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首页> 外文期刊>Hepatology: Official Journal of the American Association for the Study of Liver Diseases >Risk of severe liver disease in nonalcoholic fatty liver disease with normal aminotransferase levels: a role for insulin resistance and diabetes.
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Risk of severe liver disease in nonalcoholic fatty liver disease with normal aminotransferase levels: a role for insulin resistance and diabetes.

机译：具有正常氨基转移酶水平的非酒精性脂肪肝疾病中重度肝病的风险：对胰岛素抵抗和糖尿病的作用。

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It is uncertain whether patients with nonalcoholic fatty liver disease (NAFLD) and normal alanine aminotransferase (ALT) have a milder disease and should undergo liver biopsy. We reviewed the histological data of 458 Italian patients with NAFLD in whom liver biopsy was indicated by altered liver enzymes (395 cases, 86%), or persistently elevated ferritin or long-lasting severe steatosis (63 cases). Factors associated with nonalcoholic steatohepatitis (NASH) and fibrosis >/= 2 were identified by multivariate analysis. Patients with normal ALT were significantly older, had lower body mass index, fasting triglycerides, insulin resistance according to homeostasis model assessment (HOMA-IR), ALT, and gamma-glutamyltransferase, but a higher prevalence of hypertension. NASH was diagnosed in 59% and 74% of the patients with normal and increased ALT, respectively (P = 0.01). In the overall series of patients, NASH was independently predicted by ALT (odds ratio [OR], 1.11; 95% confidence interval [CI], 1.04-1.19per 10-IU/mL increase) and diabetes (OR, 1.5; 95% CI, 1.1-2.0). The same variables were selected in patients with increased ALT, whereas in those with normal ALT, HOMA-IR and ALT were independent predictors. Severe fibrosis was independently predicted by serum ferritin (OR, 1.04; 95% CI, 1.001-1.08 per 50-ng/mL increase), ALT (OR, 1.07; 95% CI, 1.02-1.14), and diabetes (OR, 1.8; 95% CI, 1.4-2.3) in the overall series, serum ferritin and diabetes in those with increased ALT, and only HOMA-IR (OR, 1.97; 95% CI, 1.2-3.7) in patients with normal ALT. CONCLUSION: Normal ALT is not a valuable criterion to exclude patients from liver biopsy. Alterations in glucose metabolism and insulin resistance in subjects with normal ALT should also be considered in the selection of NAFLD cases for histological assessment of disease severity and progression.
机译：尚不确定非酒精性脂肪性肝病（NAFLD）和丙氨酸氨基转移酶（ALT）正常的患者是否病情较轻，应进行肝活检。我们回顾了458例意大利NAFLD患者的组织学资料，其中肝酶检查表明肝活检改变（395例，86％），或铁蛋白持续升高或持续严重的脂肪变性（63例）。通过多变量分析确定与非酒精性脂肪性肝炎（NASH）和纤维化> / = 2相关的因素。 ALT正常的患者年龄较大，体重指数，空腹甘油三酯，根据稳态模型评估（HOMA-IR）的胰岛素抵抗，ALT和γ-谷氨酰转移酶较高，但高血压的患病率较高。 ALT正常和升高的患者分别诊断出NASH占59％和74％（P = 0.01）。在所有患者中，NASH分别通过ALT（优势比[OR]，1.11; 95％置信区间[CI]，每10-IU / mL增加1.04-1.19）和糖尿病（OR，1.5; 95％）独立预测CI，1.1-2.0）。 ALT升高的患者选择相同的变量，而ALT正常的患者，HOMA-IR和ALT是独立的预测因子。血清铁蛋白（OR，1.04; 95％CI，每增加50-ng / mL增加1.00），ALT（OR，1.07; 95％CI，1.02-1.14）和糖尿病（OR，1.8）独立预测严重纤维化;整个系列中95％CI，1.4-2.3），ALT升高者血清铁蛋白和糖尿病，ALT正常者仅HOMA-IR（OR，1.97; 95％CI，1.2-3.7）。结论：正常ALT并非排除肝活检患者的有价值的标准。在选择NAFLD病例进行组织学评估疾病严重程度和进展时，也应考虑ALT正常者的糖代谢和胰岛素抵抗的改变。

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