血清丙氨酸转氨酶与急性缺血性脑血管病临床结局的相关性研究

Correlation of Serum Alanine Aminotransferase with Clinical Outcomes in Acute Ischemic Cerebrovascular Disease

目的探索血清丙氨酸转氨酶(alanine aminotransferase,ALT)水平与急性缺血性脑血管病不良临床结局的关系。方法以中国国家卒中登记研究Ⅱ中丙氨酸转氨酶(alanine aminotransferase,ALT)水平<120 U/L的急性缺血性卒中或TIA患者为研究对象。随访研究对象的1年全因死亡、复发性卒中(包括缺血性卒中、脑出血及蛛网膜下腔出血)、复合终点事件和不良功能结局,其中复合终点事件包括复发性卒中和全因死亡,不良功能结局定义为m RS 3~6分。根据入组患者的血清ALT水平由低到高进行ALT五分位数分层(Q1~Q5),采用多因素logistic回归分析评估血清ALT水平与1年全因死亡、卒中复发、复合终点事件和不良功能结局的相关性。结果研究共纳入17178例患者,平均年龄(64.8±11.9)岁,女性6368例(37.1%)。多因素logistic回归分析结果显示,相对于ALT最低五分位数患者,最高五分位数患者1年内全因死亡风险降低45%(OR 0.55,95%CI 0.43~0.70,P<0.01)、卒中复发风险降低39%(OR 0.61,95%CI 0.45~0.83,P<0.01)、复合终点事件风险降低38%(OR 0.62,95%CI 0.49~0.77,P<0.01),不良功能结局风险降低33%(OR 0.67,95%CI 0.56~0.80,P<0.01)。年龄、性别、糖尿病、血脂异常和饮酒对ALT与各结局指标之间的相关性无交互作用。结论血清ALT水平与AIS或TIA患者1年全因死亡率、卒中复发、复合终点事件和功能不良结局的风险呈负相关。

Objective To investigate the correlation of serum alanine aminotransferase(ALT)level with poor clinical outcomes in acute ischemic stroke(AIS)or transient ischemic attack(TIA)patients.Methods Patients with AIS or TIA and having serum ALT level<120 U/L from the China National Stroke RegistryⅡ(CNSRⅡ)were included in the current analysis.The clinical outcomes included recurrent stroke(including ischemic stroke,intracranial hemorrhage and subarachnoid hemorrhage),composite endpoint events,all-cause death and poor functional outcome within one year.Composite endpoint included recurrent stroke and all-cause death.Poor functional outcome was defined as a mRS score of 3-6.Multivariable logistic regression analysis was used to evaluate the correlation of serum ALT level with the risk of 1-year all-cause death,recurrent stroke,composite endpoint and poor functional outcome,according to the sex-specific quintile of serum ALT level.Results A total of 17178 patients were included,with a mean age of 64.8±11.9 years old and 6368 females(37.1%).Compared with the lowest ALT(corresponding to the lowest serum ALT level),the adjusted odds ratio with 95% confidence interval of the highest quintile were 0.55 (0.43-0.70)for all-cause mortality (P<0.01), 0.61 (0.45-0.83) for recurrent stroke (P<0.01), 0.62 (0.49-0.77)for composite endpoint (P<0.01), and 0.67 (0.56-0.80) for poor functional outcome (P<0.01).There was no significant interaction of ALT with age, sex, diabetes, dyslipidemia and alcoholconsumption for all outcomes.Conclusions The serum ALT level may be negatively correlated with the risk of 1-year all-causemortality, recurrent stroke, and poor functional outcome in AIS or TIA patients.