The Korean Journal of Gastroenterology (대한소화기학회지)

The Korean Society of Gastroenterology (대한소화기학회)
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Nonalcoholic Fatty Liver Disease and Abnormal Liver Function Test in the Health Screen Examinees: the Relationship with Insulin Resistance

건강검진 수진자에서 비알코올성 지방간 및 간기능 장애: 인슐린 저항성과의 관계

Park, Seung-Ha;Kim, Byung-Ik;Yoo, Tae-Woo;Kim, Jeong-Wook;Cho, Yong-Kyun;Sung, In-Kyung;Park, Chang-Young;Sohn, Chong-Il;Jeon, Woo-Kyu;Lee, Won-Young;Kim, Sun-Woo
박승하;김병익;유태우;김정욱;조용균;성인경;박창영;손정일;전우규;이원영;김선우

  • Published : 20030500
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Abstract

Background/Aims: Nonalcoholic fatty liver disease (NAFLD) is one of the major causes of the elevation of aminotransferase when other causes of liver disease are excluded. Insulin resistance is an essential pathophysiologic factor in the development of NAFLD and metabolic syndrome. We hypothesized that there would be an association between the elevation of aminotransferase and metabolic syndrome. Methods: A total of 6,244 health screen exantinees (3,975 men, 2,269 women) with no evidence of viral hepatitis and alcohol abuse were enrolled in this study. We assessed the clinical characteristics using liver function test (LFT) and ultrasonography. Homeostatic model assessment (HOMA) was used as an index of insulin resistance. Results: According to the increment of HOMA, the prevalence of abnormal liver function significantly increased after adjustment with age, sex, and obesity (p<0.01). Abnormal liver function remained as an independent risk factor for metabolic syndrome in both sexes after logistic multiple regression analysis with age and body mass index (p<0.001 in male, p<0.05 in female). Conclusions: The abnormal liver function was closely associated with insulin resistance. Thus, it can be an independent risk factor for metabolic syndrome. Index of insulin resistance such as HOMA may serve as a good parameter for follow-up during the treatment of NAFLD.

목적: 만성 간염 및 알코올성 간질환 등의 다른 기저 간질환을 배제하면 비알코올성 지방간이 간기능 장애의 주요 원인이다. 비알코올성 지방간의 발생 기전에는 인슐린 저항성이 중요한 역할을 하는 것으로 알려져 있고 인슐린 저항성을 공통분모로 하는 대사증후군은 심혈관계 질환의 발생 및 사망률괴 밀접한 연관성이 있다. 저자들은 간 기능 장애와 인슐린 저항성의 상관관계를 분석하여 간기능 장애가 대사증후군과 연관성이 있는지를 알아보고자 하였다. 대상 및 방법: 20세 이상의 건강검진 수진자 6,244명(남자 3,975명, 여자 2,269명)을 대상으로 하였고 의미 있는 알코올 섭취(40g/week, 1주일에 소주 2/3병 이상)자, 복부 초음파검사, 간기능검사를 비롯한 혈액검사 소견을 파악하여 간기능 장애와 인슐린 저항성 및 대사증후군과의 연관성을 분석하였다. 결과: 간기능 장애와 비알코올성 지방간의 유병률은 각각 13.7%, 9.1%였다. homeostatic model assessment (HOMA)값이 증가할수록 간기능 장애 및 대사 증후군의 비교위험도는 증가하였고(p<0.01), 아미노전이효소치가 증가할수록 HOMA값이 증가하였다(p<0.01). 나이 및 체질량지수을 보정한 후에도 남여 모두에서 간기능 장애는 대사증후군의 독립적인 위험인자였다(남자 p<0.001, 여자 p<0.05). 결론: 간기능 장애는 인슐린 저항성과 밀접한 연관성이 있으며 대사증후군의 독립적인 위험인자이다. 간기능 장애 및 비알코올성 지방간의 위험인자들의 공통적인 특정인 인슐린 저항성의 지표는 치료 효과 판정 및 통합적인 위험인자의 관리에 도움이 될 것으로 생각된다.

Keywords

References

  1. Pratt DS, Kaplan MM. Evaluation of liver function. In: Braunwald E, Fausi AS, Kasper DL, Hauser SL, Longo DL, Jameson JL, eds. Harrison's principles of internal medicine. Volume 2. 15th eds. New York: McGraw-Hill, 2001: 1711-1715
  2. Pratt DS, Kaplan MM. Evaluation of abnormal liver-enzyme results in asymptomatic patients. N Engl J Med 2000;342:1266-1271 https://doi.org/10.1056/NEJM200004273421707
  3. Hultcrantz R, Glaumann H, Lindberg G, Nilsson LH. Liver investigation in 149 asymptomatic patients with moderately elevated activities of serum aminotransferase. Scand J Gastroenterol 1986;21:109-113
  4. Daniel S, Ben-Menachem T, Vasudevan G, Ma CK, Blumenkehl M. Prospective evaluation of unexplained chronic liver transaminase abnormalities in asymptomatic and symptomatic patients. Am J Gastroenterol 1999;94:3010-3014 https://doi.org/10.1111/j.1572-0241.1999.01451.x
  5. Teli MR, James OF, Burt AD, Bennett MK, Day CP. The natural history of nonalcoholic fatty liver: a follow-up study. Hepatology 1995;22:1714-1719 https://doi.org/10.1002/hep.1840220616
  6. Matteoni CA, Younossi ZM, Gramlich T, Boparai N, Liu YC, McCullough Al Nonalcoholic fatty liver disease: a spectrum of clicical and pathological severity. Gastroenterology 1999;116:1413-1419 https://doi.org/10.1016/S0016-5085(99)70506-8
  7. Powell EE, Cooksley WG, Hanson R, Searle J, Halliday JW, Powell LW. The natural history of nonalcoholic steatohepatitis: a follow-up study of forty-two patients for up to 21 years. Hepatology 1990;11:74-80 https://doi.org/10.1002/hep.1840110114
  8. Wanless IR, Lentz JS. Fatty liver hepatitis (steatohepatitis) and obesity: an autopsy study with analysis of risk factors. Hepatology 1990;12:1106-1110 https://doi.org/10.1002/hep.1840120505
  9. Eriksson S, Eriksson KF, Bondesson L. Nonalcoholic steatohepatitis in obesity: a reversible condition. Acta Med Scand 1986;220:83-88
  10. Marceau P, Biron S, Hould FS, et al. Liver pathology and the metabolic syndrome X in severe obesity. J Clin Endocrinol Metab 1999;84:1513-1517 https://doi.org/10.1210/jc.84.5.1513
  11. Batman PA, Scheuer PJ. Diabetic hepatitis preceding the onset of glucose intolerance. Hepatology 1985;9:237-243
  12. Bacon BR, Farahvash MJ, Janney CG, Neuschwander-Tetri BA. Nonalcoholic steatohepatitis: an expanded clinical entity. Gastroenterology 1994;107:1103-1109 https://doi.org/10.1016/0016-5085(94)90235-6
  13. Fong DG, Nehra V, Lindor KD, Buchman AL. Metabolic and nutritional considerations in nonalcoholic fatty liver. Heptology 2000;32:3-10
  14. Itoh S, Yougel T, Kawagoe K. Comparison between nonalcoholic steatohepatitis and alcoholic hepatitis. Am J Gastroenterol 1987;82:650-654
  15. Diehl AM, Goodman Z, Ishak KG. Alcoholic liver disease in nonalcoholics: a clinical and histologic comparison with alcohol-induced liver injury. Gastroenterology 1988;95: 1056-1062 https://doi.org/10.1016/0016-5085(88)90183-7
  16. Marchesini G, Brizi M, Morselli-Labate AM, et al. Association of nonalcoholic fatty liver disease with insulin resistance. Am J Med 1999;107:450-455 https://doi.org/10.1016/S0002-9343(99)00271-5
  17. Marchesini G, Brizi M, Bianchi G, et al. Nonalcoholic fatty liver disease. A feature of the metabolic syndrome. Diabetes 2001;50:1844-1850 https://doi.org/10.2337/diabetes.50.8.1844
  18. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285:2486-2496
  19. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostatic model assessment: Insulin resistance and $\beta$-cell function from fasting plasma glucose and insulin concentration in man. Diabetologia 1985;28:412-419 https://doi.org/10.1007/BF00280883
  20. WHO West Pacific Region. The Asia-Pacific perspective: Refining obesity and its treatment IOTF Feb. 2000
  21. Diehl AM, Potter J, Boitnott J, Van Duyn MA, Herlong HF, Mezey E. Relationship between pyridoxal 5' -phosphate deficiency and aminotransferase level in alcoholic hepatitis. Gastroenterology 1984;86:635-636
  22. Cohen JA, Kaplan MM. The SGOT/SGPT ratio-an indicator of alcohol liver disease. Dig Dis Sci 1979;24:835-838 https://doi.org/10.1007/BF01324898
  23. Adkins MC, Halvorsen RA Jr, duCret RP. CT evaluation of atypical hepatic fatty metamorphosis. J Comput Assist Tomography 1990;14:1013-1015 https://doi.org/10.1097/00004728-199011000-00032
  24. Nomura H, Kashiwagi S, Hayashi J, Kajiyama W, Tani S, Goto M. Prevalence of fatty liver in a general population of Okinawa, Japan. Jpn J Med 1988;27:142-149 https://doi.org/10.2169/internalmedicine1962.27.142
  25. Araujo LM, DeOliveira DA, Nunes DS. Liver and biliary ultrasonography in diabetic and non-diabetic obese women. Diabetes Metab 1998;24:458-462
  26. Hilden M, Christoffersen P, Juhl E, Dalgaard JB. Liver histology in a 'normal' population-examinations of 503 consecutive fatal traffic casualities. Scand J Gastroenterol 1977;12:593-597 https://doi.org/10.3109/00365527709181339
  27. Ground KE. Liver pathology in aircrew. Aviat Spac Environ Med 1982;53:14-18
  28. Assy N, Kaita K, Mymin D, Levy C, Rosser B, Minuk G. Fatty infiltration of liver in hyperlipidemic patients. Dig Dis Sci 2000;45:1929-1934 https://doi.org/10.1023/A:1005661516165
  29. Dixon JB, Bhathal PS, O'Brien PE. Nonalcoholic fatty liver disease: predictors of nonalcoholic steatohepatitis and liver fibrosis in the severely obese. Gastroenterology 2001;121:91-100 https://doi.org/10.1053/gast.2001.25540
  30. Comert B, Mas MR, Erdem H, et al. Insulin resistance in non-alcoholic steatohepatitis. Dig Liver Dis 2001;33:353-358 https://doi.org/10.1016/S1590-8658(01)80091-8
  31. Van Steenbergen W, Lanckmans S. Liver disturbances in obesity and diabetes mellitus. Int J Obes Relat Metab Disord 1995;19(suppl):27S- 36S
  32. Vozarova B, Stefan N, Lindsay RS, et al. High alanine aminotransferase is associated with decreased hepatic insulin sensitivity and predicts the development of type 2 diabetes. Diabetes 2002;51:1889-1895 https://doi.org/10.2337/diabetes.51.6.1889
  33. Torgerson JS, Lindroos AK, Sjostrom CD, Olsson R Lissner L, Sjostrom L. Are elevated aminotransferase and decreased bilirubin additional characteristics of the metabolic syndrome? Obes Res 1997;5:105-114
  34. Angulo P. Nonalcoholic fatty live disease. N Engl J Med 2002;346:1221-1231 https://doi.org/10.1056/NEJMra011775
  35. Matteoni CA, Younossi ZM, Gramlich T, Boparai N, Liu YC, McCullough AJ. Nonalcoholic fatty live disease: a spectrum of clinical and pathologic severity. Gastroenterology 1999;116:1413-1419 https://doi.org/10.1016/S0016-5085(99)70506-8
  36. Angulo P, Keach JC, Batts KP, Lindor KD. Independent predictors of liver fibrosis in patients with nonalcoholic stearohepatitis. Hepatology 1999;30:1356-1362 https://doi.org/10.1002/hep.510300604
  37. Ratziu V, Giral P, Charlotte F, et al. Liver fibrosis in overweight patients. Gastroenterology 2000;118:1117-1123 https://doi.org/10.1016/S0016-5085(00)70364-7
  38. Day CP, James OF. Steatohepatitis: a tale of two 'hit'? Gastroenterology 1998;114:842-845
  39. Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA 2002;287: 356-359 https://doi.org/10.1001/jama.287.3.356
  40. Meigs JB. Epidemiology of the metabolic syndrome, 2002. Am J Manag Care 2002;8(suppl):283S-292S