서병성,김동일, 홍영습, 정갑열*, 신해림*, 김준연*

강북삼성병원 산업의학과, 동아대학교 산업의학과*


Background : This study was to assess the adequacy of liver function testing items used for the periodic health examination of workers according to the Industrial Safety and Health Act.


Methods : All 1st and 2nd(re-examination of liver function tests which results were abnormal) liver function testing items incorporated in the proposed governmental regulations were conducted, as an initial examination, on clerical workers in 51 factories located in the Seoul and Kyung-gi areas between January 1st, 1998 and December 31th, 1999. Subjects who showed abnormal values on liver function testing were included in the study. 52,509 subjects (33,414 males and 19,095 females) were enrolled in the 1st study and 3,552(3,365 males and 187 females) in the 2nd study, which involved liver function testing.

Results : Statistically significant, though small, differences were found between the mean values of liver function tests conducted on the same subjects in 1998 and 1999, except for ALT and ALP(p<0.01). Correlation coefficients between liver function testing items conducted in 1998 and 1999 were statistically significant(p<0.01). Values obtained during 2nd liver function tests on the same re-examined subjects were significantly lower than those obtained during the 1st test, except for total bilirubin and direct bilirubin levels, and all correlation coefficients between tests, except AFP, were statistically signifiant(p<0.05). In the re-examination of liver function test in the 1998 and 2nd examination in the 1999, the normalized proportion of subjects who were judged as having abnormal liver function in 1998 and 1st examination in 1999 were 73.7 % and 56.0 % for AST, 58.9 % and 25.8 % for ALT, and 50.7 % and 36.6 % for γ-GT, respectively.

Conclusions : It would appear that, albumin, protein, and AFP in the male, and γ-GT, albumin, protein, and ALP in the female - are unsuitable 1st or 2nd liver function testing items, because the number of results which were abnormal was low. The re-examination of AST, ALT and γ-GT in subjects who were judged as abnormal during the first examination, showed that the results had normalized in more than half. Therefore, adding AST, ALT, and γ-GT tests to the 2nd periodic health examination, would much reduce the possibility of misjudging the liver function.

Key words : periodic health examination, liver function testing items, adequacy