从单项筛检ALT结果看常见肝病的“过度诊断”与“过度治疗”

在临床上单项筛检血清丙氨酸转氨酶（ALT）是初步判断肝细胞为主的病理损害的敏感而有效的方法。广州铁路疾病预防控制中心对14639例受检者进行血清ALT测试,结果134例超标,占总受检人群的0．92％,说明不到l％的人群需要进一步观察或诊治。然而在医疗实践中,由于种种原因导致血清ALT超标而被动接受“过度诊断”和“过度治疗”的肝病相关人群是极其常见的。本文通过客观分析国内肝病“过度诊断”和“过度治疗”的现状,提出解决这一问题的临床决策策略,为临床医生提供可资借鉴的参考依据。

A look at common overdiagnosis and overtreatment of hepatosis based on single ALT screening results

Single detection of serum alanine aminotransferase （ALT） is a preliminary sensitive and effective clinical method for finding out pathological damage of liver cells. Among 14 639 cases that were tested for single ALT in Guangzhou Railway Center of Disease Control and Prevention, 134 cases were found with the results exceeding the reference value. They accounted for 0.92% of all the cases. This meant that less than 1% of the population needed further observation or treatment. However, it is extremely common that patients receive passive excessive diagnosis and treatment for their serum ALT exceeds limits due to various reasons. This paper objectively analyzed the current situation of overdiagnosis and overtreatment of liver diseases in China and put forward some clinical strategies to solve this problem. The authors hope to provide some reference suggestions for clinicians.