ISSN 2312-3672
Shipovskaya A., Dudanova O., Lutokhina A., Larina N. The role of new reference values of alanine aminotransferase in diagnosis of various forms of nonalcoholic fatty liver disease in patients with metabolic syndrome // Journal of Biomedical Technologies. 2015. № 1. P. 9‒15. DOI: 10.15393/j6.art.2015.3284
Issue № 1 (2015)
Original research
The role of new reference values of alanine aminotransferase in diagnosis of various forms of nonalcoholic fatty liver disease in patients with metabolic syndrome
| Shipovskaya Anastasiya Andreevna | Petrozavodsk State University, 185910 Petrozavodsk, Lenina str., 33, Odudanova@gmail.com |
| Dudanova Olga Petrovna | Petrozavodsk State University, 185910 Petrozavodsk, Lenina str., 33, Odudanova@gmail.com |
| Lutokhina Anna Aleksandrovna | Petrozavodsk State University, 185910 Petrozavodsk, Lenina str., 33, Odudanova@gmail.com |
| Larina Nadezhda Alekseevna | Petrozavodsk State University, 185910 Petrozavodsk, Lenina str., 33, Odudanova@gmail.com |
|
new upper limits of normal of alanine aminotransferase levels nonalcoholic fatty liver disease cholestasis metabolic syndrome |
To date, new upper limits of normal (ULN) alanine aminotransferase (ALT) levels for patients with nonalcoholic fatty liver disease (NAFLD) are recommended: ULN = 19 IU/l for women and ULN = 30 IU/l for men, however, these limits still do not have wide acceptance in clinical practice. The aim of our work was to determine the diagnostic value of new reference ALT serum levels in the diagnosis of different forms of NAFLD in patients with metabolic syndrome (MS).
Materials and methods. The study involved 111 patients with NAFLD: 44 (36.6%) – with hepatic steatosis (HS), and 67 (63.4%) – with steatohepatitis (SH) of weak activity. The diagnosis of NAFLD was established on the basis of conventional clinical, laboratory, instrumental, and histological methods.
Results. We compared the clinical and laboratory parameters in patients with HS and SH subdivided into two groups: I – with old reference ALT standards (subgroup AI – HS, and subgroup BI – SH), and II – with new reference ALT standards (subgroup AII – HS, and subgroup BII – SH). We revealed a 10% increase in the frequency of detection of SH when using new reference ALT standards. Patients with signs of HS, according to new reference ALT standards, had significantly higher levels of alkaline phosphatase (ALP) than patients with HS defined on the basis of old reference ALT standards – 428.0 ± 85.6 IU/l vs. 294.44 ± 95.6 IU/l (p<0.05). The level of ALP in the subgroup AII correlated more strongly with indicators of MS – waist circumference, levels of triglycerides and cholesterol, than in subgroup AI: r=0.70, r=0.65, r=0.85 (p<0.05) vs. r=0.14, r=0.58, r=0.61 (p<0.05), respectively. For patients with SH, such correlations were not found.
Conclusions. Applying of new reference ALT standards for NAFLD patients with metabolic syndrome allowed to improve the differential diagnosis of steatohepatitis and hepatic steatosis without need to use histological methods of research, and to identify a more significant role of intrahepatic cholestasis in the pathogenesis of hepatic steatosis compared to steatohepatitis of weak activity. |
Displays: 2981; Downloads: 4584;