血清谷丙转氨酶在正常范围内对非酒精性脂肪性肝病的预测

Predictive significance of normal serum alanine aminotransferase in patients with nonalcoholic fatty liver disease

目的:分析血清谷丙转氨酶(ALT)与非酒精性脂肪性肝病(NAFLD)之间的关系,探讨正常范围ALT对NAFLD发生的预测价值.方法:选择2006-04-07/2010-01-09湖南省人民医院体检个体共4076例,排除过量饮酒、乙肝标志物阳性、严重感染及MS资料不全者,共2830例纳入研究,其中1367例在1-3年后再次体检.B超诊断NAFLD,记录身高、体质量、血压、血脂、外周血白细胞计数、尿酸、空腹血糖及ALT.将ALT正常个体(n=2445)四分位为A、B、C、D4组,上四分位组为D组,下四分位组为A组,比较4组代谢特征.将随访个体(n=1367)中ALT正常个体(n=1183)四分位为E、F、G、H4组,上四分位组为H组,下四分位组为E组,比较随访后4组NAFLD发病情况.结果:与非NAFLD组相比,NAFLD组患者ALT升高(36.57±26.17vs25.29±24.27,P<0.05);与A组比较,D组NAFLD患病率增高(44.26%vs19.38%,P<0.05);与A组比较,D组收缩压(125.93±18.43vs123.00±19.81,P<0.05)、舒张压(80.77±11.61vs76.65±11.36,P<0.05)、体质量指数(24.94±2.80vs22.67±3.01,P<0.05)、三酰甘油(2.00±1.47vs1.41±0.89,P<0.05)、空腹血糖(5.38±1.53vs5.16±1.26,P<0.05)及外周血白细胞计数增高(6.43±151vs5.99±1.50,P<0.05),高密度脂蛋白降低(1.36±0.36vs1.50±0.39,P<0.05).随访1-3年后(n=1367),H组NAFLD发病率高于E组(28.67%vs13.04%,OR=2.679,95%CI:1.610-4.457,P<0.05).G组NAFLD发病率高于E组(26.67%vs13.04%,OR=2.424,95%CI:1.494-3.935,P<0.05).F组NAFLD发病率高于E组(20.09%vs13.04%,OR=1.676,95%CI:1.024-2.745,P<0.05).结论:NAFLD患者血清谷丙转氨酶升高.在正常范围内,ALT的升高可预测NAFLD的发生.

AIM： To investigate the predictive significance of normal serum alanine aminotransferase （ALT） in patients with nonalcoholic fatty liver disease （NAFLD）.METHODS： Ultrasonography was used to diagnose cholecystolithiasis in 4 076 subjects who underwent routine health examination in the People’s Hospital of Hunan Province from April 2006 to January 2010.A total of 2 830 subjects were enrolled,of them 1 367 were followed up for 1-3 years.Body height,body weight,blood pressure,lipid profile,ALT,white blood cell（WBC） count,and fasting blood glucose were tested.Individuals with normal serum ALT were divided into four groups according to the quartile of ALT from the lowest to the highest： A,B,C and D.Those with normal serum ALT were also divided into four groups according to the quartile of ALT from the lowest to the highest： E,F,G and H.RESULTS： Compared with subjects without NAFLD,the mean level of ALT in patients with NAFLD was higher （36.57 ± 26.17 vs 25.29 ± 24.27,P 〈0.05）.Compared with group A,the prevalence of NAFLD was higher in group D （44.26% vs 19.38%,P〈 0.05）.Compared with group A,the levels of diastolic blood pressure （125.93 ± 18.43 vs 123.00 ± 19.81,P 〈0.05）,systolic blood pressure （80.77 ± 11.61 vs 76.65 ± 11.36,P 〈0.05）,body mass index （24.94 ± 2.80 vs 22.67 ± 3.01,P 〈0.05）,triglyceride （2.00 ± 1.47 vs 1.41 ± 0.89,P〈 0.05）,fasting blood glucose （5.38 ± 1.53 vs 5.16 ± 1.26,P〈 0.05）,WBC count （6.43 ± 151 vs 5.99 ± 1.50,P〈 0.05） were much higher in group D,while the level of high density lipoprotein was signif icantly lower （1.36 ± 0.36 vs 1.50 ± 0.39,P 〈0.05）.During 1 to 3 years of follow-up,the incidence of NAFLD was signifi cantly higher in group H than in group E （28.67% vs 13.04%,OR = 2.679;95% CI： 1.610-4.457;P〈 0.05）,in group G than in group E （26.67% vs 13.04%,OR = 2.424;95% CI： 1.494-3.935;P〈 0.05）,and in group F than in group E （20.09% vs 13.04%,OR = 1.676;95% CI： 1.024-2.745;P〈 0.05）.CONCLUSION： The levels of serum ALT in patients with NAFLD are higher than those without NAFLD.Even within normal range,elevated ALT can be used as a predictive parameter for NAFLD.