Wong V W-S, Wong G L-H, Tsang S W-C, Hui A Y, Chan A W-H, Choi P C-L, Chim A M-L, Chu S, Chan F K-L, Sung J J-Y, Chan H L-Y
Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China.
Aliment Pharmacol Ther. 2009 Feb 15;29(4):387-96. doi: 10.1111/j.1365-2036.2008.03896.x. Epub 2008 Nov 17.
Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in affluent countries. Serum alanine aminotransferase (ALT) level is commonly performed to monitor NAFLD patients, but its clinical relevance is unclear.
To evaluate the metabolic and histological features of NAFLD patients with different ALT levels.
A total of 173 consecutive patients with biopsy-proven NAFLD were studied. Patients with persistently normal ALT and those with abnormal ALT were compared.
Patients with persistently normal ALT had lower steatosis grade than patients with abnormal ALT, but they had similar degree of lobular inflammation, ballooning and fibrosis. Among 19 patients with ALT below 0.5 times the upper limit of normal (ULN) at the time of liver biopsies, 8 (42%) and 3 (16%) had steatohepatitis and significant fibrosis respectively. The within-patient coefficient of variance was similarly high in patients with simple steatosis and steatohepatitis (33.5). Age and glucose, but not ALT, were independent factors associated with significant fibrosis.
Metabolic factors, but not ALT, are associated with histological severity. Patients with ALT < 0.5 x ULN may still have non-alcoholic steatohepatitis (NASH) and significant fibrosis. Evaluation of NAFLD patients should be based on metabolic risk factors, but not ALT level.
非酒精性脂肪性肝病（NAFLD）是富裕国家最常见的慢性肝病。血清丙氨酸氨基转移酶（ALT）水平常用于监测NAFLD患者，但其临床相关性尚不清楚。
评估不同ALT水平的NAFLD患者的代谢和组织学特征。
共研究了173例经活检证实为NAFLD的连续患者。比较了ALT持续正常的患者和ALT异常的患者。
ALT持续正常的患者脂肪变性程度低于ALT异常的患者，但小叶炎症、气球样变和纤维化程度相似。在19例肝活检时ALT低于正常上限（ULN）0.5倍的患者中，分别有8例（42%）和3例（16%）发生脂肪性肝炎和显著纤维化。单纯性脂肪变性和脂肪性肝炎患者的患者内变异系数同样较高（33.5）。年龄和血糖而非ALT是与显著纤维化相关的独立因素。
代谢因素而非ALT与组织学严重程度相关。ALT<0.5×ULN的患者仍可能患有非酒精性脂肪性肝炎（NASH）和显著纤维化。对NAFLD患者的评估应基于代谢危险因素，而非ALT水平。
