Department of Clinical and Molecular Hepatology, Institute of Medical Research A Lanari-IDIM, University of Buenos Aires-National Council of Scientific and Technological Research (CONICET), Ciudad Autónoma de Buenos Aires, Argentina,
Obes Surg. 2013 Nov;23(11):1815-25. doi: 10.1007/s11695-013-0981-4.
Obstructive sleep apnea (OSA) is associated with the cluster of clinical conditions that comprise the metabolic syndrome, including nonalcoholic fatty liver disease (NAFLD). Our primary purpose was to estimate the effect of OSA on serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Our secondary purpose was to investigate the potential influence of OSA on histological severity of NAFLD to explore whether chronic intermittent hypoxia is associated with inflammation and fibrosis.
Our literature search identified 11 studies, from which we extracted information about numbers of control subjects and OSA patients, and ALT, AST, and NAFLD.
From a total of 668 OSA patients and 404 controls, we found that the standardized difference in mean values of ALT and AST levels in patients with OSA was significantly different from that in the controls. Meta-regression showed that the association was independent of body mass index and type 2 diabetes. Fatty liver was associated with OSA in five studies with 400 subjects. OSA was significantly associated with liver fibrosis in 208 subjects, but not with lobular inflammation.
Routine assessment of liver enzymes and liver damage should be implemented in OSA patients because they have an increase of 13.3% of ALT and 4.4% of AST levels, and a 2.6-fold higher risk of liver fibrosis when they have NAFLD, which is 2.6 times more frequent in OSA patients.
阻塞性睡眠呼吸暂停（OSA）与代谢综合征的一系列临床病症有关，包括非酒精性脂肪性肝病（NAFLD）。我们的主要目的是评估 OSA 对血清丙氨酸氨基转移酶（ALT）和天冬氨酸氨基转移酶（AST）的影响。我们的次要目的是研究 OSA 对 NAFLD 组织学严重程度的潜在影响，以探讨慢性间歇性低氧是否与炎症和纤维化有关。
我们的文献检索确定了 11 项研究，从中我们提取了关于对照组和 OSA 患者数量以及 ALT、AST 和 NAFLD 的信息。
从总共 668 名 OSA 患者和 404 名对照者中，我们发现 OSA 患者的 ALT 和 AST 水平的平均值的标准化差异与对照组明显不同。元回归表明，这种关联独立于体重指数和 2 型糖尿病。五项研究中有 400 名受试者发现脂肪肝与 OSA 相关。208 名受试者的 OSA 与肝纤维化显著相关，但与肝小叶炎症无关。
由于 OSA 患者的 ALT 水平升高 13.3%，AST 水平升高 4.4%，且当他们患有 NAFLD 时，肝纤维化的风险增加 2.6 倍，而 OSA 患者的肝纤维化风险增加 2.6 倍，因此应在 OSA 患者中常规评估肝酶和肝损伤。
