海南医科大学学报

目的：探讨非酒精性脂肪性肝病（nonalcoholic fatty liver disease,NAFLD）患者丙氨酸氨基转移酶（alanine aminotransfease,ALT）升高的危险因素，并建立NAFLD患者ALT升高的风险预测模型。方法：选择中日友好医院体检中心NAFLD受试者共200例，标准化采集相关临床指标及中医舌象资料，根据ALT是否升高分为ALT升高组和ALT正常组，采用logistic回归分析得出ALT升高的独立危险因素，并基于此建立NAFLD患者ALT升高的logistic回归预测模型，使用Hosmer-Lemshow拟合优度检验评价模型的校准度，使用受试者工作特征曲线下面积（AUROC）检验模型的区分度。结果：多因素logistic回归分析显示，男性、肥胖、总胆固醇升高、甘油三酯升高以及点刺舌的OR值分别为6.059、2.216、2.649、2.106、3.646,P均<0.05;logistic回归预测模型一（不含点刺舌）和模型二（含点刺舌）的AUROC曲线下面积分别为0.771(95%CI:0.703～0.840)、0.801(95%CI:0.736～0.866)，最大约登指数、灵敏度、特异度分别为0.414、0.829、0.585和0.478、0.686、0.792。结论：男性、肥胖、总胆固醇升高、甘油三酯升高以及点刺舌是NAFLD患者ALT升高的独立危险因素；本研究建立了包含舌象特征的中西医结合预测模型，对NAFLD患者ALT升高风险预测具有一定的临床价值，值得推广应用。

Objective:To explore the risk factors of elevated alanine aminotransferase(ALT)in patients with nonalcoholic fatty liver disease(NAFLD),and to establish a risk prediction model of elevated ALT in patients with NAFLD.Methods:A total of 200 NAFLD subjects were enrolled in Health Examination Center of China-Japan Friendship Hospital in Beijing. The relevant clinical indexes and TCM tongue picture data were collected standardizedly. According to the elevation of ALT,the patients were divided into ALT elevation group and ALT normal group. The independent risk factors of ALT elevation were obtained by logistic regression analysis. Based on this,the logistic regression prediction model of ALT elevation in NAFLD patients was established,and the calibration of the model was evaluated by Hosmer-Lemshow goodness-of-fit test. The area under the subject's working characteristic curve(AUROC)was used to test the discrimination of the model. Results:The multivariate logistic regression analysis showed that the OR value of male,obesity,elevated total cholesterol(TC),elevated triglyceride(TG)and prickly tongue were 6.059,2.216,2.649,2.106,3.646,respectively,and the P-values were all < 0.05. The AUROC of logistic regression prediction Model 1(without prickly tongue)and Model 2(including prickly tongue)were 0.771(95%CI:0.703-0.840)and 0.801(95%CI:0.736-0.866),respectively,and the maximum Youden index,sensitivity and specificity were 0.414,0.829,0.585 and 0.478,0.686,0.792,respectively. Conclusion:Male,obesity,elevated TC,elevated TG and prickly tongue were independent risk factors for elevated ALT in NAFLD patients. This study established an integrated traditional Chinese and Western medicine model that includes the tongue characteristics,which have certain clinical value in predicting the risk of elevated ALT in patients with NAFLD,and are worth popularizing and applying.