Chen Chien-Hua, Huang Min-Ho, Yang Jee-Chun, Nien Chiu-Kue, Yang Chi-Chieh, Yeh Yung-Hsiang, Yueh Sen-Kou
Digestive Disease Center, Changhua Show-Chwan Memorial Hospital, Changhua, Taiwan.
J Gastroenterol Hepatol. 2007 Sep;22(9):1482-9. doi: 10.1111/j.1440-1746.2006.04615.x.
The prevalence and etiologies of elevated alanine aminotransferase (ALT) have geographic variations and they are rarely reported in Taiwan. Through a population-based screening study, the prevalence and etiologies of elevated ALT in an adult population of Taiwan were assessed.
A cross-sectional community study in a rural village of Taiwan was conducted in 3260 Chinese adults (age >or=18 years) undergoing ultrasonography (US), blood tests, and interviews with a structured questionnaire. The diagnostic criteria of non-alcoholic fatty liver disease (NAFLD) included alcohol intake <20 g/week for women or <30 g/week for men, negative hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, no known etiologies of liver disease, and US consistent with fatty liver.
The prevalence of elevated ALT was 11.4% (372/3260). The probable cause of this elevation was excess alcohol consumption in 0.8%, HBV in 28.5%, HCV in 13.2%, both HBV and HCV in 2.2%, NAFLD in 33.6%, and unexplained cause in 21.8%. The etiologic distribution of elevated ALT was similar in both genders, although elevation was more common in men compared to women (17.3%vs 6.1%, P < 0.05). The prevalence of elevated ALT in NAFLD was 18.1% (125/691), and the positive predictive value was 33.6% (125/372). The development of NAFLD was related to increasing age (age between 40 years and 64 years, odds ratio [OR] 1.59, 95% confidence interval [CI]: 1.25-2.01; age >or= 65 years, OR 1.46, 95%CI: 1.08-1.96), fasting plasma glucose (FPG) >or= 126 mg/dL (OR 1.54, 95%CI: 1.11-2.14), body mass index (BMI) >or= 25 kg/m(2) (OR 5.01, 95%CI: 4.13-6.26), triglyceridemia >or= 150 mg/dL (OR 1.96, 95%CI: 1.58-2.42), and hyperuricemia (OR 1.50, 95%CI: 1.22-1.84). Elevated ALT was related to male gender, BMI >or= 25 kg/m(2), and triglyceridemia >or= 150 mg/dL in subjects without known etiologies of liver disease (all P < 0.05).
Non-alcoholic fatty liver disease appears to be the commonest cause of elevated ALT and presumed liver injury in Taiwan. The development of NAFLD is closely associated with many metabolic disorders. Metabolic disorders are also related to elevated ALT in subjects without known etiologies of liver disease.
丙氨酸氨基转移酶（ALT）升高的患病率及病因存在地域差异，而台湾地区对此鲜有报道。通过一项基于人群的筛查研究，评估台湾成年人群中ALT升高的患病率及病因。
在台湾一个乡村开展了一项横断面社区研究，纳入3260名成年中国人（年龄≥18岁），进行超声检查（US）、血液检测，并采用结构化问卷进行访谈。非酒精性脂肪性肝病（NAFLD）的诊断标准包括女性每周酒精摄入量<20 g，男性每周酒精摄入量<30 g，乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）感染阴性，无已知肝脏疾病病因，且超声检查符合脂肪肝表现。
ALT升高的患病率为11.4%（372/3260）。ALT升高可能的病因中，过量饮酒占0.8%，HBV感染占28.5%，HCV感染占13.2%，HBV和HCV合并感染占2.2%，NAFLD占33.6%，不明原因占21.8%。ALT升高的病因分布在男女两性中相似，不过男性升高更为常见，与女性相比差异有统计学意义（17.3%对6.1%，P<0.05）。NAFLD中ALT升高的患病率为18.1%（125/691），阳性预测值为33.6%（125/372）。NAFLD的发生与年龄增长（40至64岁，比值比[OR]1.59，95%置信区间[CI]：1.25 - 2.01；年龄≥65岁，OR 1.46，95%CI：1.08 - 1.96）、空腹血糖（FPG）≥126 mg/dL（OR 1.54, 95%CI：1.11 - 2.14）、体重指数（BMI）≥25 kg/m²（OR 5.01, 95%CI：4.13 - 6.26）、甘油三酯血症≥150 mg/dL（OR 1.96, 95%CI：1.58 - 2.42）及高尿酸血症（OR 1.50, 95%CI：1.22 - 1.84）相关。在无已知肝脏疾病病因的受试者中，ALT升高与男性性别、BMI≥25 kg/m²及甘油三酯血症≥150 mg/dL相关（均P<0.05）。
非酒精性脂肪性肝病似乎是台湾地区ALT升高及推测性肝损伤的最常见原因。NAFLD的发生与多种代谢紊乱密切相关。代谢紊乱在无已知肝脏疾病病因的受试者中也与ALT升高有关。
