中老年人群血清谷丙转氨酶水平与心血管疾病风险的相关性研究  

Association of serum alanine aminotransferase with the risk of cardiovascular disease in middle-aged and elderly Chinese

作　　者：马丽娜 程棣 杜瑞[1] 吴雪妍 徐瑜[1] 徐敏[1] 陈宇红[1] 毕宇芳[1] 王卫庆[1] 陆洁莉[1] Ma Lina, Cheng Di, Du Rui, Wu Xueyan, Xu Yu, Xu Min, Chen Yuhong, Bi Yufang, Wang Weiqing , Lu Jieli(Shanghai Clinical Center for Endocrine and Metabolic Disease, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China)

机构地区：[1]上海交通大学医学院附属瑞金医院内分泌代谢病科上海市内分泌代谢病研究所上海市内分泌代谢病临床医学中心,200025

出　　处：《中华内分泌代谢杂志》2018年第9期746-754,共9页Chinese Journal of Endocrinology and Metabolism

基　　金：国家自然科学基金面上项目（81670795）;科技部国家重点研发项目（2016YFC1305202）

摘　　要：目的 研究中老年人血清谷丙转氨酶（alanine aminotransferase, ALT）水平与心血管疾病风险的相关性.方法 本研究采取整群抽样的方法,对上海市嘉定区10 375名40岁及以上居民进行问卷调查、体格检查及空腹采血检查血生化等指标.最终纳入分析的8 877名居民中女性5 664人,男性3 213人,男性人群平均年龄高于女性人群[（58.68±9.22对57.65±8.93）岁,P＜0.01].心血管疾病预测风险采用10年首次严重动脉粥样硬化心血管疾病（atherosclerotic cardiovascular disease, ASCVD）事件风险评估方法.结果 男性和女性人群的心血管危险因素和心血管疾病预测风险均随着ALT水平的增加而逐渐升高.女性人群中,糖尿病的患病率随着ALT的升高而增加,而在男性人群中,糖尿病的患病率随着ALT的升高呈现U型分布.男性人群中ALT第四分位（Q4）组高血压及脂代谢异常的患病率分别高达66.04%和52.74%,女性人群中分别为64.49%和47.63%.按照ASCVD风险评分标准进行评估后发现,男性和女性人群高心血管疾病预测风险的比例随着 ALT 水平的升高而增加. Q4 组的 10 年首次心血管疾病预测高风险（ASCVD评分≥7.5%）的患病风险,与ALT第一分位（Q1）组相比,在男性和女性人群中,分别增加148%（OR＝2.48,95%CI 1.78~3.45）和139%（OR＝2.39, 95%CI 1.78~3.19）.女性人群中Q4组的高心血管疾病预测风险的患病风险较Q1组增加96%（OR＝1.96,95%CI 1.30~2.95）,而在男性人群中组间差异无统计学意义.结论 在中国中老年人群中,血清ALT水平的升高反映了高心血管危险因素及未来心血管疾病风险.Objective To investigate the association between levels of serum alanine aminotransferase （ALT） and the risks of cardiovascular disease in Chinese. Methods A survey of 10 375 subjects aged 40 or older in Jiading District of Shanghai was performed using cluster sampling. All the subjects were recruited to undergo questionnaire interview, anthropometric measurements, and fasting blood sampling. A total of 8 877 participants were included in the final analyses, including 5 664 females and 3 213 males. The mean age of individuals was （ 58.68 ± 9.22）yearsinmenand（57.65±8.93）yearsinwomen（P＜0.01）.10-yearriskforafirsthardatherosclerotic cardiovascular diseases （ASCVD） event was calculated. Results Increased ALT levels were associated with more unfavorable cardiovascular risk profiles and 10-year risk for ASCVD. Increased ALT levels were associated with the prevalence of diabetes mellitus in female participants, while in male participants the prevalence of diabetes mellitus appeared as a U-distribution. The prevalence of hypertension and hyperlipidemia were 66.04%, 52.74%and 64.49%, 47.63% respectively. Increased serum ALT was associated with higher prevalence of 10-year risk for ASCVD. As compared with participants in the first ALT quartile, the risks of 10-year risk for ASCVD were increased by 148%（OR＝2.48, 95%CI 1.78-3.45） and 139%（OR＝2.39, 95%CI 1.78-3.19）, respectively in male and female participants. As compared with participants in the first ALT quartile, higher prevalence of 10-year risk for ASCVD were increased by 96%（OR＝1.96, 95%CI 1.30-2.95）, while there was no significantly statistical difference in men. Conclusion A high-normal serum ALT level was significantly associated with an increased risk of the cardiovascular disease in middle-aged and elderly Chinese.

关 键 词：谷丙转氨酶 心血管疾病 中老年人群 ASCVD风险评分 

分 类 号：R54[医药卫生—心血管疾病]