谷丙转氨酶轨迹与新发代谢相关脂肪性肝病相关性的队列研究

A cohort study on the correlation between alanine aminotransferase trajectories and new-onset metabolic fatty liver disease

目的探讨谷丙转氨酶(ALT)轨迹与新发代谢相关脂肪性肝病(MAFLD)的相关性,为MAFLD的防治提供科学依据。方法以河南体检人群队列研究中符合入选标准的3553例观察对象组成研究队列,依据观察对象2017-2019年健康体检的ALT水平,采用R LCTMtools程序确定3个不同的ALT轨迹组,分别为低稳定组、中稳定组、高稳定组,随访各组人群2020年健康体检时MAFLD的发病情况,用乘积极限法计算各组累积发病率,用Cox比例风险回归模型分析不同ALT轨迹与新发MAFLD的相关性。结果MAFLD的发病率随着ALT轨迹的升高而不断增加,低稳定组、中稳定组、高稳定组分别为6.93%、15.42%、19.05%,差异有统计学意义(P<0.001)。Cox比例风险回归模型调整性别、腰围、血压、BMI、血糖、血脂等多种混杂因素后,ALT中稳定组、高稳定组MAFLD发病风险仍为ALT低稳定组的1.422倍(95%CI:1.115~1.813)与1.483倍(95%CI:1.040~2.114)(P<0.05)。结论发生MAFLD的风险随着长期正常范围内ALT水平的升高而增加,应对长期持续正常高值的MAFLD及时干预,延缓MAFLD疾病的进展,以实现早期预防MAFLD的目的。

Objective To explore the correlation between alanine aminotransferase(ALT)trajectories and new-onset metabolic fatty liver disease(MAFLD)to provide a scientific basis for the prevention and treatment of MAFLD.Methods The study cohort was composed of 3553 subjects who met the inclusion criteria in the cohort study of the Henan physical examination population.According to the ALT levels of the subjects'physical examination from 2017-2019,three different ALT trajectory groups were determined by R LCTMtools,namely low-stable group,medium-stable group,and high-stable group.The incidence of MAFLD during physical examination in 2020 was followed up,the cumulative incidence rate in each group was calculated by product-limit method,and Cox proportional hazards regression model analyzed the correlation between different ALT trajectories and new-onset MAFLD.Results The incidence rate of MAFLD parallelly increased with the increase of ALT locus,which was 6.93%,15.42%,and 19.05%,respectively,and the difference was statistically significant(P<0.001).After adjusting for multiple confounding factors,such as gender,waist circumference,blood pressure,BMI,fasting blood sugar,and blood lipid by Cox proportional hazards regression model,the risks of MAFLD in ALT medium-stable and the high-stable group were still 1.422 times(95%CI:1.115-1.813)and 1.483 times(95%CI:1.040-2.114)of low-stable ALT group(P<0.05).Conclusions The risk of MAFLD parallelly increases with the increase of ALT level in the normal long-term range.it is necessary to carry out the intervention for MAFLD with long-term average high value to avoid the progress of MAFLD disease to achieve the early prevention on MAFLD.