AST/ALT比值在临床诊断与疾病管理中的应用进展
Application Progress of AST/ALT Ratio in Clinical Diagnosis and Disease Management
DOI: 10.12677/acm.2025.15123644, PDF,   
作者: 刘思桦：内蒙古民族大学第二临床医学院(内蒙古林业总医院)，内蒙古 呼伦贝尔；张春香*：内蒙古林业总医院内分泌科，内蒙古 呼伦贝尔
关键词: AST/ALT比值；肝脏疾病；代谢综合征；糖尿病；心血管疾病；恶性肿瘤；AST/ALT Ratio； Liver Diseases； Metabolic Syndrome； Diabetes Mellitus； Cardiovascular Diseases； Malignancies
摘要: 天门冬氨酸氨基转移酶(AST)与丙氨酸氨基转移酶(ALT)的比值作为一项简单、经济、重要的生化指标，在临床应用中具有重要地位。本文整理了AST/ALT比值在肝脏疾病和肝外疾病中的应用，包括在酒精或非酒精性脂肪性肝病、病毒性肝炎、肝硬化、肝纤维化、肝癌以及代谢综合征、心血管疾病、肝外恶性肿瘤等众多疾病领域中的应用。通过总结AST/ALT比值临床中的应用进展，为以后的临床研究提供理论框架，希望能促进其在临床中的转化与应用。
Abstract: The aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio is a simple, economical, and profound biochemical parameter with significant clinical utility. This review consolidates the applications of the AST/ALT ratio in both hepatic and extrahepatic diseases, including alcoholic or non-alcoholic fatty liver disease, viral hepatitis, liver cirrhosis, hepatic fibrosis, hepatocellular carcinoma, as well as metabolic syndrome, cardiovascular diseases, and extrahepatic malignancies. By summarizing recent advances in the clinical application of the AST/ALT ratio, this article aims to provide a theoretical framework for future clinical research and to facilitate its translation into broader clinical practice.
文章引用：刘思桦, 张春香. AST/ALT比值在临床诊断与疾病管理中的应用进展[J]. 临床医学进展, 2025, 15(12): 2198-2205. https://doi.org/10.12677/acm.2025.15123644

参考文献

[1] Panteghini, M. and Bais, R. (2018) Serum Enzymes. In: Rifai, N., Horvath, A.R. and Wittwer, C.T., Eds., Tietz Textbook of Clinical Chemistry and Molecular Diagnostics, 6th Edition, Elsevier, 404-434.
[2] Kim, W.R., Flamm, S.L., Di Bisceglie, A.M. and Bodenheimer, H.C. (2008) Public Policy Committee of the American Association for the Study of Liver Disease Serum Activity of Alanine Aminotransferase (ALT) as an Indicator of Health and Disease. Hepatology, 47, 1363-1370. [Google Scholar] [CrossRef] [PubMed]
[3] Malnick, S.D.H., Alin, P., Somin, M. and Neuman, M.G. (2022) Fatty Liver Disease-Alcoholic and Non-Alcoholic: Similar but Different. International Journal of Molecular Sciences, 23, Article 16226. [Google Scholar] [CrossRef] [PubMed]
[4] Ikenaka, K., Kajiyama, Y., Aguirre, C., Choong, C., Taniguchi, S., Doi, J., et al. (2024) Decreased Hepatic Enzymes Reflect the Decreased Vitamin B6 Levels in Parkinson’s Disease Patients. Pharmacology Research & Perspectives, 12, e1174. [Google Scholar] [CrossRef] [PubMed]
[5] Xuan, Y., Wu, D., Zhang, Q., Yu, Z., Yu, J. and Zhou, D. (2024) Elevated ALT/AST Ratio as a Marker for NAFLD Risk and Severity: Insights from a Cross-Sectional Analysis in the United States. Frontiers in Endocrinology, 15, Article ID: 1457598. [Google Scholar] [CrossRef] [PubMed]
[6] Ding, Y., Wang, Z., Niu, H., Deng, Q., Wang, Y. and Xia, S. (2023) FIB-4 Is Closer to Fibroscan Screen Results to Detecting Advanced Liver Fibrosis and Maybe Facilitates NAFLD Warning. Medicine, 102, e34957. [Google Scholar] [CrossRef] [PubMed]
[7] Kozielewicz, D.M., Stalke, P. and Skrzypek, J. (2025) Drug-Induced Liver Injury. Part I: Classification, Diagnosis and Treatment. Clinical and Experimental Hepatology, 11, 25-33. [Google Scholar] [CrossRef] [PubMed]
[8] McGovern, A.J., Vitkovitsky, I.V., Jones, D.L. and Mullins, M.E. (2015) Can AST/ALT Ratio Indicate Recovery after Acute Paracetamol Poisoning? Clinical Toxicology, 53, 164-167. [Google Scholar] [CrossRef] [PubMed]
[9] Shin, D., Yang, J.Y., Jeong, H.N., Mun, S.J., Kim, H., Son, M.J., et al. (2025) Hepatotoxicity Evaluation Method through Multiple-Factor Analysis Using Human Pluripotent Stem Cell Derived Hepatic Organoids. Scientific Reports, 15, Article No. 10804. [Google Scholar] [CrossRef] [PubMed]
[10] Pandeya, A., Shreevastva, N.K., Dhungana, A., Pandeya, A. and Pradhan, B. (2021) Evaluation of Liver Enzymes and Calculation of AST to ALT Ratio in Patients with Acute Viral Hepatitis. Europasian Journal of Medical Sciences, 3, 90-93. [Google Scholar] [CrossRef] 
[11] Anderson, F.H., Zeng, L., Rock, N.R. and Yoshida, E.M. (2000) An Assessment of the Clinical Utility of Serum ALT and AST in Chronic Hepatitis C. Hepatology Research, 18, 63-71. [Google Scholar] [CrossRef] [PubMed]
[12] Sheth, S.G., Flamm, S.L., Gordon, F.D. and Chopra, S. (1998) AST/ALT Ratio Predicts Cirrhosis in Patients with Chronic Hepatitis C Virus Infection. American Journal of Gastroenterology, 93, 44-48. [Google Scholar] [CrossRef] [PubMed]
[13] Liu, H., Li, H., Deng, G., Zheng, X., Huang, Y., Chen, J., et al. (2024) Association of AST/ALT Ratio with 90-Day Outcomes in Patients with Acute Exacerbation of Chronic Liver Disease: A Prospective Multicenter Cohort Study in China. Frontiers in Medicine, 11, Article ID: 1307901. [Google Scholar] [CrossRef] [PubMed]
[14] Li, Y., Zhang, M., Wang, X. and Li, S. (2023) Novel Noninvasive Indices for the Assessment of Liver Fibrosis in Primary Biliary Cholangitis. Biomedical Reports, 20, Article No. 1. [Google Scholar] [CrossRef] [PubMed]
[15] Moosavy, S.H., Eftekhar, E., Davoodian, P., Nejatizadeh, A., Shadman, M., Zare, S., et al. (2023) AST/ALT Ratio, APRI, and FIB-4 Compared to Fibroscan for the Assessment of Liver Fibrosis in Patients with Chronic Hepatitis B in Bandar Abbas, Hormozgan, Iran. BMC Gastroenterology, 23, Article No. 145. [Google Scholar] [CrossRef] [PubMed]
[16] Kalkan, Ç., Yılmaz, Y., Erdoğan, B.D., Savaş, B., Yurdcu, E., Çalışkan, A., et al. (2023) Non‐Invasive Fibrosis Markers for Assessment of Liver Fibrosis in Chronic Hepatitis Delta. Journal of Viral Hepatitis, 30, 406-416. [Google Scholar] [CrossRef] [PubMed]
[17] Niu, A. and Qi, T. (2022) Diagnostic Significance of Serum Type IV Collagen (IVC) Combined with Aspartate Aminotransferase (AST)/Alanine Aminotransferase (ALT) Ratio in Liver Fibrosis. Annals of Translational Medicine, 10, 1310-1310. [Google Scholar] [CrossRef] [PubMed]
[18] Sebastiani, G., Milic, J., Cervo, A., Saeed, S., Krahn, T., Kablawi, D., et al. (2022) Two-Tier Care Pathways for Liver Fibrosis Associated to Non-Alcoholic Fatty Liver Disease in HIV Mono-Infected Patients. Journal of Personalized Medicine, 12, Article 282. [Google Scholar] [CrossRef] [PubMed]
[19] Nawalerspanya, S., Tantipisit, J., Assawasuwannakit, S., Kaewdech, A., Chamroonkul, N. and Sripongpun, P. (2024) Non-Invasive Serum Biomarkers for the Diagnosis of Cirrhosis in Patients with Autoimmune Hepatitis (AIH) and AIH-Primary Biliary Cholangitis Overlap Syndrome (AIH-PBC): Red Cell Distribution Width to Platelet Ratio (RPR) Yielded the Most Promising Result. Diagnostics, 14, Article 265. [Google Scholar] [CrossRef] [PubMed]
[20] Wang, F., Gao, S., Wu, M., Zhao, D., Sun, H., Yav, S., et al. (2023) The Prognostic Role of the AST/ALT Ratio in Hepatocellular Carcinoma Patients Receiving Thermal Ablation Combined with Simultaneous TACE. BMC Gastroenterology, 23, Article No. 80. [Google Scholar] [CrossRef] [PubMed]
[21] Shao, Y., Zhu, H., Chen, X., Feng, E., Chen, C., Shao, Z., et al. (2025) Associations of ALT, AST and ALT/AST Ratio with Metabolically Unhealthy Obesity in the Elderly. Frontiers in Nutrition, 12, Article ID: 1513029. [Google Scholar] [CrossRef] [PubMed]
[22] An, R., Ma, S., Zhang, N., Lin, H., Xiang, T., Chen, M., et al. (2022) Ast-to-Alt Ratio in the First Trimester and the Risk of Gestational Diabetes Mellitus. Frontiers in Endocrinology, 13, Article ID: 1017448. [Google Scholar] [CrossRef] [PubMed]
[23] Xie, W., Yu, W., Chen, S., Ma, Z., Yang, T. and Song, Z. (2022) Low Aspartate Aminotransferase/Alanine Aminotransferase (DeRitis) Ratio Assists in Predicting Diabetes in Chinese Population. Frontiers in Public Health, 10, Article ID: 1049804. [Google Scholar] [CrossRef] [PubMed]
[24] Luo, J., Yu, F., Zhou, H., Wu, X., Zhou, Q., Liu, Q., et al. (2024) AST/ALT Ratio Is an Independent Risk Factor for Diabetic Retinopathy: A Cross-Sectional Study. Medicine, 103, e38583. [Google Scholar] [CrossRef] [PubMed]
[25] Yang, K. and Song, M. (2023) New Insights into the Pathogenesis of Metabolic-Associated Fatty Liver Disease (MAFLD): Gut-Liver-Heart Crosstalk. Nutrients, 15, Article 3970. [Google Scholar] [CrossRef] [PubMed]
[26] Karatas, M., Keles, N., Parsova, K.E., Ciftci, H.O., Ozkok, S., Kahraman, E., et al. (2023) High AST/ALT Ratio Is Associated with Cardiac Involvement in Acute COVID-19 Patients. Medicina, 59, Article 1163. [Google Scholar] [CrossRef] [PubMed]
[27] Liu, X. and Liu, P. (2022) Elevated AST/ALT Ratio Is Associated with All-Cause Mortality in Patients with Stable Coronary Artery Disease: A Secondary Analysis Based on a Retrospective Cohort Study. Scientific Reports, 12, Article No. 9231. [Google Scholar] [CrossRef] [PubMed]
[28] Schupp, T., Rusnak, J., Weidner, K., Ruka, M., Egner-Walter, S., Dudda, J., et al. (2023) Prognostic Value of the AST/ALT Ratio versus Bilirubin in Patients with Cardiogenic Shock. Journal of Clinical Medicine, 12, Article 5275. [Google Scholar] [CrossRef] [PubMed]
[29] Ndrepepa, G., Cassese, S., Scalamogna, M., Lahu, S., Aytekin, A., Xhepa, E., et al. (2023) Association of De Ritis Ratio with Prognosis in Patients with Coronary Artery Disease and Aminotransferase Activity within and Outside the Healthy Values of Reference Range. Journal of Clinical Medicine, 12, Article 3174. [Google Scholar] [CrossRef] [PubMed]
[30] Higashitani, M., Mizuno, A., Kimura, T., Shimbo, T., Yamamoto, K., Tokioka, S., et al. (2022) Low Aspartate Aminotransferase (AST)/Alanine Aminotransferase (ALT) Ratio Associated with Increased Cardiovascular Disease and Its Risk Factors in Healthy Japanese Population. Journal of Gastrointestinal and Liver Diseases, 31, 429-436. [Google Scholar] [CrossRef] [PubMed]
[31] 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. [Google Scholar] [CrossRef] [PubMed]
[32] Canat, L., Ataly, H.A., Agalarov, S., Alkan, İ. and Alturende, F. (2018) The Effect of AST/ALT (De Ritis) Ratio on Survival and Its Relation to Tumor Histopathological Variables in Patients with Localized Renal Cell Carcinoma. International Brazilian Journal of Urology, 44, 288-295. [Google Scholar] [CrossRef] [PubMed]
[33] Mitsui, Y., Yamabe, F., Hori, S., Uetani, M., Aoki, H., Sakurabayashi, K., et al. (2023) Longitudinal Change in Castration-Resistant Prostate Cancer Biomarker AST/ALT Ratio Reflects Tumor Progression. Scientific Reports, 13, Article No. 15292. [Google Scholar] [CrossRef] [PubMed]
[34] Knittelfelder, O., Delago, D., Jakse, G., Reinisch, S., Partl, R., Stranzl-Lawatsch, H., et al. (2020) The AST/ALT (De Ritis) Ratio Predicts Survival in Patients with Oral and Oropharyngeal Cancer. Diagnostics, 10, Article 973. [Google Scholar] [CrossRef] [PubMed]
[35] Zhang, Y., Zhang, J., Shang, S., Ma, J., Wang, F., Wu, M., et al. (2024) The AST/ALT Ratio Predicts Survival and Improves Oncological Therapy Decisions in Patients with Non-Small Cell Lung Cancer Receiving Immunotherapy with or without Radiotherapy. Frontiers in Oncology, 14, Article ID: 1389804. [Google Scholar] [CrossRef] [PubMed]
[36] Niu, H. and Zhou, Y. (2021) Nonlinear Relationship between Ast-to-Alt Ratio and the Incidence of Type 2 Diabetes Mellitus: A Follow-Up Study. International Journal of General Medicine, 14, 8373-8382. [Google Scholar] [CrossRef] [PubMed]

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