Medical Faculty, University of Zurich, Pestalozzistrasse 3, CH-8032 Zurich, Switzerland.
Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Hirschengraben 84, CH-8001 Zurich, Switzerland.
Nutrients. 2023 Jul 7;15(13):3063. doi: 10.3390/nu15133063.
Associations between liver enzymes or De Ritis ratio (DRR; aspartate aminotransferase (AST)/alanine aminotransferase (ALT)) and mortality stratified by non-alcoholic fatty liver disease (NAFLD), which have rarely been analyzed in previous studies, were investigated using the National Health and Nutrition Examination Survey (NHANES) III (1988-1994). Participants without risk factors for liver diseases other than NAFLD were linked with National Death Index records through 2019 ( = 11,385) and divided into two cohorts with or without NAFLD, based on ultrasound examination. Liver enzyme concentrations were categorized into sex-specific deciles and subsequently grouped (AST and ALT: 1-3, 4-9, 10; gamma glutamyltransferase (GGT): 1-8, 9-10). DRR was categorized into tertiles. Cox proportional hazards regression models adjusted for confounders were fitted to estimate associations with mortality. Compared with low levels, high GGT and DRR in participants with and without NAFLD had significantly higher hazard ratios for all-cause mortality. Compared with intermediate concentrations, low ALT showed higher all-cause mortality in participants with and without NAFLD, whereas low AST had higher HR in participants without NAFLD and high AST in those with NAFLD. Mortality was associated with liver enzymes or DRR in participants both with and without NAFLD, indicating that the relationship is not mediated solely by hepatocellular damage.
使用 1988-1994 年国家健康和营养调查（NHANES III）研究了以前的研究很少分析的非酒精性脂肪性肝病（NAFLD）分层的肝酶或 De Ritis 比值（DRR；天冬氨酸氨基转移酶（AST）/丙氨酸氨基转移酶（ALT））与死亡率之间的关联。无除 NAFLD 以外的肝病危险因素的参与者通过国家死亡指数记录与 2019 年（=11385）相关联，并根据超声检查分为有或没有 NAFLD 的两个队列。肝酶浓度分为性别特异性十分位数，然后根据 AST 和 ALT（1-3、4-9、10；γ-谷氨酰转移酶（GGT）（1-8、9-10）进行分组。DRR 分为三分位。拟合 Cox 比例风险回归模型以调整混杂因素，以估计与死亡率的关联。与低水平相比，有和没有 NAFLD 的参与者中高水平的 GGT 和 DRR 与全因死亡率的风险比显著更高。与中间浓度相比，有和没有 NAFLD 的参与者中低 ALT 显示出更高的全因死亡率，而没有 NAFLD 的参与者中低 AST 具有更高的 HR，有 NAFLD 的参与者中高 AST 具有更高的 HR。NAFLD 有和没有 NAFLD 的参与者的肝酶或 DRR 与死亡率相关，表明这种关系不仅仅是由肝细胞损伤介导的。
