基于限制性立方样条分析老年人血清肝脏转氨酶与代谢综合征的关系研究

Relationship between Serum Liver Transaminase and Metabolic Syndrome in the Aged Based on Restrictive Cubic Spline Model

背景代谢综合征(MS)已经成为全球性的健康问题,目前多数研究关注MS及其组分与丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)的相关性,但ALT、AST与MS之间是否存在剂量-反应关系还需进一步探索。目的探讨老年人ALT、AST与MS患病风险的关系,为MS防控提供参考依据。方法于2022年采用多阶段抽样的方法,抽取河南省18个市共162个乡镇(街道)≥60岁的居民进行健康体检。对其进行体格检查及实验室检测。利用Logistic回归模型及限制性立方样条模型分析ALT、AST与MS患病风险的关系。结果共纳入112605名老年研究对象,其中MS患病率为18.6%(20935/112605),ALT异常率为5.4%(6132/112605),AST异常率为6.8%(7661/112605)。MS者ALT水平高于非MS者,AST水平低于非MS者(P<0.05)。Logistic回归分析及趋势性检验结果显示,调整混杂因素后,总人群及性别分层下MS患病风险均随着ALT水平的升高而升高,随着AST水平的变化呈“U”形变化趋势(P<0.05)。限制性立方样条结果显示,总人群及性别分层下ALT与MS患病风险均呈正向线性剂量-反应关系(P_(总趋势)<0.001,P非线性>0.05);AST与MS患病风险均呈非线性剂量-反应关系(P_(总趋势)<0.001,P_(非线性)<0.001),曲线近似呈“U”形。结论在老年人中,ALT、AST可作为MS发生的重要预测因子,尤其是ALT水平的升高。

Background Metabolic syndrome(MS)has become a global health problem,and most studies have focused on the correlation of MS and its components with alanine aminotransferase(ALT)and aspartate aminotransferase(AST),but whether there is a dose-response relationship of ALT and AST with MS needs to be further explored.Objective To explore the relationship of ALT and AST with the risk of MS in the elderly,and provide a reference basis for the prevention and control of MS.Methods A health examination with multi-stage sampling method was conducted to residents(≥60 years)from 162 townships(streets)under jurisdiction of 18 cities of Henan Province in 2022.The investigation was performed with physical examination and laboratory test.Logistic regression model combined with restricted cubic spline model was recruited to analyze the relationship of ALT and AST with the risk of MS.Results Totally,112605 research participants were enrolled,of whome the prevalence of MS was 18.6%(20935/112605),ALT abnormality was 5.4%(6132/112605),and AST abnormality was 6.8%(7661/112605).The MS group showed a higher level of ALT and a lower level of AST than the non-MS group(P<0.05).The Logistic regression analysis and trend test results showed that the risk of MS increased with increasing ALT levels in both the total population and gender stratification,with a“U”shaped trend with AST level after adjustment for confounders(P<0.05).Restricted cubic spline model results showed a positive linear dose-response relationship between ALT and the risk of MS in both total population and gender stratification(P for overall<0.001,P for nonlinear>0.05),and a nonlinear dose-response relationship between AST and the risk of MS(P for overall<0.001,P for nonlinear<0.001),with an approximate“U”-shaped curve.Conclusion ALT,especially the elevated ALT level,and AST are conductive to be predictors for the development of MS.