临床肝胆病杂志2017，Vol.33Issue(12)：2355-2360,6.DOI:10.3969/j.issn.1001-5256.2017.12.020
ALT升高的非酒精性脂肪性肝病的流行病学特征及其危险因素分析
Epidemiological characteristics of nonalcoholic fatty liver disease with elevated alanine aminotransferase and related risk factors
摘要
Abstract
Objective To investigate the epidemiological characteristics of nonalcoholic fatty liver disease (NAFLD)with elevated alanine aminotransferase (ALT)and related risk factors. Methods A total of 1007 patients with NAFLD who were admitted to The Affiliated Hos-pital of Logistics University of Chinese People′s Armed Police Forces from April 4,2016 to September 13,2016 were enrolled,and among these patients,123 had an elevated ALT level (higher than the upper limit of normal 50 U/ L)(elevated ALT group)and 884 had normal ALT (normal ALT group). A statistical analysis was performed for their general data and laboratory markers [number of peripheral blood mononuclear cells,fasting blood glucose,triglyceride (TG),total cholesterol (TC),high - density lipoprotein (HDL),low - density lipo-protein (LDL),LDL/ HDL ratio,ALT,aspartate aminotransferase (AST),gamma - glutamyl transpeptidase (GGT),alkaline phosphatase (ALP),uric acid (UA),creatinine,blood urea nitrogen,urinary protein,urinary microproteins],blood pressure,body mass index (BMI),concomitant biliary disease,and thyroid nodules. The t - test was used for comparison of normally distributed continuous data be-tween groups,and the Mann - Whitney U test was used for comparison of non - normally distributed continuous data between groups;the chi -square test was used for comparison of categorical data between groups. A multivariate logistic regression analysis was used to identify the risk factors for elevated ALT in NAFLD patients. Results Among the 1007 patients with NAFLD,there were 752 male and 255 female patients. Of all male patients,13. 7% (103 / 752)were in the elevated ALT group,and of all female patients,7. 8% (20 / 255)were in the elevated ALT group;there was a significant difference in the prevalence rate between male and female patients (χ2 = 5. 552,P = 0. 018). According to the age,the 1007 patients were divided into 20 - 39 year group with 242 patients,40 - 59 year group with 555 patients,and 60 - 90 year group with 210 patients,and there was a significant difference in the proportion of patients with an elevated ALT level between these three groups (26. 03% vs 8. 83% vs 5. 24%,χ2 = 52. 327,P < 0. 001);further comparison between any two groups showed that the 20 - 39 year group had a significantly higher proportion of patients with an elevated ALT level than the 40 - 59 year group and the 60 - 90 year group (χ2 = 39. 886 and 34. 009,both P < 0. 001). Most patients in the elevated ALT group were young and middle - aged adults,and compared with the normal ALT group,the elevated ALT group had a significantly younger age and a significant higher BMI (t = 7. 419 and - 4. 595, both P < 0. 001);there were also significant differences between the two groups in UA,number of peripheral blood mononuclear cells,LDL/HDL ratio,HDL,AST,and GGT (U = 42942,47697,48106,49086,31938,and 36283,all P < 0. 05). Of all 1007 patients,392 had NAFLD complicated by thyroid nodules,and the elevated ALT group had a significantly higher proportion of such patients than the nor-mal ALT group (40. 2% vs 30. 1%,P < 0. 05). The univariate analysis showed that male sex,age (young and middle ages),a high num-ber of peripheral blood mononuclear cells,increased LDL/ HDL ratio,a low level of HDL,a high level of GGT,a high BMI,and absence of thyroid nodules were associated with elevated ALT in NAFLD patients (all P < 0. 05). The multivariate logistic regression analysis showed that young and middle ages (20 - 39 years),a high number of peripheral blood mononuclear cells,and a high level of GGT were independ-ent risk factors for elevated ALT in NAFLD patients (all P < 0. 001). Conclusion Young and middle ages (20 - 39 years),a high number of peripheral blood mononuclear cells,and a high level of GGT are predictive factors for elevated ALT in NAFLD patients and may have a certain value in guiding the early diagnosis of nonalcoholic steatohepatitis.关键词
非酒精性脂肪性肝病/丙氨酸转氨酶/流行病学/危险因素Key words
nonalcoholic fatty liver disease/alanine transaminase/epidemiology/risk factors分类
医药卫生引用本文复制引用
丁玉平,李海,张文,夏时海,毕珣..ALT升高的非酒精性脂肪性肝病的流行病学特征及其危险因素分析[J].临床肝胆病杂志,2017,33(12):2355-2360,6.基金项目
武警后勤学院博士启动基金(WHB201517) （WHB201517）
