Analysis of risk factors and establishment of predictive model for elevated ALT in adult patients with nonalcoholic fatty liver disease

Objective:To explore the risk factors of elevated alanine aminotransferase(ALT)in patients with nonalcoholic fatty liver disease(NAFLD),and to establish a risk prediction model of elevated ALT in patients with NAFLD.Methods:A total of 200 NAFLD subjects were enrolled in Health Examination Center of China-Japan Friendship Hospital in Beijing. The relevant clinical indexes and TCM tongue picture data were collected standardizedly. According to the elevation of ALT,the patients were divided into ALT elevation group and ALT normal group. The independent risk factors of ALT elevation were obtained by logistic regression analysis. Based on this,the logistic regression prediction model of ALT elevation in NAFLD patients was established,and the calibration of the model was evaluated by Hosmer-Lemshow goodness-of-fit test. The area under the subject’s working characteristic curve(AUROC)was used to test the discrimination of the model. Results:The multivariate logistic regression analysis showed that the OR value of male,obesity,elevated total cholesterol(TC),elevated triglyceride(TG)and prickly tongue were 6.059,2.216,2.649,2.106,3.646,respectively,and the P-values were all < 0.05. The AUROC of logistic regression prediction Model 1(without prickly tongue)and Model 2(including prickly tongue)were 0.771(95%CI:0.703-0.840)and 0.801(95%CI:0.736-0.866),respectively,and the maximum Youden index,sensitivity and specificity were 0.414,0.829,0.585 and 0.478,0.686,0.792,respectively. Conclusion:Male,obesity,elevated TC,elevated TG and prickly tongue were independent risk factors for elevated ALT in NAFLD patients. This study established an integrated traditional Chinese and Western medicine model that includes the tongue characteristics,which have certain clinical value in predicting the risk of elevated ALT in patients with NAFLD,and are worth popularizing and applying.