Thong Vo Duy, Quynh Bui Thi Huong
Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
Department of Gastroenterology, Cho Ray Hospital, Ho Chi Minh City, Vietnam.
Int J Gen Med. 2021 Apr 16;14:1349-1355. doi: 10.2147/IJGM.S309311. eCollection 2021.
Non-alcoholic fatty liver disease (NAFLD) is increasingly recognized as a cause of chronic liver disease, often resulting in liver cirrhosis, portal hypertension, and hepatocellular carcinoma damaging outcomes. Alanine transaminase (ALT) and aspartate aminotransferase (AST) are indicators of hepatocellular injury. Several studies have demonstrated that high ALT levels are correlated with higher nonalcoholic steatohepatitis (NASH) risk. The aim was to determine the correlation of serum alanine aminotransferase and aspartate transaminase with liver stiffness in Vietnamese patients with NAFLD.
The study included 18 to 80 years old patients diagnosed with fatty liver on ultrasound at the University of Medical Center (UMC) liver clinic. Liver stiffness was measured using transient elastography. The histopathological, demographic, and laboratory data of the participants were also collected. The baseline and clinical characteristics of NAFLD patients were stratified by serum ALT levels.
There were 138 NAFLD patients, including 82 men (59.4%) and 56 women (40.6%) (mean ± SD age of 41 ± 11 years). Liver fibrosis (F0) between the two groups showed no significant difference (p = 0.469). Similarly, no difference was found in the mild fibrosis level (F2) of the two groups of patients (p = 0.371). ALT level was significantly higher in NAFLD patients with advanced fibrosis (F3, F4) (3.2% vs 15.9%, p = 0.0013; 3.2% vs 13.2%, p = 0.0047, respectively). NAFLD patients with mild to moderate fibrosis (F1-F2) were detected at 59 U/L cut-off value with 67% sensitivity and 51% specificity. However, severe fibrosis and/or cirrhosis patients (F3-F4) had a cut-off value of 81 U/L with 53% sensitivity and 67% specificity in patients.
Using ALT level as a marker for severe NAFLD would consider high-risk patients as mild cases, even though there is still the risk of progressive and severe hepatic disease. Our study underlines the small contribution of ALT as an independent factor for detecting NAFLD severity.
非酒精性脂肪性肝病（NAFLD）越来越被认为是慢性肝病的一个病因，常常导致肝硬化、门静脉高压以及肝细胞癌等不良后果。丙氨酸转氨酶（ALT）和天冬氨酸转氨酶（AST）是肝细胞损伤的指标。多项研究表明，高ALT水平与更高的非酒精性脂肪性肝炎（NASH）风险相关。本研究旨在确定越南NAFLD患者血清丙氨酸转氨酶和天冬氨酸转氨酶与肝脏硬度之间的相关性。
本研究纳入了在医学中心大学（UMC）肝脏门诊经超声诊断为脂肪肝的18至80岁患者。采用瞬时弹性成像技术测量肝脏硬度。还收集了参与者的组织病理学、人口统计学和实验室数据。NAFLD患者的基线和临床特征按血清ALT水平进行分层。
共有138例NAFLD患者，其中男性82例（59.4%），女性56例（40.6%）（平均±标准差年龄为41±11岁）。两组之间的肝纤维化（F0）无显著差异（p = 0.469）。同样，两组患者的轻度纤维化水平（F2）也无差异（p = 0.371）。晚期纤维化（F3、F4）的NAFLD患者的ALT水平显著更高（分别为3.2%对15.9%，p = 0.0013；3.2%对13.2%，p = 0.0047）。轻度至中度纤维化（F1 - F2）的NAFLD患者在截断值为59 U/L时检测的灵敏度为67%，特异度为51%。然而，重度纤维化和/或肝硬化患者（F3 - F4）在患者中的截断值为81 U/L，灵敏度为53%，特异度为67%。
将ALT水平用作严重NAFLD的标志物会将高危患者视为轻症病例，尽管仍存在进展为严重肝病的风险。我们的研究强调了ALT作为检测NAFLD严重程度的独立因素的作用较小。
