咖啡、肝硬化与转氨酶

Coffee, cirrhosis, and transaminase enzymes.

作者信息

Klatsky Arthur L, Morton Cynthia, Udaltsova Natalia, Friedman Gary D

机构信息

Division of Research, Department of Medicine, Kaiser Permanente Medical Care Program, Oakland, Calif 94611, USA.

出版信息

Arch Intern Med. 2006 Jun 12;166(11):1190-5. doi: 10.1001/archinte.166.11.1190.

DOI:10.1001/archinte.166.11.1190

PMID:16772246

Abstract

BACKGROUND

A minority of persons at risk develop liver cirrhosis, but knowledge of risk modulators is sparse. Several reports suggest that coffee drinking is associated with lower cirrhosis risk.

METHODS

We studied 125,580 multiethnic members of a comprehensive prepaid health care plan without known liver disease who supplied baseline data at voluntary health examinations from 1978 to 1985. Subsequently, through 2001, 330 of them were diagnosed with liver cirrhosis. Review of medical records confirmed the diagnosis of cirrhosis and ascertained probable etiology. The association of coffee drinking with cirrhosis was estimated by Cox proportional hazards models with 7 covariates. We also did a cross-sectional analysis of baseline aspartate aminotransferase and alanine aminotransferase levels, studied by logistic regression.

RESULTS

In the cohort study, relative risks of alcoholic cirrhosis (199 subjects) for coffee drinking (vs none) were less than 1 cup per day, 0.7 (95% confidence interval [CI], 0.4-1.1); 1 to 3 cups, 0.6 (95% CI, 0.4-0.8; P<.001); and 4 or more cups, 0.2 (95% CI, 0.1-0.4; P<.001). For 131 subjects with nonalcoholic cirrhosis, relative risks were less than 1 cup, 1.2 (95% CI, 0.6-2.2); 1 to 3 cups, 1.3 (95% CI, 0.8-2.1); and 4 or more cups, 0.7 (95% CI, 0.4-1.3). These relative risks for coffee drinking were consistent in subsets. Tea drinking was unrelated to alcoholic or nonalcoholic cirrhosis. In the cross-sectional analyses, coffee drinking was related to lower prevalence of high aspartate aminotransferase and alanine aminotransferase levels; for example, the odds ratio of 4 or more cups per day (vs none) for a high aspartate aminotransferase level was 0.5 (95% CI, 0.4-0.6; P<.001) and for a high alanine aminotransferase level, 0.6 (95% CI, 0.6-0.7; P<.001), with stronger inverse relations in those who drink large quantities of alcohol.

CONCLUSION

These data support the hypothesis that there is an ingredient in coffee that protects against cirrhosis, especially alcoholic cirrhosis.

摘要

背景

少数有风险的人会发展为肝硬化，但对风险调节因素的了解却很少。几份报告表明，喝咖啡与较低的肝硬化风险相关。

方法

我们研究了125580名参加综合预付医疗保健计划的多民族成员，他们均无已知肝病，于1978年至1985年自愿参加健康检查时提供了基线数据。随后，到2001年，其中330人被诊断为肝硬化。病历审查证实了肝硬化的诊断并确定了可能的病因。通过带有7个协变量的Cox比例风险模型估计喝咖啡与肝硬化之间的关联。我们还对基线天冬氨酸转氨酶和丙氨酸转氨酶水平进行了横断面分析，并采用逻辑回归进行研究。

结果

在队列研究中，对于饮酒性肝硬化（199名受试者），喝咖啡（与不喝咖啡相比）的相对风险如下：每天少于1杯，0.7（95%置信区间[CI]，0.4 - 1.1）；1至3杯，0.6（95%CI，0.4 - 0.8；P <.001）；4杯或更多杯，0.2（95%CI，0.1 - 0.4；P <.001）。对于131名非酒精性肝硬化患者，相对风险如下：少于1杯，1.2（95%CI，0.6 - 2.2）；1至3杯，1.3（95%CI，0.8 - 2.1）；4杯或更多杯，0.7（95%CI，0.4 - 1.3）。这些喝咖啡的相对风险在各亚组中是一致的。喝茶与酒精性或非酒精性肝硬化无关。在横断面分析中，喝咖啡与天冬氨酸转氨酶和丙氨酸转氨酶高水平的患病率较低相关；例如，每天喝4杯或更多杯（与不喝相比）时，天冬氨酸转氨酶水平高的比值比为0.5（95%CI，0.4 - 0.6；P <.001），丙氨酸转氨酶水平高的比值比为0.6（95%CI，0.6 - 0.7；P <.001），在大量饮酒者中这种负相关关系更强。