Sung Ki-Chul, Lee Mi-Yeon, Lee Jong-Young, Lee Sung-Ho, Kim Seong-Hwan, Kim Sun H
Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea.
Division of Biostatistics, Department of R & D Management, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea.
J Clin Med. 2019 Apr 2;8(4):445. doi: 10.3390/jcm8040445.
Nonalcoholic fatty liver disease (NAFLD) is the most common cause of elevated alanine aminotransferase (ALT), but the clinical utility of ALT in detecting and following individuals with NAFLD remains unclear. We conducted a retrospective analysis of 30,988 men and 5204 women with NAFLD diagnosed by ultrasound and stratified them according to sex-specific ALT quartiles. We compared metabolic variables at baseline and repeated ultrasound after at least 6 months among ALT quartiles (Q) in men (Q1 5-24, Q2 25-33, Q3 34-48, Q4 ≥ 49 IU/L) and women (Q1 5-14, Q2 15-20, Q3 21-28, Q4 ≥ 29 IU/L). Prevalence of obesity (BMI ≥ 25 kg/m²) and metabolic abnormalities (glucose intolerance, hypertension) significantly ( < 0.001) increased from ALT Q1 to Q4 in both men and women at baseline. After a mean follow-up of 4.93 years, 17.6% of men and 31.1% of women resolved their NAFLD. The odds ratio (OR) of resolving significantly ( < 0.001) decreased by quartiles even after multiple adjustments. The adjusted OR for resolution in Q4 was 0.20 (0.18-0.23) in men and 0.35 (0.26-0.47) in women compared with Q1. Individuals with NAFLD span the full range of ALT concentrations, but those with the highest ALT have the worst metabolic profile and persistent NAFLD.
非酒精性脂肪性肝病（NAFLD）是丙氨酸氨基转移酶（ALT）升高的最常见原因，但ALT在检测和随访NAFLD患者中的临床效用仍不明确。我们对30988名男性和5204名经超声诊断为NAFLD的女性进行了回顾性分析，并根据性别特异性ALT四分位数对他们进行分层。我们比较了男性（Q1 5 - 24，Q2 25 - 33，Q3 34 - 48，Q4≥49 IU/L）和女性（Q1 5 - 14，Q2 15 - 20，Q3 21 - 28，Q4≥29 IU/L）ALT四分位数组在基线时的代谢变量以及至少6个月后的重复超声检查结果。在基线时，男性和女性中肥胖（BMI≥25 kg/m²）和代谢异常（葡萄糖不耐受、高血压）的患病率从ALT Q1到Q4均显著（<0.001）增加。平均随访4.93年后，17.6%的男性和31.1%的女性NAFLD得到缓解。即使经过多次调整，缓解的比值比（OR）仍随四分位数显著（<0.001）降低。与Q1相比，男性Q4缓解的调整后OR为0.20（0.18 - 0.23），女性为0.35（0.26 - 0.47）。NAFLD患者的ALT浓度范围广泛，但ALT最高的患者代谢状况最差且NAFLD持续存在。
