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代谢综合征(MS)是一组以肥胖、高血压、高血糖以及血脂异常等聚集发病并严重影响机体健康的临床症候群。这些因素的聚集是引起心血管疾病的重要影响因素。随着经济的发展和人民生活水平提高,MS已逐渐成为全世界共同关注的公共卫生问题。根据中国营养健康调查数据显示,2009年中国成年人年龄标化患病率为10.5%[1]。MS的发病机制复杂,慢性炎症、氧化应激和胰岛素抵抗参与MS的发病机制[2-3]。非酒精性脂肪肝病(NAFLD)可能是MS的一个特征性表现。很多研究分析了代谢异常与各种肝酶之间的相关性,其中包括天冬氨酸氨基转移酶(AST)和丙氨酸氨基转移酶(ALT)。AST和ALT能够作为诊断NAFLD的无创性检测指标。本文利用某医院健康体检数据,分析了AST、ALT与AST/ALT比值与MS的关系。现作报道。
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研究对象年龄18~94岁,平均年龄为(46.64±14.81)岁。MS患病人数为419人,粗患病率为17.03%。随着年龄的增长,MS的患病率有上升趋势(χ2=135.77,P < 0.05)。男性患病率(21.4%)显著高于女性(10.7%)(χ2=48.54,P < 0.05)。在所有人群中,MS组BMI、SBP、DBP、TG、FPG和ALT均明显高于非代谢综合征(NMS)组(P < 0.01),而HDL、AST/ALT比值均较低(P < 0.01)。仅在男性人群中,MS组AST水平显著高于NMS组(P < 0.01)(见表 1)。
指标 男性(n=1 457) 女性(n=1 003) MS组(n=312) NMS组(n=1 145) t P MS组(n=107) NMS组(n=896) t P BMI/(kg/m2) 28.22±3.20 24.84±2.92 16.84 < 0.01 28.04±3.44 22.72±3.10 16.58 < 0.01 SBP/mmHg 144.12±18.34 125.06±16.43 16.63 < 0.01 147.14±21.07 116.15±17.76 14.61 < 0.01 DBP/mmHg 86.68±12.30 74.53±10.67 15.89 < 0.01 80.57±12.78 69.32±10.82 8.74 < 0.01 HDL/(mmol/L) 1.18±0.27 1.30±0.31 6.73 < 0.01 1.35±0.31 1.53±0.34 5.22 < 0.01 TG/(mmol/L) 2.76±1.83 1.62±1.23 10.38 < 0.01 2.52±1.53 1.16±0.69 9.09 < 0.01 FPG/(mmol/L) 6.59±1.50 5.56±1.03 11.42 < 0.01 7.30±2.46 5.28±0.65 8.46 < 0.01 AST/(U/L) 26.74±12.19 23.82±7.24 4.04 < 0.01 22.20±5.62 21.45±8.07 1.24 >0.05 ALT/(U/L) 31.72±19.92 25.19±14.28 5.42 < 0.01 20.28±8.54 17.75±12.03 2.76 < 0.01 AST/ALT 0.95±0.32 1.10±0.41 6.88 < 0.01 1.20±0.41 1.35±0.43 3.43 < 0.01 吸烟[n; 构成比(%)] 112 (35.9) 361 (31.5) 16.22 >0.05 5(4.7) 25 (2.8) 0.61Δ >0.05 饮酒[n; 构成比(%)] 116(37.2) 341(29.8) 6.23 >0.05 6(5.6) 32(3.6) 0.60Δ >0.05 Δ示校正χ2值 表 1 MS组与NMS组基本特征和临床指标比较(x±s)
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Spearman相关分析显示:AST、ALT水平与代谢组分异常数目呈显著正相关关系(P < 0.01),而AST/ALT比值与代谢组分异常数目呈显著负相关关系(P < 0.01)(见表 2)。
指标 代谢组分异常数目 rs P 0 1 2 3 ≥4 男性 AST/(U/L) 22.31±6.60 24.11±7.19 24.20±6.61 25.87±8.83 28.44±15.44 0.203 < 0.01 ALT/(U/L) 20.69±11.52 25.57±14.08 27.62±13.37 29.74±17.43 35.00±24.27 0.303 < 0.01 AST/ALT比值 1.24±0.43 1.08±0.39 0.99±0.35 1.00±0.37 0.92±0.29 -0.267 < 0.01 女性 AST/(U/L) 20.51±5.79 22.65±11.14 23.44±8.61 21.53±5.57 22.86±7.53 0.154 < 0.01 ALT/(U/L) 16.18±8.61 19.70±16.55 20.10±11.24 19.51±8.64 22.84±14.35 0.251 < 0.01 AST/ALT比值 1.39±0.37 1.31±0.55 1.28±0.35 1.21±0.43 1.13±0.34 -0.214 < 0.01 表 2 AST、ALT、AST/ALT比值与代谢组分异常数目的关系(x±s)
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以是否患MS为因变量(不患病=0,患病=1),以血清肝脏转氨酶分组为自变量进行logistic回归分析,通过调整年龄、吸烟、饮酒变量后,在男性人群中,AST水平在Q3、Q4组发生MS的风险分别是Q1组的1.61倍和2.22倍,Q2组与Q1组相比差异无统计学意义(P>0.05);ALT水平在Q3、Q4组发生MS的风险分别是Q1组的2.98倍和4.96倍,Q2组与Q1组相比差异无统计学意义(P>0.05);AST/ALT比值在Q2、Q3、Q4水平组与Q1水平组相比,发生MS风险的OR值分别为0.48,0.36和0.15,且均有统计学意义(P < 0.01)。在女性人群中,与Q1组相比,AST在Q2、Q3、Q4组发生MS的风险差异均无统计学意义(P>0.05);ALT水平在Q2、Q3组发生MS的风险分别是Q1组的2.15倍和2.64倍,Q2组与Q1组相比差异无统计学意义(P>0.05);AST/ALT比值在Q3、Q4水平组与Q1水平组相比,发生MS风险的OR值分别为0.40和0.30,且均有统计学意义(P < 0.01),而Q2组与Q1组差异无统计学意义(P>0.05)(见表 3)。
指标 男性 女性 OR95% CI OR 95% CI AST Q1 1.00 — 1.00 — Q2 1.40 (0.97~2.02) 1.56 (0.80~3.01) Q3 1.61 (1.12~2.32)* 0.98 (0.49~1.97) Q4 2.22 (1.55~3.18)** 0.87 (0.43~1.74) ALT Q1 1.00 — 1.00 — Q2 1.21 (0.80~1.86) 1.81 (0.84~3.89) Q3 2.98 (2.02~4.39)** 2.15 (1.04~4.44)* Q4 4.96 (3.33~7.38)** 2.64 (1.29~5.43)* AST/ALT Q1 1.00 — 1.00 — Q2 0.48 (0.34~0.67)** 0.84 (0.48~1.45) Q3 0.36 (0.25~0.53)** 0.40 (0.22~0.74)** Q4 0.15 (0.10~0.24)** 0.30 (0.15~0.62)** *P < 0.05,**P < 0.01 表 3 AST、ALT、AST/ALT比值与MS患病风险的OR值和95%CI
某医院健康体检人群血清肝脏转氨酶与代谢综合征的关联分析
Analysis of the correlation of serum liver transaminase with metabolic syndrome of health examinees in a hospital
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摘要:
目的探讨血清肝脏转氨酶的水平与代谢综合征患病风险的关系。 方法收集某医院体检中心健康体检者数据,包括体格检查和实验室检查。共纳入有2 460名研究对象,其中男1 457人,女1 003人,平均年龄(46.64±14.81)岁。根据四分位数法将AST、ALT、AST/ALT比值分为4组(Q1、Q2、Q3、Q4)。采用Spearman相关分析和logistic回归模型分析血清肝脏转氨酶与代谢综合征及其组分的相关性。使用SPSS 21.0软件对数据进行分析处理。 结果调查人群中代谢综合征粗患病率为17.03%。男性患病率高于女性(χ2=48.542,P < 0.05)。AST、ALT水平与代谢组分异常数目呈正相关,而AST/ALT比值与代谢组分异常数目呈负相关。通过调整年龄、吸烟、饮酒变量,男性ALT在Q4水平患代谢综合征风险为Q1的4.96倍(95%CI:3.33~7.38),女性为2.64倍(95%CI:1.29~5.43);男性AST在Q4水平患代谢综合征风险为Q1的2.22倍(95%CI:1.55~3.18)。 结论血清肝脏转氨酶与代谢综合征各组分密切相关。AST、ALT水平的增高会增加代谢综合征的患病风险。 Abstract:ObjectiveTo understand the relationship between the serum level of liver transaminase and risk of metabolic syndrome. MethodsThe data of physical examination and laboratory examination from 2 460 health examinees[including 1 457 males and 1 003 females, an average age for (46.64±14.81) years] in a hospital were investigated.The levels of AST, ALT and ratio of AST to ALT were divided into four groups (Q1, Q2, Q3 and Q4) by quartile method.The relationship between the serum level of liver transaminase and metabolic syndrome was analyzed using the Spearman correlation analysis and logistic regression model, and the data were processed using SPSS 21.0 software. ResultsThe crude prevalence of metabolic syndrome was 17.03%, which in male was higher than that in female (χ2=48.542, P < 0.05).The levels of AST and ALT were positively correlated with the abnormal number of metabolic components, but the ratio of AST to ALT was negatively correlated with the abnormal number of metabolic components.By adjusting the variates of age, smoking and alcohol, compared with Q1 group, the metabolic syndrome risk of ALT level in Q4 group were 4.96 times in males (95%CI:3.33 to 7.38), and 2.64 times in females (95%CI:1.29 to 5.43), and the metabolic syndrome risk of AST level in Q4 group was 2.22 times in males (95%CI:1.55 to 3.18). ConclusionsSerum liver transaminase is closely related to the components of metabolic syndrome.The increasing levels of AST and ALT may enhance the risk of metabolic syndrome. -
Key words:
- metabolic syndrome /
- aspartate aminotransferase /
- alanine aminotransferase
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表 1 MS组与NMS组基本特征和临床指标比较(x±s)
指标 男性(n=1 457) 女性(n=1 003) MS组(n=312) NMS组(n=1 145) t P MS组(n=107) NMS组(n=896) t P BMI/(kg/m2) 28.22±3.20 24.84±2.92 16.84 < 0.01 28.04±3.44 22.72±3.10 16.58 < 0.01 SBP/mmHg 144.12±18.34 125.06±16.43 16.63 < 0.01 147.14±21.07 116.15±17.76 14.61 < 0.01 DBP/mmHg 86.68±12.30 74.53±10.67 15.89 < 0.01 80.57±12.78 69.32±10.82 8.74 < 0.01 HDL/(mmol/L) 1.18±0.27 1.30±0.31 6.73 < 0.01 1.35±0.31 1.53±0.34 5.22 < 0.01 TG/(mmol/L) 2.76±1.83 1.62±1.23 10.38 < 0.01 2.52±1.53 1.16±0.69 9.09 < 0.01 FPG/(mmol/L) 6.59±1.50 5.56±1.03 11.42 < 0.01 7.30±2.46 5.28±0.65 8.46 < 0.01 AST/(U/L) 26.74±12.19 23.82±7.24 4.04 < 0.01 22.20±5.62 21.45±8.07 1.24 >0.05 ALT/(U/L) 31.72±19.92 25.19±14.28 5.42 < 0.01 20.28±8.54 17.75±12.03 2.76 < 0.01 AST/ALT 0.95±0.32 1.10±0.41 6.88 < 0.01 1.20±0.41 1.35±0.43 3.43 < 0.01 吸烟[n; 构成比(%)] 112 (35.9) 361 (31.5) 16.22 >0.05 5(4.7) 25 (2.8) 0.61Δ >0.05 饮酒[n; 构成比(%)] 116(37.2) 341(29.8) 6.23 >0.05 6(5.6) 32(3.6) 0.60Δ >0.05 Δ示校正χ2值 表 2 AST、ALT、AST/ALT比值与代谢组分异常数目的关系(x±s)
指标 代谢组分异常数目 rs P 0 1 2 3 ≥4 男性 AST/(U/L) 22.31±6.60 24.11±7.19 24.20±6.61 25.87±8.83 28.44±15.44 0.203 < 0.01 ALT/(U/L) 20.69±11.52 25.57±14.08 27.62±13.37 29.74±17.43 35.00±24.27 0.303 < 0.01 AST/ALT比值 1.24±0.43 1.08±0.39 0.99±0.35 1.00±0.37 0.92±0.29 -0.267 < 0.01 女性 AST/(U/L) 20.51±5.79 22.65±11.14 23.44±8.61 21.53±5.57 22.86±7.53 0.154 < 0.01 ALT/(U/L) 16.18±8.61 19.70±16.55 20.10±11.24 19.51±8.64 22.84±14.35 0.251 < 0.01 AST/ALT比值 1.39±0.37 1.31±0.55 1.28±0.35 1.21±0.43 1.13±0.34 -0.214 < 0.01 表 3 AST、ALT、AST/ALT比值与MS患病风险的OR值和95%CI
指标 男性 女性 OR95% CI OR 95% CI AST Q1 1.00 — 1.00 — Q2 1.40 (0.97~2.02) 1.56 (0.80~3.01) Q3 1.61 (1.12~2.32)* 0.98 (0.49~1.97) Q4 2.22 (1.55~3.18)** 0.87 (0.43~1.74) ALT Q1 1.00 — 1.00 — Q2 1.21 (0.80~1.86) 1.81 (0.84~3.89) Q3 2.98 (2.02~4.39)** 2.15 (1.04~4.44)* Q4 4.96 (3.33~7.38)** 2.64 (1.29~5.43)* AST/ALT Q1 1.00 — 1.00 — Q2 0.48 (0.34~0.67)** 0.84 (0.48~1.45) Q3 0.36 (0.25~0.53)** 0.40 (0.22~0.74)** Q4 0.15 (0.10~0.24)** 0.30 (0.15~0.62)** *P < 0.05,**P < 0.01 -
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