Sekkarie Ahlia, Welsh Jean A, Northstone Kate, Cioffi Catherine E, Stein Aryeh D, Figueroa Janet, Ramakrishnan Usha, Vos Miriam B
Laney Graduate School, Emory University, Atlanta, GA 30322, USA.
Department of Pediatrics, Emory School of Medicine, Atlanta, GA 30322, USA.
Children (Basel). 2020 Sep 1;7(9):117. doi: 10.3390/children7090117.
(1) Background: Alanine aminotransferase (ALT) is used to screen for non-alcoholic fatty liver disease (NAFLD) in children; however, the optimal age to commence screening is not determined. Our objective was to describe whether ALT trends from 9-24 years were associated with hepatic steatosis at 24 years in a population-based UK cohort. (2) Methods: The sample included 1156 participants who were assessed for hepatic steatosis at 24 years and had at least two ALT measurements at 9, 15, 17, and/or 24 years. Controlled attenuation parameter scores were used to assess steatosis (low (<248 dB/m), mild/moderate (248-279 dB/m), severe (>279 dB/m)). Sex-stratified mixed-effects models were constructed to assess the liver enzyme trends by steatosis level. (3) Results: The final sample was 41.4% male and 10.4% had severe steatosis. In both sexes, ALT trends from 9 to 24 years differed in those with low vs. severe steatosis at 24 years ( < 0.001). There was no evidence of differences prior to puberty. At 17 years, the low vs. severe geometric mean ratio (GMR) was 0.69, 95% CI: 0.57-0.85 in males and (0.81, 0.65-1.01) females. At 24 years, the GMR was (0.53, 0.42-0.66) in males and (0.67, 0.54-0.84) females. (4) Conclusions: Higher ALT concentration in adolescence was associated with hepatic steatosis at 24 years. The increased screening of adolescents could strengthen NAFLD prevention and treatment efforts.
(1) 背景：丙氨酸氨基转移酶（ALT）用于筛查儿童非酒精性脂肪性肝病（NAFLD）；然而，开始筛查的最佳年龄尚未确定。我们的目标是描述在英国一个基于人群的队列中，9至24岁的ALT变化趋势是否与24岁时的肝脂肪变性有关。(2) 方法：样本包括1156名参与者，这些参与者在24岁时接受了肝脂肪变性评估，并在9岁、15岁、17岁和/或24岁时至少进行了两次ALT测量。使用受控衰减参数评分来评估脂肪变性（低（<248 dB/m）、轻度/中度（248 - 279 dB/m）、重度（>279 dB/m））。构建性别分层的混合效应模型，以按脂肪变性水平评估肝酶变化趋势。(3) 结果：最终样本中男性占41.4%，10.4%有重度脂肪变性。在男女两性中，24岁时脂肪变性程度低与重度的人群，其9至24岁的ALT变化趋势存在差异（<0.001）。青春期前没有差异的证据。在17岁时，男性中脂肪变性程度低与重度的几何平均比（GMR）为0.69，95%置信区间：0.57 - 0.85，女性为（0.81，0.65 - 1.01）。在24岁时，男性的GMR为（0.53，0.42 - 0.66），女性为（0.67，0.54 - 0.84）。(4) 结论：青少年时期较高的ALT浓度与24岁时的肝脂肪变性有关。增加对青少年的筛查可以加强NAFLD的预防和治疗工作。
