨酸转氨酶 (ALT)变化。方法　将戊型肝炎抗体阳性及重叠乙型肝炎感染患者 2 73例分为 5组。A组 12 7例 ,为戊型肝炎病毒 (HEV) IgG阳性 ;B组 9例 ,为HEV IgM阳性 ;C组 64例 ,为HEV IgM和HEV IgG均阳性 ;D组 3 2例 ,为HEV IgM和HEV IgG均阳性并重叠乙型肝炎感染 ;E组 41例 ,为HEV IgG阳性并重叠乙型肝炎感染。另选戊型肝炎抗体阴性的非乙型肝炎患者 5 0 0例作为对照组。用速率法测定各组ALT值。结果　各组ALT异常增高百分率及异常增高者ALT值分别为 :A组 2 1例 ( 16.5 %) ,ALT( 183± 89)U /L ;B组 3例 ,ALT( 2 0 3± 112 )U /L ;C组 16例 ( 2 5 .8%) ,ALT( 2 17± 119)U/L ;D组 11例 ( 3 4.4%) ,ALT( 2 3 4± 12 8)U/L ;E组 13例 ( 3 1.7%) ,ALT( 2 10± 98)U/L ;对照组 5 1例 ( 10 .2 %) ,ALT( 112± 68)U/L。戊型肝炎抗体阳性各组ALT异常增高率与对照组间差异有显著性 (P <0 .0 5 ) ,戊型肝炎抗体阳性各组ALT异常增高者ALT值与对照组间差异有显著性 (P <0 .0 5 )。结论　戊型肝炎抗体阳性组ALT异常增高率和增高者ALT值均较对照组有明显增高 ,HEV IgM阳性或重叠乙型肝炎感染较单纯HEV IgG阳性者 ,ALT增高明显     

拉米夫定治疗慢性乙型肝炎2年临床疗效及病毒的变异

研究拉米夫定治疗慢性乙型肝炎病人 2年的临床疗效。方法　 88例病人按 3∶1比例随机分成治疗组和安慰剂组 ,每日服拉米夫定 10 0mg和安慰剂各一片 ,12周以后全部服拉米夫定每日 10 0mg ,持续到 10 4周。定期检测ALT、HBVDNA、HBeAg和抗 HBe。用PCR后直接测序方法检测YMDD变异。结果　 75例病人完成 2年试验。 12周时 ,治疗组和安慰剂组HBVDNA阴转分别为 47例 (80 % )和 4例 (2 1% )。 10 4周时 48例 (6 4% )HBVDNA保持阴转。血清转换 19例 (2 5 .33% ) ,8例 (10 .6 6 % )HBeAg已转阴 ,抗 HBe还未转阳。在治疗前ALT值为 <1ULN、>1～ 2ULN、>2～ 5ULN、>5ULN的病人中 ,血清转换率和e抗原转阴率分别为 5例 (13 .15 % )、6例 (33 .33% )、5例 (38.46 % )、3例(5 0 % )和 6例 (15 .78% )、6例 (33 .33% )、11例 (84.6 0 % )、4例 (6 6 .6 6 % )。治疗前和 10 4周时的ALT中位值分别为(71.82 7± 71.6 2 7)U/L和 (34.2 6 7± 31.415 )U/L(P <0 .0 1)。 36例发生YMDD变异 ,总变异率为 48%。变异和非变异者的ALT中位值分别为 (4 5 .0 5 6± 40 .90 3)U/L和 (2 3.6 2 7± 12 .6 9)U/L(P <0 .0 1)。HBVDNA中位值分别为 (2 86 .6 2 5± 482 .877)和 (10 2 .44 8± 380 .2 5 )mEq/ml。血清HBeAg转阴分别为 10和 17例     

广州市孕妇碘营养状况研究

目的　了解广州市孕妇 (孕中、晚期 )碘营养状况。方法　用砷 -铈接触法测定尿碘 ,用放射免疫分析法 (RIA )测定血清甲状腺素 (T4 )、促甲状腺激素 (TSH )。结果　孕妇孕中期尿碘中位数为 2 4 9.3μg/ L ,<10 0μg/ L者占 4 .5 % ;孕晚期尿碘中位数为 2 4 1.2μg/ L ,<10 0μg/ L者占 12 .5 % ,两期尿碘值差异无显著意义 (P >0 .0 5 )。孕中期血清 T4 (15 7.0± 6 6 .4 ) nmol/ L ,在正常范围 (5 4～ 174 nm ol/ L )者占 5 8.2 % ,超过 174 nmol/ L者占38.8% ;孕晚期血清 T4 (12 4 .4± 5 9.4 ) nm ol/ L ,在正常范围者占 78.3% ,超过 174 nmol/ L者占 13.0 %。孕中期血清 TSH (中位数 3.9m U / L ) <5 m U / L者占 6 5 .7% ,>5 m U / L者占 34.3% ;孕晚期血清 TSH (中位数 6 .9m U / L ) <5 m U/ L者占 18.2 % ,>5 m U / L者占 81.8%。两期自身对照 TSH>5 m U / L与 <5 m U / L人数构成差异有非常显著意义 (P <0 .0 1)。结论　广州市孕妇碘营养状况良好 ;孕晚期血清 TSH>5 m U / L者 (81.8% )较多 ,与尿碘、T4 水平不一致 ,有待进一步研究     

肝硬变合并胆道疾病手术体会(附18例报告)

我院4年来共为18名肝硬变合并胆道疾病患者行手术治疗,无手术死亡,疗效满意,现报告如下。1 临床资料1.1 一般资料 男14例,女4例,年龄40～74岁,平均60.2岁。急诊5例,平诊13例。1.2 临床表现 黄疸12例,疼痛5例,发热3例,休克1例,白细胞升高3例,ALT高于40赖氏单位11例,其中最高530赖氏单位。14名患者脾肿大,其中Ⅰ度肿大8例,Ⅱ度肿大5例,Ⅲ度肿大1例。外周血均减少3例。平诊患者13例,白细胞均在4.0×10~9/L以下。血清白蛋白≥35g/L10例,26～34g/L有8例,18例自球蛋白比值小于正常。18例患者凝血酶原时间均有延长,其中延长1～3秒16例,延长4～6秒2例。手术     

散发性和输血后丙型肝炎临床特点病理变化及HCV-RNA水平的比较

回顾性研究2 6例散发性丙型肝炎(SHC)和35例输血后丙型肝炎(PTHC)患者的临床资料,以比较两者的临床特点、病理变化及HCVRNA水平。SHC组中15例无任何自觉症状,2 2例肝功能反复异常,但仅抗-HCV阳性的14例ALT水平超过10 0U/L ,其他8例一直低于10 0U/L ;PTHC组急性期ALT值均超过2 0 0U/L ,33例反复ALT异常,其中2 1例常高于2 0 0U/L ;SHC组的肝脏病理组织炎症活动程度较PTHC组为轻;SHC组血清HCVRNA含量显著低于PTHC组(P <0 . 0 5 ) ;SHC患者起病隐匿,病情发展缓慢,大多无自觉症状,临床症状的发生率、病毒血症水平、ALT值和肝损害程度均显著低于PTHC患者。     

雷帕霉素在肝脏缺血再灌注损伤中对自噬相关蛋白 ULK1、LC3表达的影响

目的研究雷帕霉素在肝脏缺血再灌注损伤中对自噬相关蛋白ULK1、LC3表达的影响及意义。方法建立3组大鼠肝脏缺血再灌注损伤模型,实验组(n=10)、对照组(n=10)、假手术组(n=10)。分别于术后24、72 h取材:检测血清ALT和AST水平、肝脏病理以及ULK1、LC3 mRNA水平、蛋白水平。计量资料多组间比较采用方差分析,进一步两两比较采用LSD-t检验。结果肝脏缺血再灌注损伤24 h后血清ALT、AST水平升高,肝脏病理结构损伤(F值分别为1531. 83、1799. 97,P值均0. 05),实验组血清ALT[(354. 58±28. 40) U/L vs (556. 15±19. 32) U/L]、AST[(384. 37±8. 98) U/L vs (575. 96±30. 21) U/L]水平较对照组降低(P值均0. 05),肝脏病理结构损伤减轻;术后72 h后实验组血清ALT[(271. 81±8. 63) U/L vs (466. 33±30. 00) U/L]、AST[(358. 92±13. 20) U/L vs (497. 05±40. 14) U/L]水平低于对照组(P值均0. 05)。而术后72 h实验组、对照组血清ALT、AST水平均低于术后24 h(ALT:t=8. 87、7. 92; AST:t=5. 04、5. 34,P值均0. 05)。术后24 h和72 h实验组ULK1、LC3 mRNA水平、蛋白水平较假手术组升高(P值均0. 05),24 h实验组ULK1 mRNA水平(13. 23±6. 58 vs 4. 91±1. 64)、LC3 mRNA水平(7. 82±1. 65vs 3. 70±1. 10)、ULK1蛋白水平(1. 62±0. 19 vs 1. 17±0. 33)、LC3蛋白水平(1. 62±0. 19 vs 0. 84±0. 10)较对照组增加(P值均0. 05); 72 h实验组ULK1 mRNA水平(10. 58±3. 31 vs 4. 83±2. 66)、LC3 mRNA水平(6. 42±1. 13 vs 2. 71±0. 81)、ULK1蛋白水平(1. 29±0. 24 vs 0. 90±0. 29)、LC3蛋白水平(1. 40±0. 73 vs 0. 64±0. 08)较对照组增加(P值均0. 05)。肝脏缺血再灌注损伤72 h后实验组、对照组血清ALT、AST水平较术后24 h降低,并且肝脏病理结构损伤减轻,ULK1、LC3 mRNA水平、蛋白水平降低(P值均0. 05)。结论肝脏缺血再灌注损伤后ULK1、LC3表达增加,雷帕霉素可能在肝脏缺血再灌注损伤过程中通过上调细胞自噬保护肝脏功能。     

血清精氨酸代琥珀酸裂解酶的测定在肝病诊断中的意义

目的探讨血清精氨酸代琥珀酸裂解酶（ASL）对肝病的诊断效能。方法测定291例肝病患者、247例非肝病患者和32名健康对照血清ASL和ALT、AST、GGT、LDH、ALP活性及TBil浓度；其中31例肝病患者进行了病理组织学检查。结果ROC曲线显示ASL对判断肝病的敏感度为100．0％，特异性为91．1％（分界值=8．0U／L）；ALT和AST的敏感度为97．60%和83．8％，特异性仅分别为24．7％和28．3％（分界值=40．0U／L）。ASL在不同肝病的变化情况是肝癌〉急性肝炎〉肝硬化〉慢性肝炎；ASL浓度[（86．9±26．5）u／L]与肝病理组织学炎症活动度计分（9．83±3．36）呈正相关（r=0．417，P=0．019）。结论ASL诊断肝病的敏感度、特异性优于AST和ALT，是肝病诊断的有用指标。     

肺结核患者血清中免疫抑制酸性蛋白变化及其临床意义

目的　探讨肺结核患者血清中免疫抑制酸性蛋白 (IAP)变化及临床应用价值。方法　采用琼脂扩散法检测 336例肺结核患者及对照组血清中免疫抑制酸性蛋白水平。结果　肺结核、健康、非结核呼吸道疾病组血清中IAP分别为 (797± 16 8)、(36 7± 71)、(4 0 4± 75 )mg/L。如果将免疫功能受抑制的阳性界值定在 >5 0 0mg/L ,则 3组的阳性率分别为 96 7%、9 2 %、9 6 % (P <0 0 5 ) ,原发型肺结核、血行播散型肺结核、浸润型肺结核、慢性纤维空洞型肺结核、结核性胸膜炎患者阳性率分别为10 0 0 %、10 0 0 %、96 0 %、98 6 %、96 9%。病情进展期肺结核患者IAP水平明显高于稳定期 ,治疗后病情好转者IAP逐逝下降。结论　测定肺结核患者血清中IAP能较直观反映其免疫抑制状况及病情严重程度 ,并对观察疗效、评判预后具有较好意义。     

低水平丙氨酸氨基转移酶慢性乙型肝炎病毒感染者肝组织病理学变化研究

目的研究血清ALT≤3ULN的乙型肝炎病毒感染者肝组织病理学改变情况。方法选取血清ALT≤3ULN的乙型肝炎病毒感染者71例,在B超引导下行肝穿刺活检术,进行肝组织炎症活动度和肝纤维化程度检查。结果在71例HBV感染者,HBeAg阳性54例,HBeAg阴性17例。血清HBV DNA定量在1×103~105copies/ml 19例(26.8%),106~107copies/ml 34例(47.9%),≥108copies/ml 18例(25.3%)。ALT≤40U/L17例(23.9%),40U/L相似文献   

Subjects with sonographical hepatic steatosis should be excluded from studies to establish upper reference levels of serum transaminases

Background and aims: Correct upper reference limits (URL) of serum liver enzyme activities are used to select individuals in whom further diagnostic procedures for suspected liver disorders are warranted and to compare the prevalence and incidence of increased serum liver enzyme levels within and among populations. We sought to establish URL in a general adult population by not only generating a disease‐free population but also further excluding subjects with ultrasonographical diagnosis of hepatic steatosis. Methods: We used data from 4242 subjects (2154 women) aged 20–79 years recruited for the population‐based Study of Health in Pomerania. A reference population was selected comprising 1953 subjects (1129 women). Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) and γ‐glutamyltransferase (GGT) were measured photometrically. Results: The exclusion of 630 subjects with hepatic steatosis and 20 subjects with equivocal data on liver ultrasound from the reference population predominantly affected the URL for serum ALT and GGT levels in younger age groups. URL for serum ALT, AST and GGT levels were 1.00 μmol/L/s (60 U/L), 0.55 μmol/L/s (33 U/L) and 1.11 μmol/L/s (67 U/L), respectively, in men as well as 0.57 μmol/L/s (34 U/L), μmol/L/s (25 U/L) and μmol/L/s (39 U/L), respectively, in women. Conclusions: URL for serum liver enzyme activities are higher than recommended previously. Creating a reference population for establishing URL for serum liver enzyme activities should include liver ultrasound in order to exclude subjects with subclinical hepatic steatosis.     

Healthy ranges of serum alanine aminotransferase levels in Iranian blood donors

AIM: The healthy ranges for serum alanine aminotransferase (ALT) levels are less well studied. The aim of this study was to define the upper limit of normal (ULN) for serum ALT levels, and to assess factors associated with serum ALT activity in apparently healthy blood donors. METHODS: A total of 1,939 blood donors were included. ALT measurements were performed for all cases using the same laboratory method. Healthy ranges for ALT levels were computed from the population at the lowest risk for liver disease. Univariate and multivariate analyses were performed to evaluate associations between clinical factors and ALT levels. RESULTS: Serum ALT activity was independently associated with body mass index (BMI) and male gender, but not associated with age. Association of ALT with BMI was more prominent in males than in females. Upper limit of normal for non-overweight women (BMI of less than 25) was 34 U/L, and for non-overweight men was 40 U/L. CONCLUSION: Serum ALT is strongly associated with sex and BMI. The normal range of ALT should be defined for male and female separately.     

急性肺血栓栓塞患者血清酶学及肌钙蛋白I的变化

目的观察急性肺血栓栓塞（PTE）患者血清酶学及肌钙蛋白Ⅰ（TnI）的变化，了解其与估测肺动脉收缩压、右心运动功能及预后的关系。方法519例PTE患者来自北京24家医院参与的国家“十五”科技攻关课题——肺栓塞规范化诊治方法的研究。根据2001年5月中华医学会呼吸病学分会制定的《肺血栓栓塞症的诊断与治疗指南（草案）》的诊断标准确定大面积、次大面积、非大面积肺栓塞患者。大面积、次大面积肺栓塞患者采用溶栓治疗，非大面积肺栓塞患者采用抗凝治疗。按中心随机方法将患者分组，应用尿激酶和重组组织型纤溶酶原激活剂及普通肝素和低分子肝素。结果（1）大面积肺栓塞患者治疗前血清丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、肌酸激酶（CPK）、乳酸脱氢酶（LDH）水平[（74±33）、（88±40）、（157±75）、（419±264）U／L]明显高于次大面积肺栓塞患者[（52±21）、（43±18）、（75±30）、（284±176）U／L]和非大面积肺栓塞患者[（38±13）、（35±11）、（78±24）、（239±178）U／L]；（2）非大面积肺栓塞患者应用普通肝素治疗7d后血清ALT[（84±39）U／L]明显高于应用低分子肝素患者[（67±26）U／L]；（3）519例患者中45例肺动脉收缩压≥80mmHg（1mmHg=0．133kPa），治疗前存在右心运动功能减弱169例，预后不良48例。大面积肺栓塞患者中17例（41．5％）AIJT升高，次大面积中76例（45．5％），非大面积中26例（54．5％）。大面积肺栓塞患者中24例（54．4％）LDH升高，次大面积中68例（40．2％），非大面积中15例（30．8％）；（4）39例血清TnI≥0．07μg／L的患者中右心功能减弱24例（63．3％），预后不良者8例（24．2％）。结论（1）急性PTE患者可出现血清ALT、ASF、CPK、LDH水平升高；（2）非大面积肺栓塞患者应用抗凝治疗，普通肝素较低分子肝素更易引起血清ALT升高；（3）血清ALT、LDH以及TnI的升高与PTE患者的肺动脉收缩压、右心运动功能及预后密切相关，其变化可能有助于对急性肺栓塞患者进行危险分层。     

253例低丙氨酸氨基转移酶乙型肝炎病毒感染者临床生化和肝组织病理学分析

目的观察在低丙氨酸氨基转移酶（ALT）水平（〈2×ULN）的慢性HBV感染者中,不同ALT水平感染者临床生化指标和肝脏组织病理学分级的差异。方法根据ALT水平不同,将253例AIJT小于2倍ULN患者分为三组,A组为男性AIJT30U／L和女性ALT≤19U／L（n=74）,B组为男性30U／L〈ALT60U／L和女性19U／L〈ALT≤38U／L（n=119）,和C组为男性60U／L〈ALT80U／L和女．陛38U／L〈ALT≤80U／L（n=60）。观察各组人群血生化指标和肝脏炎症分级（G）和纤维化分期（S）的差异。结果本组A组、B组和C组患者HBeAg阳性率分别为39．2％、47．1％和71．7％（x2=15．1,P〈0．01）;三组患者年龄分别为39．5±11．9岁、34．5±11．4岁和31．6±11．6岁（F=8．1,P=000）;A组血清AST、GGT和AST／血小板比值（APRI）分别为22．9±6．6u／L、31．6±22．9u／L和0．2±0．1,B组分别为36．5±26．7u／L、39．9±30．8u/L和0.3±0．2,C组分别为44．3±11．6u／L、47-3±49．3u／L和0．4±0_3,三组相差显著（P〈O．05）;A组肝组织G2为16．2％,明显低于B组（35．3％）和C组（30．0％,P〈0．05）;3组肝组织肝纤维化程度无显著性相差（P〉O．05）。结论在ALT〈2倍ULN的HBV感染者中,不同AIJT水平者血生化指标和肝组织炎症程度存在差异,需要区别处理。     

Variability among five different commercial IGF-1 immunoassays in conditions of childhood-onset GH deficiency and GH therapy

IGF-1 measurement is used for screening of GH deficiency and monitoring of GH therapy in children. However, several commercial immunoassays are currently used and reference values provided by manufacturers are very different. The aim of this study was to compare commercial IGF-1 assays 1) in terms of absolute values and 2) in terms of clinical interpretation of results based on IGF-1 reference values in serum samples from children with GH therapy, with untreated GH deficiency and with obesity. Serum samples of 9 patients were sent frozen to 5 university hospitals using 5 different IGF-1 assays. The inter-laboratory coefficient of variation (CV) was calculated for the 9 samples. For clinical interpretation, results were expressed as SD scores based on reference values provided by manufacturers (and used in these laboratories). The mean inter-laboratory CV (range) for the 9 serum samples was 25.8% (16.7-35.9%). Major variability was noted in the SD-scores between IGF-1 assays for 3 tested serum samples from GH-treated patients with a difference between the lowest and highest SD score of 2.6 up to 3.2. In conclusion, there is a large variability among commercial IGF-1 immunoassays, not only in terms of absolute values, but also in terms of clinical interpretation in pediatric serum samples. There is a need for IGF-1 immunoassay harmonization and for the establishment of adequate reference values.     

阿德福韦酯治疗HBV野生株与变异株混合感染患者3月疗效观察

目的观察拉米夫定治疗耐药的HBV变异株感染及变异株和野生株混合感染患者在加用阿德福韦酯治疗后的近期疗效。方法在30例拉米夫定治疗耐药的慢性乙型肝炎患者,经荧光定量PCR法检测发现HBV YIDD或YVDD变异株感染者21例,变异株与野生株混合感染者9例。给予他们阿德福韦酯联合拉米夫定治疗3月,观察近期疗效。结果在21例变异株感染患者,治疗前血清HBV DNA水平为6.2±1.4 lgcopies/ml,治疗后降为2.3±2.3lgcopies/ml。ALT水平为138.8±153.2U/L,治疗后降为54.5±44.7U/L。AST水平为119.0±175.6U/L,治疗后降为39.8±32.1U/L;在9例混合性感染患者,HBV DNA基线水平为6.0±1.9 lgcopies/ml,治疗后降为2.4±2.4 lgcopies/ml。ALT基线水平为144.7±128.2 U/L,治疗后降为55.8±53.2 U/L。AST基线水平为114.2±131.1 U/L,治疗后降为42.8±32.3U/L,两组各指标相比,均无统计学差异(P>0.05);在21例变异株感染患者中,治疗后19例(90.5%)HBVDNA转阴,19例(90.5%)ALT复常,在9例混合性感染组,治疗后8例(88.9%)HBV DNA转阴,7例(77.8%)ALT复常(P>0.05)。在变异株感染患者,未发生HBeAg血清转换,而在混合性感染组有37.5%(3/8)发生HBeAg血清转换。结论阿德福韦酯联合拉米夫定治疗变异株感染或野生株与变异株混合感染患者,近期疗效相似。     

Spectrum of NAFLD and diagnostic implications of the proposed new normal range for serum ALT in obese women

The upper limit of normal for ALT activity has been recommended to be lowered to < or = 30 U/L in men and < or = 19 U/L in women. These changes have been suggested to be diagnostically useful in subjects with nonalcoholic fatty liver disease (NAFLD). Our aim was to investigate the prevalence and spectrum of NAFLD with regard to the new ALT guidelines in 233 women with class II/III obesity. We compared our prior reference range for ALT (ULN < or = 30 U/L in women) with the new standard. Our study demonstrates that only 86 patients (36.9%) would be classified as having normal ALT levels compared with 169 patients (72.5%) by the new and old standards, respectively. In patients with normal ALT activity (new vs. old standard), the prevalence of fatty liver (FL: 39.5% vs 40.2%), portal fibrosis, and steatosis (IPF: 37.2% vs. 33.7%) and nonalcoholic steatohepatitis (NASH: 23.3% vs. 26%) were similar. In comparison, newly defined patients with elevated ALT levels (>19 U/L) demonstrated an increased prevalence of FL (36%) and IPF (11.6%) but a 23.8% decrease in the prevalence of NASH as compared with the old standard. The sensitivity and specificity for NASH were 42% and 80% (ALT > 30 U/L) compared with 74% and 42% (ALT > 19 U/L). In conclusion, a significant increase in the prevalence of FL and IPF is detected in subjects with elevated ALT levels with the application of the new standard. However, the diagnostic utility for ALT to identify NASH or IPF remains poor, and significant healthcare expenditures may be incurred if this standard is adopted.     

Significance of hepatitis B core antigen in the liver in patients with chronic hepatitis B and its relation to hepatitis B virus DNA

Liver biopsies from 52 patients with chronic hepatitis B were investigated for the presence and distribution of HBcAg and the results were compared with the status of hepatitis B virus deoxyribonucleic acid (HBV-DNA). The patients consisted of 37 men and 15 women, aged 16-55 years (mean = 34 years). Serum alanine aminotransferase (ALT) was elevated in 50 patients (range: 18-969 U/L; mean = 290 U/L). Serological testing showed HBsAg in all, HBeAg in 45 (87%), and HBV-DNA in 28 (54%). Liver biopsies demonstrated HBcAg in 35 (67%) patients. HBcAg was not only present in 31 of 45 (69%) patients who were seropositive for HBeAg, but also in four of seven (57%) with antibody to HBeAg (anti-HBe). In 28 of 35 (80%) patients with HBcAg in the liver, serum HBV-DNA was detected. However, no serum HBV-DNA was detected in 17 patients who had no detectable HBcAg in the liver. The distribution of HBcAg in the liver was rather cytoplasmic and nuclear than nuclear alone. Among 33 patients with cytoplasmic HBcAg in the liver, 15 (45%) had an evidence of acute exacerbation of hepatitis with marked ALT elevation (range: 168-894 U/L; mean = 385 U/L) and nine patients showed severe chronic active hepatitis and confluent necrosis, histologically. These results indicate that the presence of HBcAg in the liver correlates with the amount of circulating hepatitis B virus as quantified by serum level of HBV-DNA. The predominant cytoplasmic HBcAg in the liver may suggest the possibility of multiple episodes of acute exacerbation and more severe ongoing hepatitis during the clinical course.     

Healthy ranges of serum alanine aminotransferase levels in Tranian blood donors

AIM:The healthy ranges for serum alanine aminotransferase (ALT) levels are less well studied. The aim of this study was to define the upper limit of normal (ULN) for serum ALT levels, and to assess factors associated with serum ALT activity in apparently healthy blood donors.METHODS: A total of 1 939 blood donors were included.ALT measurements were performed for all cases using the same laboratory method. Healthy ranges for ALT levels were computed from the population at the lowest risk for liver disease. Univariate and multivariate analyses were performed to evaluate associations between clinical factors and ALT levels.RESULTS: Serum ALT activity was independently associated with body mass index (BMI) and male gender, but not associated with age. Association of ALT with BMI was more prominent in males than in females. Upper limit of normal for non-overweight women (BMI of less than 25) was 34 U/L,and for non-overweight men was 40 U/L.CONCLUSION: Serum ALT is strongly associated with sex and BMI. The normal range of ALT should be defined for male and female separately.     

亚临床甲状腺功能减退症

亚临床甲状腺功能减退症（甲减）是一种亚临床甲状腺疾病。诊断标准是血清促甲状腺激素（TSH）水平高于正常上限而游离T4水平尚在正常范围。目前全世界亚临床甲减的平均患病率为4％-10％,主要发生在女性和老年人群。桥本甲状腺炎是最常见的病因。其主要的临床危害包括引起血脂异常、导致动脉粥样硬化和冠心病、影响认知功能,还可导致不孕和流产。治疗主要针对血清TSH〉10ml U／L的患者,应用左旋-T4替代治疗。对于血清TSH4～10ml U／L,特别是甲状腺自身抗体阳性者需密切监测。此外,对妊娠期亚临床甲减患者的治疗要求控制TSH〈2．5ml U／L。