长期动态丙氨酸转氨酶水平与代谢相关脂肪性肝病的双向关系研究  

The bidirectional relationship between long-term dynamic alanine aminotransferase level and metabolic associated fatty liver disease

作　　者：陈静锋 吴卓青 闫肃 王佑翔 宋晓琴 丁素英[1] Chen Jingfeng;Wu Zhuoqing;Yan Su;Wang Youxiang;Song Xiaoqin;Ding Suying(Health Management Center,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Institute of Systems Engineering,Dalian University of Technology,Dalian 116024,China)

机构地区：[1]郑州大学第一附属医院健康管理中心,郑州450052 [2]大连理工大学系统工程研究所,大连116024 [3]郑州大学公共卫生学院,郑州450000

出　　处：《中华内分泌代谢杂志》2023年第12期1028-1036,共9页Chinese Journal of Endocrinology and Metabolism

基　　金：国家自然科学基金(72101236);中国博士后科学基金(2022M722900);河南省重点研发与推广专项(科技攻关)支持项目(222102310226)。

摘　　要：目的探索长期动态变化的丙氨酸转氨酶(ALT)水平与代谢相关脂肪性肝病(MAFLD)潜在的方向性关系。方法回顾性选取河南体检人群队列研究中2017年至2020年连续4次进行健康体检的6864名受检者为研究对象,采用多状态马尔科夫模型分析ALT水平与MAFLD状态分组转移风险的相关性,运用带随机截距的交叉滞后模型探索ALT水平与MAFLD间的双向关系。结果调整混杂因素后的多状态马尔科夫模型显示,ALT Q2、Q3、Q4组相对于Q1组,由正常进展为MAFLD状态的转移风险逐渐升高,而非酒精性脂肪性肝病和MAFLD状态组相对于正常状态组对ALT水平正常向异常状态转移风险逐渐升高。调整混杂因素后,带随机截距的交叉滞后模型显示,MAFLD和ALT水平之间存在显著正向的双向关系,MAFLD→ALT水平的交叉滞后效应为0.083(95%CI 0.078~0.087),ALT→MAFLD的交叉滞后效应为0.044(95%CI 0.039~0.050),且随着时间周期的延长,交叉滞后效应逐渐减小。结论长期动态变化的ALT水平与MAFLD之间存在显著的双向关系,MAFLD的发生更容易增加ALT水平升高的风险,应加强对MAFLD的早期防治。ObjectiveTo explore the relationship between the long-term dynamic change in alanine aminotransferase(ALT)level and metabolic associated fatty liver disease(MAFLD).MethodsA retrospective study was conducted on 6864 subjects who underwent four consecutive physical examinations from 2017 to 2020 in a cohort study of physical examination population in Henan Province.The relation between ALT level and the shift of MAFLD risk was analyzed using a multi-state Markov model,and the bidirectional relationship between ALT level and MAFLD was explored using a random intercept cross-lagged model.ResultsMulti-state Markov model after adjusting for confounding factors showed that the risk of MAFLD in ALT Q2,Q3,Q4 group was gradually higher than that in Q1 group;Compared with health status,non-alcoholic fatty liver disease and MAFLD status gradually increased the risk of ALT shifting from normal to abnormal.The random intercept cross-lagged model after adjusting for confounding factors showed that there was a significant positive bidirectional relationship between MAFLD and ALT level.The cross-lag effect of MAFLD→ALT level was 0.083(95%CI 0.078-0.087),and the cross-lag effect of ALT→MAFLD was 0.044(95%CI 0.039-0.050).And with the extension of time,the cross-lag effect gradually decreased.ConclusionsThere is a significant bidirectional relationship between the long-term dynamic change of ALT level and MAFLD.The occurrence of MAFLD is more likely to increase the risk of elevated ALT level,emphasizing the need for enhanced early prevention and treatment of MAFLD.

关 键 词：丙氨酸转氨酶 代谢相关脂肪性肝病 多状态马尔科夫模型 带随机截距的交叉滞后模型 双向关系 

分 类 号：R575.5[医药卫生—消化系统]