Chang Yoosoo, Ryu Seungho, Sung Eunju, Jang Yumi
Health Screening Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Clin Chem. 2007 Apr;53(4):686-92. doi: 10.1373/clinchem.2006.081257. Epub 2007 Feb 1.
In nonalcoholic fatty liver disease (NAFLD), increased alanine aminotransferase (ALT) concentrations are considered to be a consequence of hepatocyte damage. We performed a prospective study to examine the association between ALT within its reference interval and risk for subsequent development of NAFLD.
The study cohort comprised 5237 healthy men without diagnosed NAFLD and without increases of either ALT (> or =35 U/L) or gamma-glutamyltransferase (GGT; > or =40 U/L) above the reference intervals. We assessed alcohol intake via self-reporting (questionnaire) and performed biochemical tests for liver and metabolic function and abdominal ultrasonography. We used the Cox proportional hazards model to calculate the adjusted hazard ratios (aHRs) in the model for NAFLD.
During 13 276.6 person-years of follow-up over a 4-year period, 984 new incident cases of NAFLD developed. We adjusted for age, weight change, body mass index, glucose, blood pressure, triglycerides, HDL cholesterol, smoking, alcohol consumption, regular exercise, homeostasis model assessment of insulin resistance, C-reactive protein, and incident diabetes. Compared with an ALT concentration of <16 U/L, aHR values (95% confidence intervals) for ALT concentrations were 1.53 (1.18-1.98), 1.66 (1.29-2.13), 1.62 (1.26-2.08), and 2.21 (1.73-2.81) for ALT concentrations of 16-18, 19-21, 22-25, and 26-34 U/L, respectively. This relationship remained significant even among normal-weight participants who were still within the reference interval of ALT and GGT at all follow-up examinations.
In apparently healthy, nondiabetic Korean men, increased ALT concentration, even within the reference interval, was an independent predictor of incident NAFLD.
在非酒精性脂肪性肝病(NAFLD)中,丙氨酸氨基转移酶(ALT)浓度升高被认为是肝细胞损伤的结果。我们进行了一项前瞻性研究,以检验参考区间内的ALT与后续发生NAFLD风险之间的关联。
研究队列包括5237名未诊断出NAFLD且ALT(≥35 U/L)或γ-谷氨酰转移酶(GGT;≥40 U/L)均未高于参考区间的健康男性。我们通过自我报告(问卷)评估酒精摄入量,并进行肝脏和代谢功能的生化检测以及腹部超声检查。我们使用Cox比例风险模型计算NAFLD模型中的调整后风险比(aHRs)。
在4年期间的13276.6人年随访中,出现了984例新的NAFLD病例。我们对年龄、体重变化、体重指数、血糖、血压、甘油三酯、高密度脂蛋白胆固醇、吸烟、饮酒、规律运动、胰岛素抵抗的稳态模型评估、C反应蛋白和新发糖尿病进行了校正。与ALT浓度<16 U/L相比,ALT浓度为16 - 18、19 - 21、22 - 25和26 - 34 U/L时的aHR值(95%置信区间)分别为1.53(1.18 - 1.98)、1.66(1.29 - 2.13)、1.62(1.26 - 2.08)和2.21(1.73 - 2.81)。即使在所有随访检查中体重正常且仍处于ALT和GGT参考区间内的参与者中,这种关系仍然显著。
在表面健康、非糖尿病的韩国男性中,即使ALT浓度在参考区间内升高,也是新发NAFLD的独立预测因素。