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Using Bone Mineral Density to Determine the Level of Liver Cirrhosis by the GOT/GPT Ratio

透過GOT/GPT比率探討肝硬化與骨質密度的相關性

摘要


Background: Many studies had proven the relationship between liver disease and bone mineral density (BMD). Glutamic-oxaloacetic transaminase (GOT) and glutamic-pyruvic transaminase (GPT) are indicators of liver damage, but few studies have explored the relationship between the GOT/GPT ratio and BMD. This retrospective study aimed to develop a model for predicting the GOT/ GPT ratio using BMD values. Methods: Data was collected from patients attending a physical examination center of a regional hospital in southern Taiwan, from June 2014 to July 2020. We excluded subjects with hepatitis B virus, hepatitis C virus, a history of drinking, and GOT > 40 U/L. GOT, GPT, and the GOT/GPT ratio were analyzed using univariate linear regression for the relationship between these values and demographic and clinical factors. Univariate and multivariate linear regression analyses were used to determine the association between GOT/GPT and BMD values (lumbar spine, right hip neck area, right hip total area, left hip neck area, and left hip total area). Results: The study included 13,542 subjects, with a mean of age 56.8 ± 11.6 years, body mass index (BMI) 23.9 ± 3.4 kg/m^2, GOT 21.4 ± 6.1 U/L, GPT 27.2 ± 11.9 U/L, and GOT/ GPT 0.87 ± 0.31. Univariate linear regression analysis showed that GOT/GPT was negatively correlated with each measure of BMD (r = -0.202 to -0.126, p < 0.001). In multivariate linear regression analysis, adjusted for BMI, fasting blood glucose, systolic blood pressure, total cholesterol, triglycerides, uric acid, exercise, and smoking history, GOT/GPT also correlated negatively with each measure of BMD (r = -0.102 to -0.051, p < 0.001). The adjusted model of BMD explained 12.2-18.9% of GOT/GPT. Conclusions: We found that the higher the GOT/GPT ratio, the more severe the liver cirrhosis. The GOT/GPT ratio also revealed that BMD was significantly negatively correlated with liver cirrhosis. Therefore, patients with liver cirrhosis need to care for their bone health, too.

並列摘要


目的:目前有許多研究已探討過肝臟疾病與骨骼密度之間的相關性。天門冬胺酸轉胺酶(glutamic oxaloacetic transaminase, GOT)及丙胺酸轉胺酶(glutamic pyruvic transaminase, GPT)為判斷肝臟是否受損的指標之一,但少有研究藉由GOT/GPT比率,去探討肝硬化與骨骼密度之間的相關性。因此本篇回顧性研究的主要目的為建構一個GOT/GPT比率與骨骼密度之間的相關性預測模型。方法:本篇研究數據收集自2014年6月至2020年7月一間南臺灣醫院的健檢中心。我們剔除有B型肝炎、C型肝炎、喝酒史和GOT數值大於40U/L的患者。統計方法採用單變項和多變項線性回歸,進行GOT/GPT比率及骨骼密度的相關性分析。另外,相關因子也將與GOT、GPT及GOT/GPT比率分別進行單變量的線性回歸。結果:本篇研究共收案13,542名病患進行統計分析,是一個平均年齡56.8±11.6歲、身體質量指數(body mass index, BMI)23.9 ± 3.4 kg/m^2、GOT21.4 ± 6.1 U/L、GPT 27.2 ± 11.9 U/L、GOT/GPT比率0.87 ± 0.31的族群。透過單變項線性回歸分析,發現GOT/GPT比率與本篇研究中各部位的骨骼密度有顯著的負相關(r = -0.202 至-0.126,p < 0.001)。多變項線性回歸分析中,我們使用了BMI、血糖、收縮壓、總膽固醇、三酸甘油脂、尿酸、運動和抽菸史作為預測因子,進行模型的調整。發現GOT/GPT比率與骨骼密度同樣有顯著的負相關關係(r = -0.102 至-0.051,p < 0.001)。且調整後的模型可預測骨骼密度12.2-18.9%的變異性。結論:由文章中得知,當病患的GOT/GPT比率較高時,他們肝硬化的程度也會越嚴重。本篇研究透過GOT/GPT比率,發現到肝硬化與骨骼密度之間有顯著的負相關。因此,罹患肝硬化的病患也需要注意本身的骨骼健康。

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