Chronological development of elevated aminotransferases in a nonalcoholic population
Chronological development of elevated aminotransferases in a nonalcoholic population
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DOI：
10.1002/hep.20543
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发表时间：
2005-01-01
期刊：
影响因子：
13.5
通讯作者：
Lindor, K
中科院分区：
文献类型：
--
作者：
Suzuki, A;Angulo, P;Lindor, K
非酒精性脂肪性肝病(NAFLD)的发病率和危险因素从未被前瞻性地确定。为了确定NAFLD的频率和危险因素，以及NAFLD、体重增加和胰岛素抵抗特征之间的时间顺序，在日本工作场所进行了一项历史队列研究。队列中没有肝脏损伤，饮酒量超过140g/wk，没有乙肝或丙型肝炎感染(1537名受试者中有529名)，以及287名没有胰岛素抵抗相关特征的受试者。非酒精者中升高的转氨酶被用来替代NAFLD。在亚队列中寻求高转氨酶、体重增加超过2公斤以及与胰岛素抵抗相关的特征长达5年。高转氨酶的发生率为每千人年31例(71例)。在高氨基转移酶的形成过程中，年龄和性别之间存在显著的交互作用。在年龄小于40岁的受试者中，男性(危险比[HR]：4.6)、体重指数升高(HR：2.1)、高血压(HR：2.6)和低高密度脂蛋白胆固醇(HR：2.8)增加了高转氨酶的风险，而年龄(每5年HR：0.6)降低了风险。在年龄大于40岁的受试者中，糖耐量异常(HR：5.3)是唯一显著的危险因素。在亚队列中，体重增加先于高转氨酶和其他与胰岛素抵抗相关的特征，这些特征依次出现在低高密度脂蛋白胆固醇、hypertriglyceridemia/hypertransaminasemia/hypertension，和葡萄糖耐量异常。总之，这项队列研究清楚地显示了时间顺序以及升高的转氨酶与NAFLD危险因素之间的关系。
The incidence and risk factors of nonalcoholic fatty liver disease (NAFLD) have never been prospectively determined. To determine the frequency and risk factors of NAFLD and chronological ordering between NAFLD, weight gain, and features of insulin resistance, a historical cohort study was conducted in a Japanese workplace. A cohort free of previous liver injury, alcohol consumption of more than 140 g/wk, and hepatitis B or C infection (529 of 1,537 subjects), and a subcohort of 287 subjects free of insulin resistance-related features were identified. Elevated aminotransferases in nonalcoholics were used as a surrogate for NAFLD. High aminotransferases together with weight gain of more than 2 kg and insulin resistance-related features in the subcohort were sought for up to 5 years. The incidence of high aminotransferases was 31 per 1,000 person-years (71 events). A significant interaction occurred between age and sex in the development of high aminotransferases. In subjects younger than age 40 years, male sex (hazard ratio [HR]: 4.6), elevated body mass index (HR: 2.1), hypertension (HR: 2.6), and low high-density lipoprotein cholesterol (HR: 2.8) increased the risk of high aminotransferases, whereas age (HR: 0.6 for each 5 years) decreased the risk. In subjects older than age 40 years, glucose intolerance (HR: 5.3) was the only significant risk factor. In the subcohort, weight gain preceded high aminotransferases and other insulin resistance-related features, which appeared sequentially in order of low high-density lipoprotein cholesterol, hypertriglyceridemia/hypertransaminasemia/hypertension, and glucose intolerance. In conclusion, this cohort study clearly showed chronological ordering and an association between development of elevated aminotransferases and risk factors of NAFLD.