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

丁玉平; 李海; 张文; 夏时海; 毕珣

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

DOI: 10.3969/j.issn.1001-5256.2017.12.020

1. 中国人民武装警察部队后勤学院附属医院消化二科
2. 中国人民武装警察部队后勤学院附属医院体检管理中心

基金项目:

武警后勤学院博士启动基金(WHB201517)；

详细信息

中图分类号: R575.5
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出版历程
- 收稿日期: 2017-10-16
- 出版日期: 2017-12-20

Epidemiological characteristics of nonalcoholic fatty liver disease with elevated alanine aminotransferase and related risk factors

Second Department of Gastroenterology, The Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces

Research funding:

摘要

摘要:
目的探讨非酒精性脂肪性肝病（NAFLD）中ALT升高患者的流行病学特征和相关危险因素。方法收集2016年4月4日-2016年9月13日中国人民武装警察部队后勤学院附属医院收治的NAFLD患者1007例,其中ALT升高（大于正常值上限50U/L）123例（ALT升高组）,ALT正常884例（ALT正常组）。对患者一般资料及实验室指标血常规外周血单核细胞数、空腹血糖、TG、TC、HDL、LDL、LDL/HDL、ALT、AST、GGT、ALP、尿酸（UA）、肌酐、尿素氮、尿蛋白、尿微量蛋白、血压、BMI、胆系伴发疾病情况及甲状腺结节情况等进行统计分析。符合正态分布的计量资料2组间比较采用t检验,不符合正态分布的计量资料2组间比较采用Mann-Whitney U检验;计数资料组间比较采χ2检验。多因素分析采用logistic回归分析。结果 1007例NAFLD患者中男752例,女255例。ALT升高组中男性占13.7%（103/752）,女性占7.8%（20/255）,男女患病率比较差异有统计学意义（χ2=5.552,P=0.018）。1007例患者按照年龄分为2039岁...
- 非酒精性脂肪性肝病 /
- 丙氨酸转氨酶 /
- 流行病学 /
- 危险因素
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 Hospital 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 lipoprotein ( 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 between 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 = 42 942, 47 697, 48 106, 49 086, 31 938, and 36 283, 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 normal ALT group ( 40. 2% vs 30. 1%, P < 0. 05) . The univariate analysis showed that male sex, age ( young and middle ages) , a high number 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 independent 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.
- nonalcoholic fatty liver disease /
- alanine transaminase /
- epidemiology /
- risk factors

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