|
AST/ALT比值与尿白蛋白/肌酐比值(ACR)相关性研究:从生物标志物到临床应用
|
Abstract:
天门冬氨酸氨基转移酶(AST)与丙氨酸氨基转移酶(ALT)比值(AAR),传统上用于肝脏功能评估,近年来研究发现它与肝外疾病,如心血管疾病、代谢综合征和肾脏功能等存在关联。尿白蛋白肌酐比(ACR)作为肾脏敏感指标,在预测心血管风险、脑卒中、糖尿病和全因死亡率方面具有重要意义。本文旨在探讨AST/ALT比值与ACR相关潜在机制的关联性,以利用这两个指标全面评估人体健康,并通过它们的关系,利用肝损伤指标预测肾脏状况,从而对肾病患者实施早期临床管理。
The ratio of aspartate aminotransferase (AST) to alanine aminotransferase (ALT), traditionally known as the AST/ALT ratio (AAR), has been used for the assessment of liver function. Recent studies have identified its association with extrahepatic diseases, such as cardiovascular diseases, metabolic syndrome, and renal function. The urinary albumin-to-creatinine ratio (ACR) serves as a sensitive marker for kidney health and holds significant prognostic value in predicting cardiovascular risks, stroke, diabetes, and all-cause mortality. This article aims to explore the correlation between the AST/ALT ratio and ACR in chronic kidney disease, to utilize these two indicators for a comprehensive assessment of human health. Furthermore, by understanding their relationship, liver injury markers can be used to predict kidney conditions, thereby facilitating early clinical management for patients with kidney disease.
[1] | Akbuğa, K., Yayla, K.G. and Yayla, Ç. (2022) Evaluation of the Relationship between Aspartate Aminotransferase/Alanine Aminotransferase Ratio and Coronary Slow-Flow Phenomenon. Biomarkers in Medicine, 16, 783-789. https://doi.org/10.2217/bmm-2022-0028 |
[2] | 田蕊萍, 李伟, 王琰, 等. 尿白蛋白/肌酐比值与缺血性脑卒中关系的研究进展[J]. 神经疾病与精神卫生, 2020, 20(6): 444-449. |
[3] | Yang, Z., Fu, Y., Wei, X., Fu, B., Huang, J., Zhang, G., et al. (2023) Optimal Threshold of Urinary Albumin-to-Creatinine Ratio (UACR) for Predicting Long-Term Cardiovascular and Noncardiovascular Mortality. International Urology and Nephrology, 55, 1811-1819. https://doi.org/10.1007/s11255-023-03499-z |
[4] | Oshima, M., Neuen, B.L., Li, J., Perkovic, V., Charytan, D.M., de Zeeuw, D., et al. (2020) Early Change in Albuminuria with Canagliflozin Predicts Kidney and Cardiovascular Outcomes: A Post Hoc Analysis from the CREDENCE Trial. Journal of the American Society of Nephrology, 31, 2925-2936. https://doi.org/10.1681/asn.2020050723 |
[5] | Wang, J., Wang, Y., Li, Y., Hu, Y., Jin, L., Wang, W., et al. (2022) High Normal Urinary Albumin-Creatinine Ratio Is Associated with Hypertension, Type 2 Diabetes Mellitus, HTN with T2DM, Dyslipidemia, and Cardiovascular Diseases in the Chinese Population: A Report from the REACTION Study. Frontiers in Endocrinology, 13, Article 864562. https://doi.org/10.3389/fendo.2022.864562 |
[6] | De Ritis, F., Coltorti, M. and Giusti, G. (1957) An Enzymic Test for the Diagnosis of Viral Hepatitis: The Transaminase Serum Activities. Clinica Chimica Acta, 2, 70-74. https://doi.org/10.1016/0009-8981(57)90027-x |
[7] | Botros, M. and Sikaris, K.A. (2013) The de Ritis Ratio: The Test of Time. Clinical Biochemist Reviews, 34, 117-130. |
[8] | Ferrannini, G., Rosenthal, N., Hansen, M.K. and Ferrannini, E. (2022) Liver Function Markers Predict Cardiovascular and Renal Outcomes in the CANVAS Program. Cardiovascular Diabetology, 21, Article No. 127. https://doi.org/10.1186/s12933-022-01558-w |
[9] | Chen, W., Wang, W., Zhou, L., Zhou, J., He, L., Li, J., et al. (2022) Elevated AST/ALT Ratio Is Associated with All‐cause Mortality and Cancer Incident. Journal of Clinical Laboratory Analysis, 36, e24356. https://doi.org/10.1002/jcla.24356 |
[10] | Ferrè, S., Storfer-Isser, A., Kinderknecht, K., Montgomery, E., Godwin, M., Andrews, A., et al. (2023) Fulfillment and Validity of the Kidney Health Evaluation Measure for People with Diabetes. Mayo Clinic Proceedings: Innovations, Quality & Outcomes, 7, 382-391. https://doi.org/10.1016/j.mayocpiqo.2023.07.002 |
[11] | Tuttle, K.R., Brosius, F.C., Cavender, M.A., Fioretto, P., Fowler, K.J., Heerspink, H.J.L., et al. (2020) SGLT2 Inhibition for CKD and Cardiovascular Disease in Type 2 Diabetes: Report of a Scientific Workshop Sponsored by the National Kidney Foundation. Diabetes, 70, 1-16. https://doi.org/10.2337/dbi20-0040 |
[12] | 崔健, 夏青, 周茜宁. 尿白蛋白/肌酐比值与2型糖尿病慢性并发症关系的研究进展[J]. 医学综述, 2023, 29(24): 5765-5768. |
[13] | Zou, Y., Zhao, L., Zhang, J., Wang, Y., Wu, Y., Ren, H., et al. (2022) Metabolic-Associated Fatty Liver Disease Increases the Risk of End-Stage Renal Disease in Patients with Biopsy-Confirmed Diabetic Nephropathy: A Propensity-Matched Cohort Study. Acta Diabetologica, 60, 225-233. https://doi.org/10.1007/s00592-022-01978-w |
[14] | Cao, Y., Deng, Y., Wang, J., Zhao, H., Zhang, J. and Xie, W. (2021) The Association between NAFLD and Risk of Chronic Kidney Disease: A Cross-Sectional Study. Therapeutic Advances in Chronic Disease, 12, 1-12. https://doi.org/10.1177/20406223211048649 |
[15] | Oye-Somefun, A., Kuk, J.L. and Ardern, C.I. (2021) Associations between Elevated Kidney and Liver Biomarker Ratios, Metabolic Syndrome and All-Cause and Coronary Heart Disease (CHD) Mortality: Analysis of the U.S. National Health and Nutrition Examination Survey (NHANES). BMC Cardiovascular Disorders, 21, Article No. 352. https://doi.org/10.1186/s12872-021-02160-w |
[16] | Zhao, L., Cheng, J., Chen, Y., Li, Q., Han, B., Chen, Y., et al. (2017) Serum Alanine Aminotransferase/Aspartate Aminotransferase Ratio Is One of the Best Markers of Insulin Resistance in the Chinese Population. Nutrition & Metabolism, 14, Article No. 64. https://doi.org/10.1186/s12986-017-0219-x |
[17] | Simental-Mendía, L.E., Rodríguez-Morán, M., Gómez-Díaz, R., Wacher, N.H., Rodríguez-Hernández, H. and Guerrero-Romero, F. (2017) Insulin Resistance Is Associated with Elevated Transaminases and Low Aspartate Aminotransferase/Alanine Aminotransferase Ratio in Young Adults with Normal Weight. European Journal of Gastroenterology & Hepatology, 29, 435-440. https://doi.org/10.1097/meg.0000000000000811 |
[18] | Yilmaz, Y., Alahdab, Y.O., Ozdogan, O. and Dolar, E. (2009) Non-Alcoholic Fatty Liver Disease and Microalbuminuria in Non-Diabetic Patients: Role of Insulin Resistance. Internal Medicine Journal, 39, 709-710. https://doi.org/10.1111/j.1445-5994.2009.02029.x |
[19] | Kobayashi, H., Tokudome, G., Hara, Y., Sugano, N., Endo, S., Suetsugu, Y., et al. (2009) Insulin Resistance Is a Risk Factor for the Progression of Chronic Kidney Disease. Clinical Nephrology, 71, 643-651. https://doi.org/10.5414/cnp71643 |
[20] | Moh, M.C., Pek, S.L.T., Sze, K.C.P., Low, S., Subramaniam, T., Ang, K., et al. (2023) Associations of Non-Invasive Indices of Liver Steatosis and Fibrosis with Progressive Kidney Impairment in Adults with Type 2 Diabetes. Acta Diabetologica, 60, 827-835. https://doi.org/10.1007/s00592-023-02058-3 |
[21] | Xu, J., Shi, X. and Pan, Y. (2021) The Association of Aspartate Aminotransferase/Alanine Aminotransferase Ratio with Diabetic Nephropathy in Patients with Type 2 Diabetes. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 14, 3831-3837. https://doi.org/10.2147/dmso.s330741 |
[22] | Wynn, T.A. and Ramalingam, T.R. (2012) Mechanisms of Fibrosis: Therapeutic Translation for Fibrotic Disease. Nature Medicine, 18, 1028-1040. https://doi.org/10.1038/nm.2807 |
[23] | Ciardullo, S., Ballabeni, C., Trevisan, R. and Perseghin, G. (2021) Liver Fibrosis Assessed by Transient Elastography Is Independently Associated with Albuminuria in the General United States Population. Digestive and Liver Disease, 53, 866-872. https://doi.org/10.1016/j.dld.2021.02.010 |
[24] | Liu, Y., Chai, S. and Zhang, X. (2023) Effect of MAFLD on Albuminuria and the Interaction between MAFLD and Diabetes on Albuminuria. Journal of Diabetes, 16, e13501. https://doi.org/10.1111/1753-0407.13501 |
[25] | Choi, J.W., Lee, C.H. and Park, J. (2019) Comparison of Laboratory Indices of Non-Alcoholic Fatty Liver Disease for the Detection of Incipient Kidney Dysfunction. PeerJ, 7, e6524. https://doi.org/10.7717/peerj.6524 |
[26] | Ciardullo, S., Muraca, E., Perra, S., Bianconi, E., Zerbini, F., Oltolini, A., et al. (2020) Screening for Non-Alcoholic Fatty Liver Disease in Type 2 Diabetes Using Non-Invasive Scores and Association with Diabetic Complications. BMJ Open Diabetes Research & Care, 8, e000904. https://doi.org/10.1136/bmjdrc-2019-000904 |
[27] | Wang, C., Cui, Y., Li, C., Zhang, Y., Xu, S., Li, X., et al. (2013) Nrf2 Deletion Causes “Benign” Simple Steatosis to Develop into Nonalcoholic Steatohepatitis in Mice Fed a High-Fat Diet. Lipids in Health and Disease, 12, Article No. 165. https://doi.org/10.1186/1476-511x-12-165 |
[28] | Ochiai, H., Shirasawa, T., Yoshimoto, T., Nagahama, S., Watanabe, A., Sakamoto, K., et al. (2020) Elevated Alanine Aminotransferase and Low Aspartate Aminotransferase/Alanine Aminotransferase Ratio Are Associated with Chronic Kidney Disease among Middle-Aged Women: A Cross-Sectional Study. BMC Nephrology, 21, Article No. 471. https://doi.org/10.1186/s12882-020-02144-6 |
[29] | Tang, W., Hung, W., Wang, C., Wu, C., Hsuan, C., Yu, T., et al. (2022) The Lower Limit of Reference of Urinary Albumin/Creatinine Ratio and the Risk of Chronic Kidney Disease Progression in Patients with Type 2 Diabetes Mellitus. Frontiers in Endocrinology, 13, Article 858267. https://doi.org/10.3389/fendo.2022.858267 |