Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA.
Dig Dis Sci. 2012 Jul;57(7):1925-31. doi: 10.1007/s10620-012-2098-3. Epub 2012 Feb 29.
The course of liver enzymes and their clinical correlations in nonalcoholic fatty liver disease (NAFLD) remains largely undescribed.
The objective of this study was to determine the spontaneous course of liver enzymes, and the association between changes in liver enzymes with changes in body weight and liver histology in NAFLD.
Follow-up data were prospectively collected for 2 years in 73 untreated patients with NAFLD. Liver enzymes were measured every 3 months, and liver biopsy repeated at 2 years.
A significant improvement in serum levels of aminotransferases, alkaline phosphatase, and γ-glutamyltransferase levels, and a significant decrease in albumin levels occurred with no significant change in body weight over the 2 years. During this period, alanine aminotransferase levels were persistently elevated in 68% of patients, fluctuated between normal and elevated in 22% of patients, and normalized in 10% of patients. There was no clear-cut correlation between the pattern of alanine aminotransferase levels and changes in steatosis, inflammation, hepatocyte ballooning, or fibrosis stage over time.
Liver enzyme levels and aminotransferase activity are insensitive tools to follow changes in liver histological features in NAFLD. These data should be taken into consideration in patient counseling and monitoring, and in the design of future therapeutic trials.
非酒精性脂肪性肝病（NAFLD）患者的肝酶水平及其临床相关性尚不清楚。
本研究旨在确定肝酶的自发变化，并探讨 NAFLD 患者肝酶变化与体重变化和肝组织学变化之间的关系。
前瞻性收集 73 例未经治疗的 NAFLD 患者 2 年的随访数据。每 3 个月检测一次肝酶，2 年后重复肝活检。
血清转氨酶、碱性磷酸酶和γ-谷氨酰转移酶水平显著改善，白蛋白水平显著下降，而体重在 2 年内无明显变化。在此期间，68%的患者丙氨酸氨基转移酶水平持续升高，22%的患者丙氨酸氨基转移酶水平在正常和升高之间波动，10%的患者丙氨酸氨基转移酶水平正常化。丙氨酸氨基转移酶水平的变化模式与脂肪变性、炎症、肝细胞气球样变或纤维化分期的变化之间没有明确的相关性。
肝酶水平和氨基转移酶活性是监测 NAFLD 患者肝组织学特征变化的不敏感工具。在患者咨询和监测以及未来治疗试验的设计中应考虑这些数据。
