社区老年人血清丙氨酸氨基转移酶与代谢综合征的相关性研究

The correlation between serum alanine aminotransferase and metabolic syndrome in the community elderly

目的探讨老年人血清丙氨酸氨基转移酶(ALT)水平与代谢综合征(MS)及其各组分的关系,为MS的早期预防提供依据。方法选取2015年1月1日至12月31日在天津某社区卫生服务中心建立健康档案并进行免费体检的全部≥60岁的2 554名老年人为研究对象。测量调查对象的身高、体重和血压,检测其血脂、血糖、肝功能及肾功能等生化指标。采用SAS 9.3统计软件包进行统计描述与分析,两组间比较用独立样本t检验,不满足正态分布的计量资料用非参数检验,计数资料的比较用χ~2检验,采用多因素非条件logistic回归分析ALT异常和MS的影响因素,采用多分类logistic回归进行ALT水平与MS构成组分聚集程度分析。结果调查对象ALT异常的检出率为4.15%。ALT异常组的超重或肥胖、高血糖、高血压、血脂紊乱和MS检出率分别为72.64%、61.32%、77.36%、57.55%和62.26%;ALT异常组除高血压外,MS各组分检出率均明显高于ALT正常组,差异均有统计学意义(P<0.01)。多因素非条件logistic回归分析结果显示,高龄是血清ALT水平的保护因素(P<0.01),血清天冬氨酸氨基转移酶(AST)异常为导致血清ALT水平升高的危险因素(P<0.01);ALT异常是发生MS显著的危险因素(P<0.01)。将调查对象分为无MS构成组分、1~2个MS构成组分和≥3个MS构成组分,进行不同ALT水平与MS构成组分聚集程度的多分类logistic回归分析,结果显示,随着ALT水平的增高,MS的危险性逐步增加;在调整相关因素后,与ALT水平<25 U/L比较,ALT水平为25~50和>50 U/L时有≥3个MS构成组分与无MS构成组分比较的OR值(95%CI)分别为1.920(1.338~2.755)和4.987(1.672~14.876),且存在剂量反应关系。结论血清ALT与MS及其各组分关系密切,能较好地预测MS危险因素聚集。

Objective To explore the relationships between alanine aminotransferase（ALT） and metabolic syndrome（MS） as well as its components, and to provide the basis for early prevention. Methods From January 1 to December 31 of 2015, 2 554 elderly（≥ 60 years old） with health file and physical examination record in a community health service center were served as the subjects. The height, weight and blood pressure were measured; the biochemical indexes（blood lipid, blood glucose, liver function and renal function） were detected for all subjects. The used software was SAS 9.3. The t test was used to compare the differences for continuous variables and wilcoxon rank sum test was used to compare the continous variables which were abnormal. χ~2 test was used for categorical variables. The multivariate non-condition logistic regression method was utilized to analyze the influence factors of abnormal ALT and MS. Multiple classification logistic regression was used to analyze the cluster degree between ALT level and MS components. Results The abnormal ALT rate was 4.15 %. The rates of overweight or obesity, hyperglycemia,hypertension, dyslipidemia and MS in the abnormal ALT group were 72.64%, 61.32%, 77.36%, 57.55% and 62.26%, respectively.The MS component detection rates（except for hypertension） in the abnormal ALT group were significantly greater than those in normal ALT group（P〈0.01）. The multivariate non-condition logistic regression showed that older age was a protected factor for serum ALT level（P〈0.01）, but abnormal serum AST may be a risk factor for high ALT level（P〈0.01）; also abnormal ALT level was a significant risk factor for MS（P〈0.05）. The subjects were divided into no MS component subgroup, 1-2 MS components subgroup and ≥ 3 MS component subgroup; then the cluster degree between different ALT levels and MS components was analyzed by multiple classification logistic regression, the results showed that MS risk increased with ALT level; after adjusting the related factors, as compared with residents with the lowest level of ALT（ 25 U/L）,the OR values of ≥ 3 MS components in residents with the higher ALT levels（25-50 U/L or 50 U/L） were 1.920（95%CI： 1.338-2.755） and 4.987（95%CI： 1.672-14.876） respectively, and with dose-response relationships. Conclusion The concentration of ALT was closely associated with MS and its components.