代谢综合征患者职业应激与转氨酶活力的关联性研究

Association between occupational stress and aminotransferase activity in patients with metabolic syndrome

目的探讨代谢综合征患者职业应激与天冬氨酸转氨酶（AST）及丙氨酸转氨酶（ALT）活力的关系。方法采用病例对照研究方法，按照纳入和排除标准，于2011年10月至2012年10月在宁夏医科大学附属医院及吴忠市人民医院进行健康检查的20～60岁企事业单位在职人员中，选择622例无血缘关系的代谢综合征患者为病例组，600例无血缘关系的健康人为对照组，对研究对象进行问卷调查、职业应激调查、体格检查以及实验室检测。结果病例组血清AST、ALT平均水平和异常率均明显高于对照组，差异均有统计学意义（t=-4．338、-5．485，χ^2=11．168、34．302，均P〈0．05）。病例组和对照组中不同职业应激组间血清AST平均水平及异常率差异均无统计学意义（F=2．192、2．567，χ^2=2．694、5．402，均P〉0．05），合计人群中差异均有统计学意义（F=5．005，χ^2=6．398，均P〈0．05）；病例组、对照组及合计人群中不同职业应激组间血清ALT平均水平及异常率差异均无统计学意义（F=0．845、0．450、1．416，χ^2=2．564、1．344、3．147，均P〉0．05）。偏相关分析结果显示，职业应激总分与血清AST水平呈正相关（r=0．071，P〈0．05），与ALT水平无相关性（r=-0．044，P〉0．05），血清AST水平与ALT水平呈正相关（r=0.736，P〈0．05）；控制年龄、性别、民族、吸烟、饮酒、婚姻状况和文化程度后，职业应激总分与血清AST水平呈正相关（r=0．069，P〈0．05），与ALT水平无相关性（r=-0．042，P〉0．05），血清AST水平与ALT水平呈正相关（r=0．730，P〈0．05）。多重线性回归分析结果显示，职业应激水平升高时，AST表达升高（b=0．131，P=-0．013）。结论职业应激与血清AST水平有关，随着职业应激水平升高，血清AST水平升高；职业应激与代谢综合征发病关联可能与其引起的AST活力升高有关。

Objective To investigate the association between occupational stress and activity of aspartate aminotransferase （AST） and alanine aminotransferase （ALT） in patients with metabolic syndrome. Methods A case-control study was performed. According to inclusion and exclusion criteria, among the staff members of enterprises and public institutions aged 20-60 years who underwent physical examination in The Affiliated Hospital of Ningxia Medical University and The People＇s Hospital of Wuzhong from October 2011 to October 2012, 622 patients with metabolic syndrome who did not have a blood relationship with each other were enrolled as case group, and 600 healthy staff members who also did not have a blood relationshipwith each otherwere enrolled as control group. Questionnaire investigation, chronic occupational stress investigation, physical examination, and laboratory tests were performed for all subjects. Results Compared with the control group, the case group had significantly higher serum levels and abnormal rates of AST and ALT （t=-4.338 and -5.485, χ^2= 11.168 and 34.302, all P〈0.05）. There were no significantdifferences in the serum level and abnormal rate of AST between the subgroups with different occupational stresses in both groups （F=2.192 and 2.567, χ^2=2.694 and 5.402, all P〉0.05）, but there were significant differencesbetween the subgroups in all subjects （F=5.005,χ^2=6.398, all P〈0.05）. There were no significant differences in the serum level and abnormal rate of ALT between thesubgroups with different occupational stresses in the case group, the control group, and all subjects （F=0.845, 0.450, and 1.416, χ^2=2.564, 1.344, and 3.147, all P〉0.05）. The partial correlation analysis showed that the total score of occupational stress was positively correlated withthe serum level of AST （r=0.071, P〈 0.05） and was not correlated with the serum level of ALT（r=-0.044, P〉0.05）, and that the serum level of AST was positively correlated with that of ALT （r=0.736, P〈0.05）. After the adjustment for age, sex, nationality, smoking, drinking, marital status, and degree of education, the total score of occupational stress was positively correlated with the serum level of AST （r=0.069, P〈0.05） and was not correlated with the serum level of ALT （r=-0.042, P〉0.05 ）, and the serum level of AST was positively correlated with that of ALT（r=0.730, P〈0.05）. The multiple linear regression analysis showed that the serum level of AST increased with the increasing occupational stress （b=0.131, P=0.013）. Conclusion Occupational stress is associated with increased serum level of AST, and the serum level of AST increases with the increasing occupational stress. Increased risk of metabolic syndrome caused by occupational stress may be associated with the increased activity of AST caused by occupational stress.