Lee Hyejin, Shin Dong Wook, Lee Tae Hoon, Yang Hyung-Kook, Ahn Eunmi, Yoon Jae-Moon, Lee Hyun-Ki, Suh Beomseok, Son Ki Young, Kim Jun Suk, Cho BeLong
From the Department of Family Medicine and Health Promotion Center (HL, DWS, EA, J-MY, H-KL, BS, KYS, JSK, BC), Seoul National University Hospital; Department of Family Medicine (DWS, BC), College of Medicine, Seoul National University, Seoul, Korea; Division of Gastroenterology and Hepatology (THL), Metro Health Medical Center, Case Western Reserve University, Cleveland, OH; and Cancer Policy Branch (H-KY), National Cancer Control Institute, National Cancer Center, Goyang, Korea.
Medicine (Baltimore). 2016 Mar;95(12):e3158. doi: 10.1097/MD.0000000000003158.
There is little information on how the change in serum aminotransferase affects mortality. We investigated the association between changes in serum aminotransferase levels and mortality from all causes, cardiovascular disease (CVD), and liver disease.Three percent of men from the Korean National Health Insurance database were sampled randomly at the end of 2002. After excluding patients with cancer, CVD, CVD risk factors, or liver disease, those who participated in 2 consecutive rounds of the national health screening examination were included (n = 68,431). The primary outcome was CVD mortality. Secondary outcomes were liver disease mortality and all-cause mortality. Change in metabolic profiles was analyzed based on changes in liver enzyme levels. Elevated levels of serum aminotransferase were associated with CVD, liver disease, and all-cause mortality. Men who had sustained elevation of serum aminotransferase during 2 subsequent liver enzyme tests showed a significantly higher risk of CVD mortality (adjusted hazard ratio [aHR] 1.95; 95% confidence interval [CI] 1.07-3.56, 2.29; 1.27-4.12) than the sustained normal group. In contrast, the normalization group (aHR 1.52, 95% CI 0.82-2.81 for aspartate aminotransferase [AST]; aHR 1.35, 95% CI 0.70-2.61 for alanine aminotransferase [ALT]) and the new elevation group (aHR 1.27, 0.66-2.44 for AST; aHR 0.99, 95% CI 0.49-2.20 for ALT) were not different from the sustained normal group in CVD mortality.Individuals with serum aminotransferase elevation, particularly when sustained, are at higher risk of mortality, and should receive appropriate medical attention.
关于血清氨基转移酶变化如何影响死亡率的信息很少。我们研究了血清氨基转移酶水平变化与全因死亡率、心血管疾病（CVD）和肝病死亡率之间的关联。2002年底，从韩国国民健康保险数据库中随机抽取了3%的男性。在排除患有癌症、心血管疾病、心血管疾病危险因素或肝病的患者后，纳入了连续参加两轮全国健康筛查检查的患者（n = 68431）。主要结局是心血管疾病死亡率。次要结局是肝病死亡率和全因死亡率。基于肝酶水平的变化分析代谢谱的变化。血清氨基转移酶水平升高与心血管疾病、肝病和全因死亡率相关。在随后的两次肝酶检测中血清氨基转移酶持续升高的男性，其心血管疾病死亡率风险显著高于持续正常组（调整后风险比[aHR] 1.95；95%置信区间[CI] 1.07 - 3.56，2.29；1.27 - 4.12）。相比之下，正常化组（天冬氨酸氨基转移酶[AST]的aHR 1.52，95% CI 0.82 - 2.81；丙氨酸氨基转移酶[ALT]的aHR 1.35，95% CI 0.70 - 2.61）和新升高组（AST的aHR 1.27，0.66 - 2.44；ALT的aHR 0.99，95% CI 0.49 - 2.20）在心血管疾病死亡率方面与持续正常组无差异。血清氨基转移酶升高的个体，尤其是持续升高时，死亡风险更高，应接受适当的医疗关注。
