成年人群血清肝酶与代谢综合征的相关性研究

发布时间：2018-01-10 03:10

  本文关键词：成年人群血清肝酶与代谢综合征的相关性研究　出处：《天津医科大学》2016年硕士论文　论文类型：学位论文

  更多相关文章： 代谢综合征 丙氨酸转氨酶 天冬氨酸氨基转移酶 碱性磷酸酶 谷氨酰转肽酶

【摘要】：目的:本研究旨在通过研究血清肝酶水平与代谢综合征的关联,从而确定肝酶水平诊断代谢综合征(metabolic syndrome,MS)的最佳临界点,为代谢综合征早期临床诊断提供参考。方法:本研究为横断面研究,基于2007-2014年“天津人群慢性炎症与健康促进队列研究(TCLSIHealth)”的部分基线人群,根据纳入和排除标准,签署知情同意后最终12454人被纳入研究中。本研究所涉及变量包括年龄、性别、身体质量指数(body mass index,BMI)、腰围、收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、吸烟情况、饮酒情况、家族疾病史(心血管疾病(cardiovascular disease,CVD)、高血压、糖尿病和高脂血症)、个人疾病史、总胆固醇(total cholesterol,TC)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、甘油三酯(triglycerides,TG)、空腹血糖(fasting plasma glucose,FBG)、餐后两小时血糖(2 hour-postprandial plasma glucose,2h PG)、血清丙氨酸转氨酶(alanine transaminase,ALT)、天冬氨酸氨基转移酶(aspartate aminotransferase,AST)、碱性磷酸酶(alkaline phosphatase,ALP)、谷氨酰转肽酶(gamma glutamyl transpeptidase,GGT)等。本研究采用2013年中华医师协会糖尿病分会制定的《中国2型糖尿病防治指南》作为代谢综合征诊断标准,满足以下五项中的任意三项以上即被诊断为代谢综合征,包括腹部肥胖(男性腰围≥90cm,女性腰围≥85cm)、TG≥1.70mmol/L、HDL1.04mmol/L、血压升高(SBP≥130mm Hg,DBP≥80mm Hg)和血糖水平(FBG≥6.1mmol/L或2h PG≥7.8mmol/L)。在调整年龄、性别、BMI、吸烟情况、饮酒情况、家族史后,采用Spearman偏相关分析血清肝酶ALT,AST,ALP,GGT与代谢综合征各组分的相关性,多元logistic回归评估血清肝酶与代谢综合征的关联,通过受试者工作曲线(receiver operating characteristic curve,ROC)分析,确定血清肝酶水平预测代谢综合征的最佳临界值。结果:1.本研究人群中MS患病率为26.92%(男性34.91%,女性15.75%)。其中MS各组分的人群患病情况分别为中心型肥胖48.88%(男58.29%,女性35.75%),血压升高48.01%(男性52.35%,女性41.94%),高TG血症37.84%(男性47.31%,女性24.62%),低HDL-C血症16.84%(男性23.28%,女性7.83%),血糖升高13.67%(男性16.05%,女性10.36%)。2.校正年龄、性别、BMI、吸烟情况、饮酒情况、家族史后,Spearman偏相关分析显示,在总人群中ALT,AST,ALP,GGT水平与腰围、SBP、DBP、TG、HDL-C、FBG显著相关(P0.05)。在男性研究对象中,得出了与总人群相似的结果。而女性研究对象,血清ALT水平与SBP,AST水平与腰围、SBP无显著相关。3.在研究人群中,MS的患病率随着肝酶水平的升高而增加。多元logistic回归分析显示,以肝酶水平第一分位组为基准,在校正年龄、BMI、性别、吸烟情况、饮酒情况以及家族史后,ALT,AST,ALP,GGT第四分位组患MS的比值比(odds ratio,OR)及其95%可信区间(confidence interval,CI)分别为2.57(2.22,2.99),1.26(1.12,1.43),2.47(2.15,2.83),4.72(4.00,5.59)(趋势性P值均0.001)。在男性人群中,ALT,AST,ALP,GGT第四分位组患MS的OR值,与第一分位相比,分别为2.36(2.01,2.79),1.28(1.11,1.48),2.10(1.80,2.45)和4.16(3.49,4.97)(趋势性P值均P0.001)。在女性人群中,ALT、AST、ALP和GGT第四分位组,与第一分位组相比,OR值分别为1.86(1.46,2.39),3.41(2.48,4.77)和5.16(3.88,6.95)(其中AST趋势性P=0.502,其余三者趋势性P值均0.001)。4.ALT,AST,ALP,GGT诊断MS的ROC曲线的曲线下面积(areas under curve,AUC),在总人群中AUC(95%CI)分别为0.68(0.67,0.69)、0.58(0.57,0.59)、0.61(0.60,0.62),0.73(0.72,0.74);男性研究对象中AUC(95%CI)分别为0.64(0.62,0.65)、0.55(0.54,0.57),0.57(0.55,0.58)、0.67(0.66,0.69);女性研究对象中AUC(95%CI)分别为0.65(0.63,0.67)、0.56(0.54,0.59)、0.70(0.68,0.71)、0.73(0.71,0.75)。ROC曲线分析得出ALT,AST,ALP,GGT诊断MS最佳临界值(灵敏度,特异度),在总人群中,分别为23.50U/L(0.59,0.67)、23.50U/L(0.40,0.73),60.50U/L(0.67,0.49)和24.50U/L(0.70,0.41);男性研究对象中,最佳临界值(灵敏度,特异度)分别为25.50U/L(0.56,0.64)、27.50U/L(0.28,0.82)、60.50U/L(0.51,0.59)和27.50U/L(0.72,0.53);女性研究对象中,最佳临界值(灵敏度,特异度)分别为18.50U/L(0.61,0.63)、23.50U/L(0.32,0.79)、60.50U/L(0.78,0.52)和16.50U/L(0.74,0.62)。结论:1.随着肝酶水平的增加MS患病率增加,且二者具有相关性。2.肝酶水平预测MS的价值:总人群中GGTALTALPAST;男性研究对象中GGTALTALPAST;女性研究对象中GGTALPALTAST。3.在本研究人群中,血清肝酶水平对MS具有诊断价值。4.需要更多的研究探讨是否下调临床肝酶水平去辅助诊断MS患者。
[Abstract]:Objective: This study aims to study the association of serum levels of liver enzymes and metabolic syndrome, to determine liver enzyme levels in diagnosis of metabolic syndrome (metabolic syndrome MS) the best critical point, metabolic syndrome as early reference of clinical diagnosis. Methods: This study used a cross-sectional surface, the 2007-2014 "Tianjin population of chronic inflammation and health promotion based cohort study (TCLSIHealth)" part of the baseline population, according to the inclusion and exclusion criteria, signed informed consent after the final 12454 were included in the study. The study involved variables including age, sex, body mass index (body mass, index, BMI), waist circumference, systolic blood pressure (systolic, blood pressure. SBP), diastolic blood pressure (diastolic blood pressure, DBP), smoking, drinking, family history of diseases (cardiovascular disease (cardiovascular, disease, CVD), hypertension, diabetes and hyperlipidemia), personal disease The history of total cholesterol (total, cholesterol, TC), high density lipoprotein cholesterol (high density lipoprotein cholesterol, HDL-C), low density lipoprotein cholesterol (low density lipoprotein cholesterol LDL-C (triglycerides), triglycerides, fasting blood glucose (TG), fasting plasma glucose, FBG), two hour postprandial blood glucose (2 hour-postprandial plasma glucose, 2h PG), serum alanine aminotransferase (alanine, transaminase, ALT), aspartate aminotransferase (aspartate, aminotransferase, AST), alkaline phosphatase (alkaline phosphatase, ALP), r-glutamyltranspeptidase (gamma glutamyl, transpeptidase, GGT). This research adopts the 2013 Chinese Medical Association Diabetes Branch the < China guidelines for the prevention and treatment of type 2 Diabetes > as the diagnostic criteria of metabolic syndrome, satisfies the following five in any three or more was diagnosed with metabolic syndrome, including abdominal fat Fat (male waistline female waist is larger than 90cm, more than 85CM), TG = 1.70mmol/L, HDL1.04mmol/L, blood pressure (SBP = 130mm Hg DBP = 80mm, Hg) and blood glucose levels (FBG = 6.1mmol/L or 2H = PG 7.8mmol/L). After adjustment for age, sex, BMI, smoking status, alcohol consumption, family history. The Spearman partial correlation analysis of serum liver enzymes ALT, AST, ALP, GGT and the correlation between metabolic syndrome components, multivariate logistic regression to evaluate serum liver enzymes and metabolic syndrome association, the receiver operating characteristic (receiver operating characteristic curve, ROC) analysis, determine the best prediction of critical value of metabolic syndrome serum liver enzyme levels. Results: 1. groups in this study, the prevalence rate of MS was 26.92% (34.91% male, 15.75% female). The MS components of the population prevalence of central obesity was 48.88% (male 58.29%, female 35.75%), elevated blood pressure 48.01% (52.35% male, 41 female .94%), high TG in 37.84% (47.31% male, 24.62% female), low HDL-C level 16.84% (23.28% male, 7.83% female), blood glucose increased 13.67% (male 16.05%, female 10.36%).2. adjusted for age, sex, BMI, smoking status, alcohol consumption, family history, partial correlation analysis of Spearman showed that in the general population in ALT, AST, ALP, SBP, GGT level and waist circumference, DBP, TG, HDL-C, FBG were significantly correlated (P0.05). In the male subjects, and obtained similar results. The total population of women and the object of study, the serum level of ALT and SBP, AST and waist circumference, SBP have no significant correlation in.3. in the study population, the prevalence rate of MS increased with the elevated levels of liver enzymes. Multivariate logistic regression analysis showed that the liver enzyme levels first group as a benchmark, after adjustment for age, sex, BMI, smoking, drinking and family history, ALT, AST, ALP, GGT fourth group with MS the odds ratio (odds, ratio, OR) 鍙婂叾95%鍙�淇″尯闂�(confidence interval,CI)鍒嗗埆涓，

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