Kim Kang Mo, Kim Yoon Jun, Lee Kwang Hyuck, Paek Domyung
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Korean J Hepatol. 2005 Jun;11(2):144-56.
BACKGROUND/AIMS: The liver function tests (LFTs), such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyltranspeptidase (gamma-GT), have been widely used as screening tests but their low positive predictive value can cause many false positive results. To evaluate the clinical usefulness of these tests, we analyzed the serial LFT results for factory workers, and we compared the risk factors for the groups that were divided according to the serial LFT results.
From June 2001 to October 2001, 1223 consecutive healthy workers in a single factory were enrolled in our study; a questionnaire, LFT and liver ultrasonography were done for all the subjects. The previous LFT results were collected from the Annual health examination survey. According to the abnormalities on the serial LFT, the participants were classified into three groups (abnormal-in-both, alternating or, normal-in-both) and the risk factors were compared among these groups using multiple logistic regression analysis.
The prevalence of LFT abnormality on a single test was 16.8%, but on the serial LFT, only 5% of the study participants showed consistent abnormality. The risk factors for the abnormal-in-both group, compared with the alternating group, were liver ultrasonography abnormality such as a fatty liver (odds ratio, 2.2; P=0.026) and a heavy alcohol intake (more than 210 g/week) (odds ratio, 7.2; P=0.064). HBsAg was not a significant risk factor for any of the three groups.
In factory workers having serial LFT abnormalities, alcoholic liver disease could be the principal cause of abnormal LFT. Even if the HBsAg were positive in patients with abnormal LFT, there is the possibility of another causes for LFT abnormalities such as alcoholic liver disease and non-alcoholic steatosis or steatohepatitis.
背景/目的：肝功能检查（LFTs），如天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）和γ-谷氨酰转肽酶（γ-GT），已被广泛用作筛查试验，但其低阳性预测值会导致许多假阳性结果。为评估这些检查的临床实用性，我们分析了工厂工人的系列肝功能检查结果，并比较了根据系列肝功能检查结果划分的各组的危险因素。
2001年6月至2001年10月，我们纳入了一家工厂的1223名连续健康工人；对所有受试者进行问卷调查、肝功能检查和肝脏超声检查。从年度健康检查调查中收集既往肝功能检查结果。根据系列肝功能检查的异常情况，将参与者分为三组（两次均异常、交替异常或两次均正常），并使用多因素逻辑回归分析比较这些组之间的危险因素。
单次检查时肝功能异常的患病率为16.8%，但在系列肝功能检查中，只有5%的研究参与者表现出持续异常。与交替异常组相比，两次均异常组的危险因素为肝脏超声异常，如脂肪肝（比值比，2.2；P=0.026）和大量饮酒（每周超过210克）（比值比，7.2；P=0.064）。乙肝表面抗原（HBsAg）对三组中的任何一组都不是显著的危险因素。
在系列肝功能检查异常的工厂工人中，酒精性肝病可能是肝功能异常的主要原因。即使肝功能异常患者的HBsAg呈阳性，也有可能存在其他导致肝功能异常的原因，如酒精性肝病和非酒精性脂肪变性或脂肪性肝炎。
