丙氨酸氨基转移酶异常与高尿酸血症对高脂血症的交互作用

Interactive effect ofabnormal alanine aminotransferase and hyperuricemia on hyperlipemia

目的研究丙氨酸氨基转移酶(ALT)异常与高尿酸血症(HUA)的交互作用对高脂血症的影响。方法选取2018年3—11月5155例湖北宜昌地区居民的健康体检数据,其中1542例高脂血症者作为病例组,在3613例血脂正常者中取与病例组性别、年龄相匹配的1349例血脂正常者作为对照组,比较分析两组人群的代谢特征。应用logistic回归模型研究危险因素的独立效应,应用相加模型、相乘模型对危险因素间的交互作用进行分析。结果病例组的总蛋白、白蛋白水平及HUA、ALT异常、天冬氨酸氨基转移酶(AST)异常、高血糖、超重或肥胖、高血压、脂肪肝百分率均高于对照组,总胆红素、直接胆红素水平低于对照组,差异有统计学意义(P均<0.001)。ALT、UA与血脂4单项及非高密度脂蛋白胆固醇均相关,控制混杂因素后多因素logistic回归分析结果:ALT异常和HUA并存时患高脂血症的风险是正常ALT和UA者的11.93倍(95%CI:3.35~39.8,P<0.001),两因素对高脂血症存在正相加交互作用,不存在相乘交互作用。交互作用指数、相对超危险度比、归因比、纯因子归因交互效应百分比分别为4.44、8.47、70.99%、77.49%。结论高脂血症患者同时存在多种代谢指标异常,ALT异常与HUA的正相加交互作用为其重要危险因素,两者共存可显著增加患病风险。

Objective To investigate interaction effect of abnormal alanine aminotransferase(ALT)and hyperuricemia(HUA)on the patients withhyperlipemia.Methods From March to November 2018,5155 cases with complete and suitable data were enrolled in the physical medical examination in Yichang,Hubei province of China.A total of 1542 hyperlipemia cases were selected and included in the case group,whereas 1349 gender-and age-matched subjects who had normal blood lipids were included in the control group.The metabolic characteristics of the two groups were compared and analyzed.Logistic regression model was used to study the independent effects of risk factors,and the interaction between risk factors was analyzed by additive model and multiplicative model.Results The levels of total protein and albumin,and the incidences of HUA,abnormal ALT,abnormal AST,hyperglycemia,overweight/obesity,hypertension,and fatty liver were significantly higher in case group than those in control group(all P<0.001).ALT and UA were significantly associated with the 4 lipid item and non-high density lipoprotein-cholesterol.After adjusting some confounding factors,multivariate logistic regression analysis showed that risk of hyperlipemia was 11.93 times higher in subjects with abnormal ALT and hyperuricemia than in subjects without them(95%CI:3.35-39.8,P<0.001).Interaction analysis of risk factors for hyperlipemia showed that there was no multiplicative interaction between abnormal ALT and hyperuricemia,but with additive interaction,the synergy index was 4.44,the relative excess risk due to interaction was 8.47,the attributable proportion due to interaction was 70.99%.Pure factor attribution interaction was 77.49%.Conclusion There are severalmetabolic syndromes in individuals with hyperlipemia.The positive interaction between abnormal ALT and hyperuricemia are among theimportant risk factors for hyperlipemia patients,both of which can significantly increase the risk of illness.