新兵二次复检无症状谷丙转氨酶升高的原因分析

Analysis of The Causes of Asymptomatic ALT Increase during The Second Recheck of Qualified Recruits

目的探讨初筛合格的入伍新兵二次复检时无症状谷丙转氨酶(ALT)升高的原因,为新兵的体格复检和终极鉴定工作提供指导。方法对笔者所在医院2009年—2018年连续10年进行二次复检的286例无症状ALT升高新兵的临床资料进行回顾性分析。结果286例中,男283例,女3例,平均年龄19.1岁。仅ALT升高59例,ALT波动范围52~165 U/L;ALT、AST同时升高227例,ALT波动范围54~321 U/L,AST波动范围48~179 U/L。非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)和一过性肝损伤发病率最高,分别为127例(44.4%)、110例(38.5%),且有逐年上升趋势,其他原因所致肝损伤47例(16.4%)、病毒性肝炎2例(0.7%),呈逐年递减趋势。结论NAFLD和一过性肝损伤为新兵无症状ALT升高的两大主要原因。针对无症状ALT升高的入伍新兵,应详细询问病史,全面细致检查,必要时可反复复查,综合各种情况做出正确结论,保证退兵工作万无一失。

Objective To explore the causes of asymptomatic ALT increase during the second re-examination of newly recruited qualified recruits,and to provide guidance for the re-examination and final identification of recruits.Methods The clinical data of 286 recruits with asymptomatic ALT elevation who were reexamined for 10 consecutive years in our hospital from 2009 to 2018 were retrospectively analyzed.Results Among the 286 people,283 were male and 3 were female,with an average age of 19.1 years.Only 59 cases of ALT increased,ALT fluctuation range was 52-165 U/L;227 cases of ALT and AST increased simultaneously,ALT fluctuation range was 54-321 U/L,AST fluctuation range was 48-179 U/L.The incidence of non-alcoholic fatty liver disease(NAFLD)and transient liver injury was the highest,with 127 cases(44.4%)and 110 cases(38.5%)respectively,and there was an upward trend year by year,other reasons 47 cases(16.4%)of liver injury and 2 cases(0.7%)of viral hepatitis decreased year by year.Conclusion NAFLD and transient liver injury are the two main causes of asymptomatic ALT increase in recruits.For recruits recruited without asymptomatic ALT,they should ask for a detailed medical history and conduct a comprehensive and detailed examination.If necessary,they can be re-examined repeatedly to make a correct conclusion based on various situations to ensure that the withdrawal of troops is foolproof.