Prevalence and etiology of elevated serum alanine aminotransferase level in an adult population in Taiwan
Prevalence and etiology of elevated serum alanine aminotransferase level in an adult population in Taiwan
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DOI：
10.1111/j.1440-1746.2006.04615.x
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发表时间：
2007-09-01
影响因子：
4.1
通讯作者：
Yueh, Sen-Kou
中科院分区：
文献类型：
--
作者：
Chen, Chien-Hua;Huang, Min-Ho;Yueh, Sen-Kou
背景：谷丙转氨酶（ALT）升高的流行及病因有地域差异，在台湾很少有报导。通过一项以人群为基础的筛查研究，评估台湾成年人群中ALT升高的患病率和病因。方法：在台湾某农村进行横断面社区研究，对3260名中国成年人（年龄bb0 = 18岁）进行超声检查（美国）、血液检查和结构化问卷访谈。非酒精性脂肪性肝病（NAFLD）的诊断标准包括：女性酒精摄入量< 20 g/周或男性< 30 g/周，乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）感染阴性，无已知的肝病病因，以及与脂肪肝一致的US。结果：ALT升高的发生率为11.4%（372/3260）。这种升高的可能原因是过量饮酒（0.8%）、HBV（28.5%）、HCV（13.2%）、HBV和HCV（2.2%）、NAFLD（33.6%）和不明原因（21.8%）。ALT升高的病因学分布在两性中相似，尽管男性比女性更常见（17.3%比6.1%,P < 0.05）。NAFLD中ALT升高的患病率为18.1%(125/691)，阳性预测值为33.6%（125/372）。NAFLD的发生与年龄增加（年龄在40岁至64岁之间，优势比[OR] 1.59, 95%可信区间[CI]: 1.25-2.01；年龄>= 65岁，OR 1.46, 95%CI: 1.08-1.96）、空腹血糖(FPG) >= 126 mg/dL （OR 1.54, 95%CI: 1.11-2.14）、体重指数(BMI) >= 25 kg/m(2) （OR 5.01, 95%CI: 4.13-6.26）、甘油三酯血症>= 150 mg/dL （OR 1.96, 95%CI: 1.58-2.42）和高尿酸血症（OR 1.50, 95%CI: 1.22-1.84）有关。ALT升高与男性、BMI >= 25 kg/m(2)、甘油三酯血症>= 150 mg/dL有关（均P < 0.05）。结论：非酒精性脂肪肝似乎是台湾地区ALT升高和肝损伤的最常见原因。NAFLD的发生与多种代谢紊乱密切相关。在没有已知肝病病因的受试者中，代谢紊乱也与ALT升高有关。
Background: The prevalence and etiologies of elevated alanine aminotransferase (ALT) have geographic variations and they are rarely reported in Taiwan. Through a population-based screening study, the prevalence and etiologies of elevated ALT in an adult population of Taiwan were assessed.Methods:A cross-sectional community study in a rural village of Taiwan was conducted in 3260 Chinese adults (age >= 18 years) undergoing ultrasonography (US), blood tests, and interviews with a structured questionnaire. The diagnostic criteria of non-alcoholic fatty liver disease (NAFLD) included alcohol intake < 20 g/week for women or < 30 g/week for men, negative hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, no known etiologies of liver disease, and US consistent with fatty liver.Results:The prevalence of elevated ALT was 11.4% (372/3260). The probable cause of this elevation was excess alcohol consumption in 0.8%, HBV in 28.5%, HCV in 13.2%, both HBV and HCV in 2.2%, NAFLD in 33.6%, and unexplained cause in 21.8%. The etiologic distribution of elevated ALT was similar in both genders, although elevation was more common in men compared to women (17.3% vs 6.1%, P < 0.05). The prevalence of elevated ALT in NAFLD was 18.1% (125/691), and the positive predictive value was 33.6% (125/372). The development of NAFLD was related to increasing age (age between 40 years and 64 years, odds ratio [OR] 1.59, 95% confidence interval [CI]: 1.25-2.01; age >= 65 years, OR 1.46, 95%CI: 1.08-1.96), fasting plasma glucose (FPG) >= 126 mg/dL (OR 1.54, 95%CI: 1.11-2.14), bodymass index (BMI) >= 25 kg/m(2) (OR 5.01, 95%CI: 4.13-6.26), triglyceridemia >= 150 mg/dL (OR 1.96, 95%CI: 1.58-2.42), and hyperuricemia (OR 1.50, 95%CI: 1.22-1.84). Elevated ALT was related to male gender, BMI >= 25 kg/m(2), and triglyceridemia >= 150 mg/dL in subjects without known etiologies of liver disease (all P < 0.05).Conclusions:Non-alcoholic fatty liver disease appears to be the commonest cause of elevated ALT and presumed liver injury in Taiwan. The development of NAFLD is closely associated with many metabolic disorders. Metabolic disorders are also related to elevated ALT in subjects without known etiologies of liver disease.