参考范围内天冬氨酸氨基转移酶与丙氨酸氨基转移酶的德瑞蒂斯比值的预后价值。

Prognostic value of De Ritis ratio with aspartate aminotransferase and alanine aminotransferase within the reference range.

作者信息

Ndrepepa Gjin, Holdenrieder Stefan, Kastrati Adnan

机构信息

Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany.

Institut für Laboratoriumsmedizin, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany.

出版信息

Clin Chim Acta. 2023 Jan 1;538:46-52. doi: 10.1016/j.cca.2022.11.005. Epub 2022 Nov 9.

DOI:10.1016/j.cca.2022.11.005

PMID:36370837

Abstract

BACKGROUND

Whether aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (De Ritis ratio) with AST and ALT activities within the reference range has prognostic value is unknown.

METHODS

This study included 3392 patients with stable coronary artery disease and AST and ALT activities within the reference range. Patients are categorized in groups according to tertiles of the De Ritis ratio: a group with De Ritis ratio in the 1st tertile (De Ritis ratio: 0.22 to 0.81; n = 1131), a group with De Ritis ratio in the 2nd tertile (De Ritis ratio: >0.81 to 1.09; n = 1130) and a group with De Ritis ratio in the 3rd tertile (De Ritis ratio: >1.09 to 3.40; n = 1131). The primary endpoint was 3-year mortality.

RESULTS

The mean value of De Ritis ratio was 1.00 ± 0.39 (range: 0.22-3.40). Overall, there were 234 deaths at 3 years: 43 deaths in patients of 1st tertile, 75 deaths in patients of 2nd tertile and 116 deaths in patients of 3rd tertile of De Ritis ratio (Kaplan-Meier estimates of 3-year mortality, 4.4 %, 7.8 % and 12.5 %, respectively; (adjusted hazard ratio = 1.24, 95 % confidence interval 1.12 to 1.38; P < 0.001 for 1 unit higher De Ritis ratio). The C-statistic of the risk prediction model for mortality with baseline demographical and clinical variables without De Ritis ratio was 0.803 [0.774-0.832] and it increased to 0.810 [0.782-0.839] after inclusion of De Ritis ratio into the model (P = 0.038).

CONCLUSIONS

An elevated De Ritis ratio with aminotransferase levels within the reference range was associated with the increased risk of mortality.

摘要

背景

天冬氨酸氨基转移酶（AST）与丙氨酸氨基转移酶（ALT）的比值（德瑞蒂斯比值），以及处于参考范围内的AST和ALT活性是否具有预后价值尚不清楚。

方法

本研究纳入了3392例冠状动脉疾病稳定且AST和ALT活性处于参考范围内的患者。根据德瑞蒂斯比值的三分位数将患者分为几组：第一三分位数组（德瑞蒂斯比值：0.22至0.81；n = 1131），第二三分位数组（德瑞蒂斯比值：>0.81至1.09；n = 1130）和第三三分位数组（德瑞蒂斯比值：>1.09至3.40；n = 1131）。主要终点是3年死亡率。

结果

德瑞蒂斯比值的平均值为1.00±0.39（范围：0.22 - 3.40）。总体而言，3年时有234例死亡：德瑞蒂斯比值第一三分位数组患者中有43例死亡，第二三分位数组患者中有75例死亡，第三三分位数组患者中有116例死亡（德瑞蒂斯比值的3年死亡率的Kaplan - Meier估计值分别为4.4%、7.8%和12.5%；（调整后的风险比 = 1.24，95%置信区间1.12至1.38；德瑞蒂斯比值每升高1个单位，P < 0.001）。不包括德瑞蒂斯比值的基线人口统计学和临床变量的死亡率风险预测模型的C统计量为0.803 [0.774 - 0.832]，将德瑞蒂斯比值纳入模型后，该值增至0.810 [0.782 - 0.839]（P = 0.038）。