Klisic Aleksandra, Kavaric Nebojsa, Ninic Ana
Primary Health Care Center, Podgorica, Montenegro.
Department for Medical Biochemistry, University of Belgrade - Faculty of Pharmacy, Belgrade, Serbia.
J Med Biochem. 2019 Mar 26;38(4):407-417. doi: 10.2478/jomb-2019-0001. eCollection 2019 Oct.
Alanine-aminotransferase (ALT) and uric acid cut-off levels used in non-alcoholic fatty liver disease (NAFLD) diagnosis are advised to be lowered. Due to contradictory results on the utility of both these biomarkers for NAFLD screening, we aimed to determine their cut-off levels that can be applied to Montenegrin population with the fatty liver disease.
A total of 771 volunteers were enrolled. A fatty liver index (FLI) score ≥60 was used as proxy of NAFLD. The receiver operating characteristic curve analysis with the area under the curve (AUC) was used to determine the cut-off values of ALT and uric acid associated with FLI ≥60.
ALT was independent predictor of FLI in both men and women, whereas serum uric acid was its independent predictor only in women. Lower cut-off levels of ALT are associated with the increased prevalence of NAFLD [i.e., ALT was 19 IU/L (AUC=0.746, sensitivity 63%, specificity 72%, P<0.001) in women and 22 IU/L (AUC=0.804, sensitivity 61%, specificity 95%, P<0.001) in men]. The cut-off value for uric acid was 274 μmol/L (AUC=0.821, sensitivity 68%, specificity 82%, P<0.001) in women.
Lower cut-off levels of ALT in both genders, and serum uric acid in females, can be reliable predictors of the FLI.
建议降低用于非酒精性脂肪性肝病（NAFLD）诊断的丙氨酸转氨酶（ALT）和尿酸临界值。由于这两种生物标志物用于NAFLD筛查的效用结果相互矛盾，我们旨在确定可应用于黑山共和国脂肪肝患者人群的临界值。
共纳入771名志愿者。脂肪肝指数（FLI）评分≥60被用作NAFLD的替代指标。采用曲线下面积（AUC）的受试者工作特征曲线分析来确定与FLI≥60相关的ALT和尿酸临界值。
ALT在男性和女性中均为FLI的独立预测因子，而血清尿酸仅在女性中为其独立预测因子。较低的ALT临界值与NAFLD患病率增加相关[即女性中ALT为19 IU/L（AUC = 0.746，敏感性63%，特异性72%，P<0.001），男性中为22 IU/L（AUC = 0.804，敏感性61%，特异性95%，P<0.001）]。女性尿酸临界值为274 μmol/L（AUC = 0.821，敏感性68%，特异性82%，P<0.001）。
两性中较低的ALT临界值以及女性中的血清尿酸可作为FLI的可靠预测指标。
