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 Hos-pital 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 lipo-protein (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 be-tween 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 = 42942,47697,48106,49086,31938,and 36283,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 nor-mal ALT group (40. 2% vs 30. 1%,P < 0. 05). The univariate analysis showed that male sex,age (young and middle ages),a high num-ber 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 independ-ent 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.%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50 U/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20~39岁组(n=242)、40~59岁组(n=555)及60~90岁组(n=210),3组间ALT升高比例比较差异有统计学意义(26.03%vs 8.83%vs 5.24%,χ2=52.327,P<0.001),进一步两两比较,20~39岁ALT升高患者所占比例高于40~59岁组和60~90岁组(χ2值分别为39.886、34.009,P值均<0.001).ALT升高组年龄相对年轻(以中青年为主)、BMI相对较高,差异显著(t值分别为7.419、-4.595,P值均<0.001);2组的UA、外周血单核细胞数、LDL/HDL、HDL、AST、GGT水平比较差异均有统计学意义(U值分别为42942、47697、48106、49086、31938、36283,P值均<0.05).ALT升高组NAFLD患者合并甲状腺结节罹患率(392/1007)比ALT正常组低,差异有统计学意义(40.2%vs 30.1%,P<0.05).单因素分析显示,男性、年龄(中青年)、高外周血单核细胞数量、LDL/HDL增高、低水平的HDL、高水平GGT、较高的BMI、无甲状腺结节与NAFLD患者ALT升高有一定相关度(P值均<0.05);多因素logistic回归分析发现中青年(20~39岁)、高水平外周血单核细胞、高水平GGT是NAFLD患者ALT升高的独立危险因素(P值均<0.001).结论 中青年(20~39岁)、高外周血单核细胞水平、高GGT水平是NAFLD患者中ALT升高的预警因素,对非酒精性脂肪性肝炎的早期诊断可能具有提示意义.
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