Ma Cheng, Zhang Xiaoqian, Zhang Wenxin, Duan Jianzhou, Yang Hui
Department of Infectious Diseases, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi Province, China.
First Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi Province, China.
Medicine (Baltimore). 2025 Jul 25;104(30):e43395. doi: 10.1097/MD.0000000000043395.
Homocysteine (Hcy) can induce liver cell damage, but its relationship with alcohol-related liver disease (ALD) has rarely been reported. This study aimed to investigate the association between serum Hcy levels and advanced hepatic fibrosis in patients with ALD. We included 10,033 participants from the 1999 to 2006 National Health and Nutrition Examination Survey. Four hundred ninety six individuals with excessive alcohol consumption, elevated liver enzymes, and no other chronic liver disease were identified as ALD. Fibrosis-4 index, aspartate aminotransferase to platelet ratio index, and Frons index were used as noninvasive indicators for assessing the extent of liver fibrosis. Weighted multivariate logistic regression was used to analyze the correlation between serum Hcy levels and advanced hepatic fibrosis in ALD participants. Compared to non-alcoholic liver disease, ALD participants had higher serum Hcy levels (P < .001). In weighted multivariable-adjusted logistic regression models, we observed a positive correlation between serum Hcy levels and the risk of advanced hepatic fibrosis in ALD (odds ratio [OR] = 1.07, 95% confidence interval [CI], 1.01-1.12, P < .05), and the highest tertile of Hcy was significantly associated with an increased risk of advanced hepatic fibrosis (OR = 3.36, 95% CI, 1.34-8.43, P < .05). In subgroup analyses stratified by gender, physical activity, and body mass index, this association remained significant in men (OR = 1.07, 95% CI, 1.01-1.13, P = .026), vigorously physically active (OR = 1.46, 95% CI, 1.06-2.01, P = .027), and obese participants (OR = 1.36, 95% CI, 1.10-1.67, P = .008). In ALD participants, the area under the working characteristic curve of Hcy for advanced hepatic fibrosis was 0.686 (95% CI, 0.639-0.733). Serum Hcy levels were independently associated with an increased risk of advanced hepatic fibrosis in ALD, especially among men, vigorously physically active, and obese populations. This study supports the predictive value of Hcy for advanced hepatic fibrosis and suggests that Hcy may become a therapeutic entry point for ALD.
同型半胱氨酸（Hcy）可诱导肝细胞损伤，但其与酒精性肝病（ALD）的关系鲜有报道。本研究旨在调查ALD患者血清Hcy水平与晚期肝纤维化之间的关联。我们纳入了1999年至2006年国家健康与营养检查调查中的10,033名参与者。496名饮酒过量、肝酶升高且无其他慢性肝病的个体被确定为ALD患者。Fibrosis-4指数、天冬氨酸氨基转移酶与血小板比值指数和Frons指数被用作评估肝纤维化程度的非侵入性指标。采用加权多变量逻辑回归分析ALD参与者血清Hcy水平与晚期肝纤维化之间的相关性。与非酒精性肝病患者相比，ALD参与者的血清Hcy水平更高（P <.001）。在加权多变量调整逻辑回归模型中，我们观察到ALD患者血清Hcy水平与晚期肝纤维化风险呈正相关（比值比[OR]=1.07，95%置信区间[CI]，1.01 - 1.12，P <.05），且Hcy最高三分位数与晚期肝纤维化风险增加显著相关（OR = 3.36，95% CI，1.34 - 8.
