非酒精性脂肪肝患者ALT升高相关危险因素分析

Analysis of the Related Risk Factors for Elevated ALT Level in Patients with Non-Alcoholic Fatty Liver Diseases

目的分析非酒精性脂肪肝(non-alcoholic fatty liver diseases,NAFLD)ALT升高相关危险因素。方法选择非酒精性脂肪肝ALT升高患者56例(男性25例,女性31例)与ALT正常患者153例(男性64例,女性89例),正常人群160例(男性80例,女性80例)。应用速率法测定ALT,酶法测定总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、尿酸(UA),比浊法测定游离脂肪酸(FFA)。将ALT与TC,TG,LDL-C,HDLC,UA,FFA进行spearman相关分析,并利用二元Logistic回归分析ALT升高的危险因素。结果尽管男性与女性非酒精性脂肪肝患者(包括ALT升高与ALT正常组)TC,TG,LDL-C,U A,FF A水平明显高于正常组,HDL-C明显低于正常组,差异具有统计学意义。但是,Logistic回归分析与Spearman相关分析显示只有UA与FFA为ALT升高的危险因素,并与ALT呈显著的正相关。男性UA,FFA异常分别可使ALT升高危险性增加3.96倍(95CI%=1.40~11.22,P=0.010)与3.27倍(95%CI=1.14~9.40,P=0.028),二者与ALT相关系数分别为0.40(P=0.000),0.29(P=0.006);女性UA,FFA升高,ALT升高Exp(B)值则分别为4.49(95CI%=1.79~11.28,P=0.001)与3.17(95CI%=1.25~8.04,P=0.015),相关系数分别为0.34(P=0.000),0.27(P=0.003)。结论非酒精性脂肪肝ALT升高并非与血脂异常相关而是与UA,FFA水平相关,二者可以作为预测肝损程度的候选指标。

Objective To analysis the risk factors for elevated ALT level in patients with Non-alcoholic fatty liver diseases （NAFLD）. Method Fifty-six （male 25 ,female 31） NAFLD patients with elevated ALT and 153 NAFLD patients （male 64, female 89） with normal ALT and 160 （male 80, female 80） health subjects were selected. ALT was detected by rate assay, total cholesterol （TC）, triglycerides （TG）, low-density lipoprotein cholesterols （LDL-C）, high-density cholesterol （HDL-C） and uric acid （UA） were detected by enzymatic method. Free fatty acid （FFA） was detected by immunoturbidimetry assay. Spearman correlation was used to analysis the relation between ALT and TC, TG, LDL-C, HDL-C,UA and FFA. Logistic regression was used to analyses the risk factor for elevated ALT level. Results TC,TG,LDL-C,UA and FFA levels were significantly higher in NAFLD group （including normal ALT group and elevated ALT group） than those in health group no matter male and female, HDL-C was significantly lower in these two groups when compared to control group,hut binary logistic regression and spearman analysis showed that only UA and FFA were the risk factors for elevated ALT level and significantly positively correlated with ALT level, abnormal UA and FFA for male were associated with 3.96-fold（95CI% = 1.40-11.22,P= 0. 010） and 3.27-fold（ 95% CI = 1.14 - 9.40, P = 0. 028） of increased risk of elevated ALT level respectinely,correlation coefficient were 0.40（P=0. 000） ,0.29（P=0. 006） ,Meanwhile Exp（B） of elevated ALT level for female with abnormal UA,FFA were 4.49 （95CI%=1.79-11.28,P=0. 001） and 3.17 （95CI%=1.25-8.04,P=0. 015）, correlation coefficient were 0.34 （P = 0. 000）, 0.27 （P = 0. 003）. Conclusion Elevated ALT level was not associated with dyslipidemias,but related to UA and FFA. They can be used as candidate markers for predicting severity of liver damage.