卫生研究

目的探讨宁夏回汉人群血清中转氨酶活性与代谢综合征(metabolic syndrome,MS)及其相关指标的关系。方法采用病例-对照研究方法,2011年10月—2012年10月期间在宁夏医科大学附属医院及吴忠市人民医院进行定期健康体检人群中,筛选出877例无血缘关系的代谢综合征患者为病例组和655名无血缘关系的健康人为对照组。通过问卷方式调查研究对象的一般情况、生活方式、疾病及用药史、家族史等情况,通过体格检查测量研究对象的身高、体重、腰围、臀围及血压等。采集空腹静脉血进行实验室生化指标检测,包括空腹血糖(FPG)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)等。采用χ2检验、t检验和方差分析研究指标与MS患病的关系。结果病例组AST和ALT平均水平(t=-3.971,t=-6.048,P<0.01)及异常率(χ2=11.556,χ2=33.231,P<0.01)均高于对照组,差异有统计学意义。以对照组人群AST、ALT水平的75%以及40 U/L为界将研究对象分为低、中、高三组,调整性别、年龄、民族、文化程度、吸烟、饮酒等因素后,AST、ALT中水平人群MS患病风险分别是低水平人群的1.663倍(95%CI 1.263².189)和2.126倍(95%CI 1.586².852),高水平人群是低水平人群的2.801倍(95%CI 1.696⁴.624)和4.918倍(95%CI 2.980⁸.116),高水平人群是低水平+中水平人群的2.517倍(95%CI 1.530⁴.142)和4.194倍(95%CI 2.554⁶.885)。随着代谢综合征组分数量的增加,AST和ALT平均水平逐渐增加,差异均有统计学意义(F=7.742,F=11.753,P<0.01)。不同年龄组间AST和ALT平均水平除对照组外,其余组间差异均有统计学意义(P<0.05)。回族AST和ALT平均水平虽高于汉族,但差异均无统计学意义。男性AST、ALT平均水平均明显高于女性,除病例组AST水平外,其余组别差异均有统计学意义(P<0.01)。不同BMI水平间AST和ALT平均水平差异均有统计学意义(P<0.05)。结论 AST、ALT平均水平与MS的患病密切相关,正常范围内AST、ALT水平的偏高即可增加MS的患病风险,异常增高者MS患病风险的增加更为显著。AST、ALT水平可能成为预测MS患病、综合评价MS危险因素以及MS进展情况的重要因子。

Objective To analyze the relationship between the transaminase activity in serum and metabolic syndrome( MS) and its related indicators in Hui and Han nationality of Ningxia Province. Methods Using the method of case-control study,people of regional organizations who received regular health checks in the General Hospital of Ningxia Medical University and Wuzhong City People's Hospital from the October 2011 to October 2012 were enrolled in the study. According to inclusion and exclusion criteria,we selected 877 unrelated cases with metabolic syndrome as the case group and 655 unrelated health cases as control group. Date were collected through questionnaire investigation,physical examination and laboratory tests. The association between the transaminase activity and MS was analyzed by Chi-square test,t test and analysis of variance. Results The average levels and abnormality rate of AST and ALT in case group were significantly higher than that of control group,especially the average levels and abnormality rate of ALT,there were significant difference( t =-3. 971,t =-6. 048,χ2= 11. 556,χ2=33. 231,all P < 0. 01). To control the AST and ALT levels of seventy-five percent in control group and 40 U/L as the boundary and divided all the research object into low,medium and high groups. After adjustment for gender,age,nationality,culture degree,smoking and drinking,the odds ratios for MS were 1. 663( 95% CI 1. 263-2. 189) and2. 126( 95% CI 1. 586-2. 852) in the people with the medium AST,ALT levels people and low AST and ALT levels people,the odds ratios for MS were 2. 801( 95% CI 1. 696-4. 624) and 4. 918( 95% CI 2. 980-8. 116) in the people with the high AST,ALT levels people and low AST and ALT levels people,the odds ratios for MS were 2. 517( 95% CI1. 530-4. 142) and 4. 194( 95% CI 2. 554-6. 885) in the people with the high AST,ALT levels people and low and medium AST and ALT levels people. With the number of components of metabolic syndrome increases,the average levels of AST,ALT increased gradually,there were significant difference( F = 7. 742,F = 11. 753,all P < 0. 01).Comparing the average levels of AST and ALT of different age groups,except the control group,there were significant difference( all P < 0. 05). The average levels of AST and ALT of Hui is higher than that of Han nationality,but there were no significant difference( all P > 0. 05). The average levels of AST and ALT of male was significantly higher than that of female,there were significant difference in addition to the average levels of AST of case group( all P < 0. 01). There were significant difference in the average levels of AST,ALT in case,control and total survey population between different BMI levels( all P <0. 05). Conclusion The average levels of AST and ALT are closely related with the incidence of MS,in normal range,the levels of AST and ALT on the high side can increase the risk of MS,and the risk of MS creased significantly in the abnormal increase ones. The levels of AST and ALT can become an important factor to predict the risk of MS,synthetically evaluate the risk factors of MS and predict the progress of the MS.