ALT als Screeningparameter für Lebererkrankungen: eine kritische Evaluation der Evidenz

Zusammenfassung

Erhöhte Serum-Aminotransferasen können eine Leberschädigung anzeigen. Dementsprechend wird im Rahmen von Screeninguntersuchungen bei Verdacht auf Lebererkrankungen eine Bestimmung der Aspartat-Aminotransferase (AST) und Alanin-Aminotransferase (ALT) durchgeführt. Ziel der vorliegenden Arbeit ist es, die Evidenz für ALT-Bestimmungen als Screeningtest für Leberkrankungen kritisch zu hinterfragen. Zusammenfassend stellen wir fest, dass 1. erhöhte Serum-ALT-Werte mit hoher Spezifität und guter Sensitivität Lebererkrankungen anzeigen, 2. 10 – 25 % der erwachsenen deutschen Bevölkerung erhöhte ALT-Werte aufweisen, 3. ALT-Werte bei vielen, aber nicht bei allen Patienten mit Lebererkrankungen erhöht sind, 4. erhöhte ALT-Werte mit einer erhöhten leberspezifischen Mortalität assoziiert sind, 5. erhöhte ALT Werte auch als Risikofaktor für primär nicht hepatische Erkrankungen wie Diabetes Mellitus Typ 2, metabolisches Syndrom, kardiovaskuläre Erkrankungen und Tumorerkrankungen angesehen werden müssen, 6. für viele Lebererkrankungen, die mit einem ALT-Screening identifiziert werden, effiziente Therapien vorliegen, die klinische Endpunkte verhindern können, 7. ALT-Testungen wahrscheinlich kosteneffektiv sind, wobei hier allerdings weitere Studien für Deutschland notwendig sind.

Abstract

Elevated serum amino-transferase levels may be associated with liver injury. Testing for aspartate aminotransferase (AST) or alanine aminotransferase (ALT) is part of many routine screening approaches. The aim of this manuscript was to scrutinize the evidence for using ALT testing as a primary screening parameter for liver diseases. We conclude that (i) elevated serum ALT levels indicate a high specificity and a reasonable sensitivity liver injury, (ii) 10 – 25 % of German adults have elevated ALT levels, (iii) ALT values are increased in the majority but not all patients with acute and chronic liver disease (iv) elevated ALT-values are associated with an increased risk of liver-specific mortality, (v) elevated ALT values are also a risk factor for non-hepatic diseases including diabetes mellitus type 2, metabolic syndrome, cardiovascular diseases and malignancies, (vi) many liver diseases identified by an ALT screening can be treated successfully including prevention of development of clinical endpoints, (vii) an ALT-screening is very likely to be cost-effective although studies are needed for Germany to support this conclusion.

Schlüsselwörter

Leber - Virushepatitis - Autoimmunhepatitis

Key words

liver - viral hepatitis - autoimmune hepatitis

Literatur

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