妊娠早期丙氨酸转氨酶水平对新生儿出生体重的影响  

Effect of alanine aminotransferase in early pregnancy on neonatal birth weight

作　　者：王杉杉 黄慧君 郑添 倪丽芳 刘宇 杨新军 Wang Shanshan;Huang Huijun;Zheng Tian;Ni Lifang;Liu Yu;Yang Xinjun(Department of Preventive Medicine,School of Public Health and Management,Wenzhou Medical University,Wenzhou 325000,China)

机构地区：[1]温州医科大学公共卫生与管理学院预防医学系,325000

出　　处：《中华内分泌代谢杂志》2022年第1期24-29,共6页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的探讨妊娠早期丙氨酸转氨酶(ALT)水平及其与体重指数(BMI)的交互作用对新生儿出生体重的影响。方法收集温州市2014—2016年妊娠早期首次产检的单胎足月分娩的母婴资料。应用倾向性评分匹配方法,对暴露(ALT>40 U/L)和非暴露(ALT≤40U/L)组进行1∶4匹配。采用logistic回归法分析妊娠早期ALT水平对异常出生体重的影响,以及联合妊娠早期BMI的交互作用。结果多因素分析结果显示,ALT>40 U/L的孕妇分娩巨大儿和大于胎龄儿(LGA)的风险是ALT≤40 U/L孕妇的1.584(95%CI 1.323~1.896)和1.292(95%CI 1.142~1.461)倍。妊娠早期ALT与BMI对巨大儿的发生风险存在相加交互作用[相对超危险度比(RERI)=2.032,95%CI 0.307~3.757;归因比(API)=0.448,95%CI 0.221~0.684;交互作用指数(S)=2.348,95%CI 1.274~4.324]。但未发现ALT与BMI对LGA的发生风险存在交互作用,也未发现妊娠早期ALT与低体重儿和小于胎龄儿的关联。结论妊娠早期ALT>40 U/L会增加高出生体重的风险,且对妊娠早期超重或肥胖孕妇的影响更明显。建议对妊娠早期肥胖孕妇加强ALT监测。Objective To investigate the effect of alanine aminotransferase(ALT)level in early pregnancy and its interaction with maternal body mass index(BMI)on neonatal birth weight.Methods Data of full-term singleton delivery mother-infant pairs from 2014 to 2016 in Wenzhou were collected.The exposure(ALT>40 U/L)and non-exposure(ALT≤40 U/L)groups were matched using 1∶4 propensity score matching.Logistic regression analysis was used to analyze the relationship between increased ALT level in the first trimester and abnormal birth weight as well as the effect of its interaction with BMI on abnormal birth weight.Results Multivariate analysis showed that the risks of macrosomia and large for gestational age(LGA)in pregnant women with ALT>40 U/L were 1.584(95%CI 1.323-1.896)and 1.292(95%CI 1.142-1.461)compared with those with ALT≤40 U/L.ALT in the first trimester displayed an additive interaction with BMI on the risk of macrosomia[the relative excess risk due to interaction(RERI)=2.032,95%CI 0.307-3.757,the attributable proportion due to interaction(API)=0.448,95%CI 0.221-0.684,the synergy index(S)=2.348,95%CI 1.274-4.324].In addition,there was no interaction between ALT and BMI on the risk of LGA,and nor did the association of ALT in the first trimester with low birth weight or small for gestational age exist.Conclusion ALT>40 U/L in the first trimester increases the risk of high birth weight,especially in overweight or obese pregnant women in the first trimester.Therefore,it is suggested to strengthen the monitoring of ALT level in obese pregnant women during the first trimester.

关 键 词：丙氨酸转氨酶 异常出生体重 体重指数 交互作用 倾向性评分匹配 

分 类 号：R722[医药卫生—儿科]