血清AST水平与非酒精性脂肪性肝病的进展性肝纤维化有关  

Aspartate aminotransferase level and its association with progressive fibrosis in non-alcoholic fatty liver disease

作　　者：荀运浩[1] 施军平[1] 胡晨波[2] 张莉[2] 刘红[1] 娄国强[1] 

机构地区：[1]浙江中医药大学附属杭州第六医院,杭州310014 [2]浙江中医药大学

出　　处：《肝脏》2010年第3期160-163,共4页Chinese Hepatology

基　　金：浙江省重大科技专项重点社会发展项目(2008C13027)

摘　　要：目的探讨我国成人非酒精性脂肪性肝病(NAFLD)进展性肝纤维化的预测因素。方法通过分析2005年1月—2009年3月经病理学证实的NAFLD患者的人口学、生化学及病理学资料,研究与组织学进展性肝纤维化相关的危险因素。非酒精性脂肪性肝炎(NASH)定义为肝组织G2以上炎症或出现BruntNASH病理标准中的肝纤维化,进展性肝纤维化定义为2期以上肝纤维化。结果总计有108例NAFLD患者纳入研究,其中单纯性脂肪肝、NASH、NASH相关肝硬化分别有67例(62.04%)、39例(36.11%)、2例(1.85%)。男性90.7%、平均年龄(36.6±11.1)岁、体质量指数(BMI)(26.34±3.38)kg/m2、收缩压(120.13±11.17)mmHg、舒张压(76.61±8.93)mmHg。肝脏病理学结果显示,肝纤维化分期S055例(50.5%)、S128例(25.9%)、S215例(13.9%)、S38例(7.4%)、S42例(1.9%),与S0-1组(83例)患者相比,S2-4组(25例)BMI、血清ALT和AST水平更高(P<0.05),年龄、血清总胆红素水平更低(P<0.05)。Logistic逐步回归分析表明,仅血清AST增高与进展性肝纤维化相关(P=0.027,OR=3.536,CI=1.159～10.790),ROC曲线下面积为0.724(CI=0.600～0.849,P=0.002)。结论血清AST水平增高是NAFLD出现进展性肝纤维化的重要预测因素,但准确性欠佳。Objective To explore the predictors of progressive fibrosis in Chinese patients with non-alcoholic fatty Liver disease（NAFLD）.Methods Clinical,demographic,and biochemical data of 108 consecutive patients（male 90.7%）with a biopsy-proven NAFLD were retrieved from the medical database between Jan 2005 and Mar 2009.Non-alcoholic steatohepatitis（NASH）was defined as necroinflammatory grade≥2 and/or Brunt＇s criteria,progressive fibrosis was defined as fibrosis stage≥2.Blood samples were collected on the day of liver biopsy.Independent risk factors for progressive fibrosis were analyzed by multiple Logistic regression analysis.Results Totally 108 cases of NAFLD were enrolled in this study,including simple steatosis（67 cases,62.4%）,nonalcoholic steatohepatitis（39 cases,36.11%）and cirrhosis（2 cases,1.85%）.Clinical parameters were as follows,the percentage of male was 90.7%,mean age of the patients was 36.6±11.1,body mass index（BMI）was（26.34±3.38）kg/m^2,systolic blood pressure（SBP）was（120.13±11.17）mm Hg and diastolic blood pressure（DBP）was（76.61±8.93）mm Hg.In terms of fibrosis stage,55（50.5%）patients were classified as S0,28（25.9%）as S1,15（13.9%）as S2,8（7.4%）as S3 and 2（1.9%）as S4.Compared with non/moderate fibrosis group,BMI,the levels of ALT and AST in progressive fibrosis group were higher,while mean age and serum level of bilirubin were lower（P〈0.05）.Logistic regression analysis revealed that only elevated aspartate aminotransferase（P=0.027,OR=3.536,CI=1.159-10.790）was a potential predictor of progressive fibrosis.The area under the receiver operating characteristics curves of AST to predict progressive fibrosis was 0.724（CI=0.600-0.849,P=0.002）.Conclusion Elevated aspartate aminotransferase level is independent predictor of progressive fibrosis.However,its accuracy needs improved.

关 键 词：非酒精性脂肪性肝病 非酒精性脂肪性肝炎 病理学 纤维化 天冬氨酸氨基转移酶 

分 类 号：R575.2[医药卫生—消化系统]