天冬氨酸氨基转移酶与丙氨酸氨基转移酶的比值：在区分非酒精性脂肪性肝炎与酒精性肝病中的潜在价值。

The ratio of aspartate aminotransferase to alanine aminotransferase: potential value in differentiating nonalcoholic steatohepatitis from alcoholic liver disease.

作者信息

Sorbi D, Boynton J, Lindor K D

机构信息

Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA.

出版信息

Am J Gastroenterol. 1999 Apr;94(4):1018-22. doi: 10.1111/j.1572-0241.1999.01006.x.

DOI:10.1111/j.1572-0241.1999.01006.x

PMID:10201476

Abstract

OBJECTIVE

The ratio of aspartate aminotransferase (AST) to alanine aminotransferase (ALT) is often greater than 2:1 in alcoholic hepatitis. The purpose of this study was to determine whether this ratio may be used to distinguish nonalcoholic steatohepatitis (NASH) from alcoholic liver disease.

METHODS

Patients with NASH were matched with controls with alcoholic liver disease based on age, gender, and date of diagnosis. The diagnosis of alcoholic liver disease was based on exclusion of other causes and a significant history of alcohol consumption. The diagnosis of nonalcoholic steatohepatitis was based on exclusion of other causes of liver disease and a liver biopsy showing > 10% steatosis and inflammation. The two sided Student t test was used for statistical analysis.

RESULTS

From 1990 to 1996, 70 patients with NASH were matched with 70 subjects with alcoholic liver disease. Patients with NASH had a mean AST to ALT ratio of 0.9 (range 0.3-2.8, median 0.7) and subjects with alcoholic liver disease a mean ratio of 2.6 (range 1.1-11.2, median 2.0). The mean AST levels were 66 U/L and 152 U/L, and the mean ALT levels 91 U/L and 70 U/L, in the nonalcoholic steatohepatitis and alcoholic liver disease groups, respectively. Although the absolute aminotransferase levels were significantly different in the two groups (p < 0.05), the greatest difference was observed in the AST to ALT ratio (p < 0.000001). Subset analysis of patients with NASH revealed mean AST to ALT ratios of 0.7, 0.9, and 1.4 for subjects with no fibrosis, mild fibrosis, or cirrhosis, respectively. The differences among these ratios were statistically significant (p < 0.05).

CONCLUSIONS

The AST to ALT ratio appears to be a useful index for distinguishing nonalcoholic steatohepatitis from alcoholic liver disease. Although values < 1 suggest NASH, a ratio of > or = 2 is strongly suggestive of alcoholic liver disease.

摘要

目的

在酒精性肝炎中，天冬氨酸转氨酶（AST）与丙氨酸转氨酶（ALT）的比值通常大于2:1。本研究旨在确定该比值是否可用于区分非酒精性脂肪性肝炎（NASH）与酒精性肝病。

方法

根据年龄、性别和诊断日期，将NASH患者与酒精性肝病患者进行匹配。酒精性肝病的诊断基于排除其他病因以及大量饮酒史。非酒精性脂肪性肝炎的诊断基于排除其他肝病病因以及肝活检显示脂肪变性和炎症>10%。采用双侧Student t检验进行统计分析。

结果

1990年至1996年，70例NASH患者与70例酒精性肝病患者相匹配。NASH患者的AST与ALT平均比值为0.9（范围0.3 - 2.8，中位数0.7），酒精性肝病患者的平均比值为2.6（范围1.1 - 11.2，中位数2.0）。非酒精性脂肪性肝炎组和酒精性肝病组的平均AST水平分别为66 U/L和152 U/L，平均ALT水平分别为91 U/L和70 U/L。虽然两组间绝对转氨酶水平有显著差异（p < 0.05），但AST与ALT比值差异最大（p < 0.000001）。对NASH患者的亚组分析显示，无纤维化、轻度纤维化或肝硬化患者的AST与ALT平均比值分别为0.7、0.9和1.4。这些比值之间的差异具有统计学意义（p < 0.05）。