儿童期谷丙转氨酶水平与心脏结构指标的关联

Association between alanine aminotransferase levels and cardiac structure in childhood

目的 探讨儿童期谷丙转氨酶(ALT)水平与心脏结构指标的关联,为促进儿童心脏健康提供科学依据。方法 研究数据基于2017年11月—2018年1月开展的“桓台儿童心血管健康随访队列”基线调查,将数据完整的1 340名儿童纳入研究。采用问卷调查儿童的人口学信息和生活方式,并通过体格检查和血生化检测获取儿童的体质量指数(BMI)、血压、空腹血糖(FPG)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)和谷丙转氨酶(ALT)等指标,通过超声检查测量儿童的左心室舒张末期内径(LVDD)、左心室收缩末期内径(LVSD)、左心室后壁厚度(LVPWT)以及舒张末期室间隔厚度(IVST),并计算相对室壁厚度(RWT)、左心室质量(LVM)和左心室质量指数(LVMI)。采用多元线性回归模型分析ALT水平对左心室结构指标的影响,采用限制性立方样条(RCS)模型探讨ALT水平与左心室结构指标的剂量-反应关系。结果 不同ALT水平组儿童LVDD、LVSD、IVST、LVPWT、LVM、LVMI、RWT等心脏指标差异均有统计学意义(F值分别为78.69,60.08,72.86,74.89,83.14,36.70,20.46,P值均<0.05)。多元线性回归模型分析显示,调整可能协变量后,ALT水平与LVDD、LVSD、IVST、LVPWT、LVM、LVMI存在正相关(β值分别为0.10,0.20,0.16,0.16,0.23,0.18,P值均<0.05)。RCS模型分析显示,调整可能协变量后,儿童ALT水平与LVDD、LVSD、IVST和LVMI均存在线性剂量-反应关系(P_(非线性值均)>0.05);ALT水平与LVPWT、LVM均存在非线性剂量反应关系(P_(非线性值均)<0.05)。结论 儿童期ALT水平与心脏多数结构指标呈正相关,且存在线性或非线性剂量-反应关系。

Objective To explore the association between alanine aminotransferase(ALT)levels and cardiac structure in childhood,so as to provide scientific evidence to promote childhood cardiac health.Methods Data were obtained from the baseline survey of the"Huantai Childhood Cardiovascular Health Cohort Study"conducted from November 2017 to January 2018.A total of 1340 children with complete data were included in the study.Demographic information and lifestyle factors were collected through questionnaires.Physical examinations and blood biochemical tests were performed to obtain children's body mass index(BMI),blood pressure,fasting plasma glucose(FPG),triglyceride(TG),high-density lipoprotein-cholesterol(HDL-C),low-density lipoprotein-cholesterol(LDL-C),and ALT levels.Further,cardiac structural indicators such as left ventricular end-diastolic diameter(LVDD),left ventricular end-systolic diameter(LVSD),left ventricular posterior wall thickness(LVPWT),and interventricular septal thickness(IVST)were measured by ultrasound.Relative wall thickness(RWT),left ventricular mass(LVM),and left ventricular mass index(LVMI)were calculated.Multivariate linear regression models were used to analyze the relationship between ALT levels and cardiac structural indicators.Restricted cubic spline(RCS)models were used to explore the dose-response relationship between ALT levels and cardiac structural indicators.Results There were significant differences in LVDD,LVSD,IVST,LVPWT,LVM,LVMI and RWT in different ALT level groups(F=78.69,60.08,72.86,74.89,83.14,36.70,20.46,P<0.05).Multivariate linear regression analysis showed that ALT levels were positively associated with LVDD,LVSD,IVST,LVPWT,LVM,and LVMI(β=0.10,0.20,0.16,0.16,0.23,0.18,P<0.05)after adjusting for potential covariates.The RCS showed a linear dose-response relationship between ALT levels and LVDD,LVSD,IVST,and LVMI after adjusting for potential covariates(P_(non-linear)>0.05).In contrast,a non-linear dose-response relationship was found between ALT levels and LVPWT and LVM(P_(non-linear)<0.05).Conclusions ALT levels in childhood are positively associated with the majority of cardiac structural indicators,presenting a linear or non-linear dose-response relationship.