한국 성인 남성에서 음주와 AST/ALT 비의 연관성
Association between Alcohol Drinking and the Ratio of Aspartate Aminotransferase toAlanine Aminotransferase in Korean Adult Male
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연구배경: 과음은 간질환을 일으키는 흔한 원인 중에 하나로 간 기능검사의 변화를 일으킨다. AST/ALT 비는 과음시 증가하는 경향이 있는 것으로 알려져 있다. 본 연구는한국 남성에서 음주량에 따른 AST/ALT 비와 AST/ALT 비의 과음 예측도를 살펴보고자 하였다. 방법:2015년 충남대학교병원 종합검진센터에서 검진을받은 남성 중, 간 기능 수치에 영향을 주는 질병력 및 약물복용력이 없는 환자 830명을 대상으로 하였다. 음주량은알코올 14 g을 표준잔으로 하였고, 주당 8잔 이하, 8잔 초과14잔 이하, 14잔 초과 음주군으로 나누어 AST/ALT 비가1을 초과하는 교차비를 로지스틱 회귀분석을 통해 혼란변수들을 보정하여 비음주군과 비교하였다. 또한 AST/ALT 비가 1을 초과하는 경우 NIAAA와 한국 기준의 과음을 선별하는데 있어서 민감도, 특이도, 양성예측도, 음성예측도, 양성우도비, 음성우도비, 교차비를 조사하였다. 결과:AST/ALT 비에 영향을 줄 수 있는 연령, BMI, 운동여부, 흡연량을 보정한 후 AST/ALT 비가 1을 초과하는odds ratio (95% confidence interval)는 음주군에서 8잔 이하 음주군에서 1.607 (1.048-2.464), 8잔 초과 14잔 이하에서2.172 (1.160-4.065), 14잔 초과의 경우 3.670 (2.218-6.053)이었다. 음주군에서 AST/ALT 비가 1을 초과할 때 NIAAA guidelines 기준의 과음을 선별하는데 있어 민감도, 특이도, 양성예측도, 음성예측도, 양성우도비, 음성우도비, 교차비는 57.2%, 52.7%, 23.2%, 76.8%, 1.21 (1.04-1.41), 0.81 (0.67-0.98), 1.49 (1.05-2.01)를 보였다. Korean guidelines 기준의 경우 각각 55.2%, 55.3%, 33.7%, 66.3%, 1.24 (1.03-1.36), 0.84 (0.72-0.98), 1.40 (1.04-1.89)을 보였다. 결론: 무증상의 건강한 성인 남성에서 비음주군과 비교하여 음주군에서 음주량이 증가함에 따라 AST/ALT 비가1을 초과할 교차비가 증가하였고, AST/ALT 비가 1을 초과할 때 과음을 예측하는데 있어 다른 혈액 마커와 함께 임상에서 활용하는 것이 좋겠다.
Abstract
Background:The aspartate transaminase (AST)/alanine transferase (ALT) ratio increases with alcohol consumption. This study investigated AST/ALT ratio according to alcohol drinking and predictive power of AST/ALT ratio for heavy drinking in Korean men Methods:In 2015, 830 men with no history of disease or medication affecting liver function values were selected. Using 14 g of alcohol as the standard glass, odd ratios (ORs) of AST/ALT ratio over 1 among the drinking group were compared with the non-drinking group by multiple logistic analyses. Screening of heavy drinkers was conducted according to both NIAAA and Korean guidelines. Using AST/ALT ratio >1, sensitivity, specificity, positive predictive values, negative predictive values, positive likelihood ratios, negative likelihood ratios and odds ratios were investigated. Results:After correcting for age, body mass index, exercising, and smoking history, ORs (95% confidence interval) of AST/ALT >1 were 1.607 (1.048-2.464) in <8 glasses group, 2.172 (1.160-4.065) in the 14 glasses group, and 3.670 (2.218-6.053) in the >14 glasses group. When AST/ALT >1 in the drinking group, sensitivity, specificity, positive predictive values, negative predictive values, likelihood ratios (LR)+, LR- and OR according to NIAAA guidelines, were 57.2%, 52.7%, 23.2%, 76.8%, 1.21 (1.04-1.41), 0.81 (0.67-0.98), and 1.49 (1.05-2.01), respectively. By Korean guidelines, these values were 55.2%, 55.3%, 33.7%, 66.3%, 1.24 (1.03-1.36), 0.84 (0.72-0.98), and 1.40 (1.04-1.89), respectively. Conclusions:Healthy male adults showed a positive correlation between risk of AST/ALT >1 and drinking amount compared to the non-drinking group. Use of the AST/ALT >1 in combination with other blood markers to predict excessive drinking is advisable.
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