血清碱性磷酸酶与高血压合并非酒精性脂肪性肝病的相关性分析

Association between serum alkaline phosphatase and non-alcoholic fatty liver disease in patients with hypertension

目的检测血清碱性磷酸酶(ALP)水平,分析其与高血压合并非酒精性脂肪性肝病(NAFLD)的相关性。方法选取2016年6月-2019年1月期间在江苏大学附属医院诊疗的高血压患者共309例为研究人群。按照是否合并NAFLD分为NAFLD组(n=150)和非NAFLD组(n=159),依据腹部彩超结果将NAFLD患者分为轻度组(n=44)、中度组(n=57)、重度组(n=49)3组,比较各组性别、体质量指数(BMI)、血尿酸(SUA)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)、总胆固醇(TC)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、谷氨酰转肽酶(GGT)的差异,分析ALP与各项临床指标的相关性,探究ALP对高血压患者发生NAFLD的诊断价值。结果NAFLD组女性所占比例、BMI、SUA、LDL-C、TG、TC、ALT、AST、GGT、ALP高于非NAFLD组,高密度脂蛋白胆固醇低于非NAFLD组,差异均有统计学意义(χ^(2)/t/Z=11.082、-7.385、-2.539、-3.204、7.428、-4.003、-5.180、-4.220、-5.722、-9.229、3.697,P均<0.05)。NAFLD脂肪肝的严重程度(轻中重)与BMI、ALT、AST、GGT、ALP成正相关(r=0.213、0.189、0.298、0.202、0.312,P均<0.05)。在高血压患者中,ALP与BMI、LDL-C、TC成正相关(r=0.152、0.191、0.217,P均<0.05)。ALP预测NAFLD的曲线下面积(AUC)为0.766(95%CI:0.715~0.817,P<0.001),最佳临界值为63.9 U/L,敏感度为85.3%,特异度为52.8%。结论血清ALP升高与肥胖、高血脂密切相关,可能在高血压和NFALD疾病的发生发展中起一定作用。

Objective To investigate the association between serum alkaline phosphatase(ALP)and non-alcoholic fatty liver disease(NAFLD)in patients with hypertension.Methods A total of 309 patients with hypertension who were hospitalized in the Affiliated Hospital of Jiangsu University,from June 2016 to January 2019 were selected as study population.According to the presence of NAFLD,the patients were divided into NAFLD group(n=150)and non-NAFLD group(n=159),and according to the results of abdominal ultrasound,the patients with NAFLD were divided into mild group(n=44),moderate group(n=57),and severe group(n=49).Gender,body mass index(BMI),serum uric acid(SUA),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),triglycerides(TG),total cholesterol(TC),alanine aminotransferase(ALT),aspartate aminotransferase(AST),gamma-glutamyl transpeptidase(GGT)were compared among different groups,and their correlations with ALP were analyzed.Furthermore,the diagnostic value of ALP for the occurrence of NAFLD in patients with hypertension were investigated.Results Compared with the non-NAFLD group,the NAFLD group had significantly higher proportion of female patients,BMI,SUA,LDL-C,TG,TC,ALT,AST,GGT,and ALP levels(χ^(2)/t/Z=11.082,-7.385,-2.539,-3.204,7.428,-4.003,-5.180,-4.220,-5.722,-9.229;all P<0.05),as well as significantly lower high density lipoprotein cholesterol(t=3.697,P<0.05).The severity of NAFLD(mild,moderate or severe)was positively correlated with BMI,ALT,AST,GGT,and ALP(r=0.213,0.189,0.298,0.202,0.312;all P<0.05).In the patients with hypertension,ALP was positively correlated with BMI,LDL-C and TC(r=0.152,0.191,0.217;all P<0.05).The area under the curve(AUC)of ALP for predicting NAFLD was 0.766(95%CI:0.715-0.817,P<0.001),and the optimal cut-off value was 63.9 U/L,and the sensitivity and specificity were 85.3%and 52.8%,respectively.Conclusions Elevated serum ALP level was closely associated with obesity and hyperlipemia and might play a role in the development and progression of hypertension and NAFLD.