Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
MJ Health Research Foundation, Taipei, Taiwan.
Am J Gastroenterol. 2019 Sep;114(9):1478-1487. doi: 10.14309/ajg.0000000000000332.
Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are 2 commonly ordered liver function tests, and ALT has long been considered more liver-specific than AST. Between the 2, the one which is better in predicting liver or non-liver-related mortality remains unsettled.
The cohort, 416,122 adults, came from a self-paying comprehensive health surveillance program during 1994-2008 and was followed up till 2008. Mortality came from National Death Index, with 10,412 deaths identified. Hazard ratios (HRs), computed by Cox model, and life expectancy, by life table method, were presented for 5 levels of AST and ALT with elevated AST or ALT defined as ≥40 IU/L. Liver disease included liver cancer and other liver conditions.
There were 3 times more elevated ALT (15.4%) than AST (5.7%). However, those with elevated AST had higher mortality for all-cause (HR = 2.44), for liver disease (HR = 27.2), and for liver cancer (HR = 47.6) than its ALT counterparts (HR = 1.69, 10.8, and 20.2, respectively). Elevated AST also lost more years of life expectancy (10.2) than those lost by ALT (5.2) and larger than most common risks. Elevated AST had increased mortality from all cancers (HR = 3.57), stroke (HR = 1.36), respiratory diseases (HR = 1.34), and injuries (HR = 1.82), other than just liver disease. All-cause mortality remained significantly increased, when high risk groups were excluded, such as frequent drinkers, hepatitis carriers, those died from nonmedical conditions, those died in the first 3 years, or advanced fibrosis index based on 4 factors or aspartate transaminase-to-platelet ratio index. Results were consistent between those returned for second visits and those analyzed in initial visits.
Those with elevated AST (≥40 IU/L) had life expectancy cut short by 10.2 years, doubled the number of years lost with elevated ALT. For all-cause and for liver-related mortality, AST was an important predictor, better than ALT.
血清丙氨酸氨基转移酶（ALT）和天冬氨酸氨基转移酶（AST）是两种常用的肝功能检测指标，长期以来，ALT 被认为比 AST 更具肝脏特异性。然而，在预测肝脏或非肝脏相关死亡率方面，哪种指标更好仍存在争议。
该队列包括 416122 名成年人，他们来自于 1994 年至 2008 年期间的一项自费全面健康监测计划，并在 2008 年之前进行了随访。死亡率来自国家死亡指数，共确定了 10412 例死亡。通过 Cox 模型计算危险比（HR），并通过寿命表法计算预期寿命，AST 和 ALT 升高的定义为≥40IU/L。肝脏疾病包括肝癌和其他肝脏疾病。
ALT 升高（15.4%）的比例是 AST 升高（5.7%）的三倍。然而，AST 升高的患者全因死亡率（HR=2.44）、肝脏疾病死亡率（HR=27.2）和肝癌死亡率（HR=47.6）均高于其 ALT 升高的对应值（HR=1.69、10.8 和 20.2）。AST 升高还导致预期寿命减少 10.2 年，高于 ALT 升高导致的 5.2 年，且大于大多数常见风险因素导致的寿命损失。AST 升高还与所有癌症（HR=3.57）、中风（HR=1.36）、呼吸系统疾病（HR=1.34）和损伤（HR=1.82）等非肝脏疾病的死亡率增加有关。排除了饮酒频繁、肝炎携带者、非医疗原因死亡、死亡发生在最初 3 年内或基于 4 个因素的纤维化指数或天冬氨酸转氨酶-血小板比值指数较高的高危人群后，全因死亡率仍然显著升高。二次就诊和初始就诊的分析结果一致。
AST 升高（≥40IU/L）的患者预期寿命缩短了 10.2 年，比 ALT 升高的患者多损失 5.2 年。在全因和肝脏相关死亡率方面，AST 是一个重要的预测指标，优于 ALT。
