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山东沿海地区非酒精性脂肪性肝病患者血清ALT、AST、GGT和ALP与血压的相关性分析

刘怡静 赵真真 刘守胜 徐艳艳 辛永宁

引用本文:
Citation:

山东沿海地区非酒精性脂肪性肝病患者血清ALT、AST、GGT和ALP与血压的相关性分析

DOI: 10.3969/j.issn.1001-5256.2021.09.027
基金项目: 

国家自然科学基金 (31770837)

利益冲突声明:本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。
作者贡献声明:刘怡静、辛永宁、赵真真负责课题设计,资料分析,撰写论文;赵真真、刘守胜、徐艳艳参与收集数据,修改论文;辛永宁、赵真真负责拟定写作思路,指导撰写文章并最后定稿。
详细信息
    通信作者:

    辛永宁,xinyongning@163.com

  • 中图分类号: R575.5

Correlation of serum alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transpeptidase, and alkaline phosphatase with blood pressure in patients with nonalcoholic fatty liver disease in coastal regions of Shandong Province in China

Research funding: 

National Natural Science Foundation of China (31770837)

  • 摘要:   目的  探讨山东沿海地区非酒精性脂肪性肝病(NAFLD)患者血清肝酶水平与血压水平是否存在相关性。  方法  随机选取2019年12月—2020年6月在青岛市市立医院就诊或接受体格检查,长期居住于山东沿海地区的269例NAFLD患者,其中105例患有高血压(高血压组),164例未患高血压(非高血压组)。测量受试者的晨起血压值,计算平均动脉压(MAP);实验室检测受试者血清肝酶(ALT、AST、GGT和ALP)水平及空腹血糖(FBG)。符合正态分布的计量资料2组间比较采用独立样本t检验,不符合正态分布的计量资料2组间比较采用Mann-Whitney U检验。计数资料2组间比较采用χ2检验。应用Pearson相关分析4种肝酶与MAP等指标之间的相关性,应用二元logistic回归模型分析血清肝酶对高血压的影响程度。  结果  高血压组的BMI、MAP和GGT均明显高于非高血压组(P值均 < 0.05)。在总NAFLD患者和非高血压NAFLD患者中,男性的BMI、MAP、ALT、AST、GGT均显著高于女性(P值均 < 0.05),在NAFLD伴高血压组中,男性的GGT水平显著高于女性(P < 0.05)。NAFLD伴高血压组超出正常范围的GGT人数比例高于非高血压组(χ2=4.781, P=0.029)。血清GGT水平与正常范围内的MAP(70~105 mm Hg)有相关性(r=0.178, P=0.011),MAP超出正常范围时,相关性无统计学意义(P=0.415)。应用二元logistic回归模型校正年龄和性别后,NAFLD人群中AST水平与高血压存在正关联(OR=1.011, 95%CI: 1.000~1.022, P=0.040);在此基础上进一步校正BMI和FBG,结果显示NAFLD人群中AST水平仍与高血压存在正关联(OR=1.011, 95%CI: 1.000~1.022, P=0.044)。  结论  在山东沿海地区NAFLD人群中,AST水平增高可能预示着高血压患病风险增加。

     

  • 表  1  不同性别NAFLD患者的临床特征

    指标 总受试者(n=269) 高血压组(n=105) 非高血压组(n=164)
    男(n=187) 女(n=82) 男(n=78) 女(n=27) 男(n=109) 女(n=55)
    年龄(岁) 46.0(42.0~61.0) 47.5(39.0~63.0) 46.0(42.0~62.0) 59.0(46.0~64.0) 47.0(41.5~60.5) 44.0(36.0~61.0)
    BMI(kg/m2) 26.03(24.51~27.68) 25.36(23.41~27.46) 1) 26.37(24.79~28.47) 27.18(24.01~29.13) 25.95(24.20~27.46) 25.15(23.23~26.35)1)
    FBG(mmol/L) 4.98(4.58~5.60) 5.09(4.57~5.82) 5.01(4.51~5.57) 5.42(4.74~6.49) 4.98(4.60~ 5.76) 4.99(4.44~5.54)
    MAP(mm Hg) 100.00(93.33~105.67) 96.67(86.67~103.33)1) 106.67(103.33~110.75) 107.33(103.33~113.33) 93.33(88.34~97.33) 90.00(83.33~97.00)1)
    ALT(U/L) 27.27(19.54~45.63) 18.84(15.38~27.86)1) 26.61(18.08~46.19) 21.67(16.63~32.52) 27.60(20.11~41.55) 17.83(14.93~23.62)1)
    AST(U/L) 23.25(18.38~33.36) 20.01(16.25~24.88)1) 22.11(18.44~33.45) 23.54(19.91~27.04) 23.43(18.26~31.20) 18.89(15.93~23.76)1)
    GGT(U/L) 33.65(22.76~48.42) 21.81(16.16~30.59)1) 37.14(26.67~53.84) 28.30(20.15~43.68)1) 30.81(22.19~45.42) 19.87(15.73~26.62)1)
    ALP(U/L) 76.10(62.57~88.48) 77.95(64.06~96.19) 76.83(62.15~87.69) 78.70(68.67~91.52) 75.61(62.98~90.33) 75.68(61.41~98.01)
    注:与同组男性比较,1)P < 0.05。
    下载: 导出CSV

    表  2  伴高血压NAFLD与非高血压NAFLD患者血清肝酶情况比较

    指标 高血压组(n=105) 非高血压组(n=164) χ2 P
    ALT[例(%)] 2.634 0.268
        低于正常 0 2(1.2)
        正常 82(78.1) 133(81.1)
        高于正常 23(21.9) 29(17.7)
    AST[例(%)] 1.193 0.551
        低于正常 4(3.8) 8(4.9)
        正常 91(86.7) 134(81.7)
        高于正常 10(9.5) 22(13.4)
    GGT[例(%)] 4.781 0.029
        低于正常 0 0
        正常 73(69.5) 133(81.1)
        高于正常 32(30.5) 31(18.9)
    ALP[例(%)] 0.644 0.725
        低于正常 5(4.8) 5(3.0)
        正常 96(91.4) 154(93.9)
        高于正常 4(3.8) 5(3.0)
    下载: 导出CSV

    表  3  血清肝酶与MAP及部分高血压危险因素的相关性分析

    指标 ALT AST GGT ALP
    r P r P r P r P
    MAP -0.003 0.958 0.029 0.633 0.146 0.016 0.045 0.459
        70 mm Hg≤MAP≤105 mm Hg -0.037 0.603 0.025 0.721 0.178 0.011 0.078 0.271
        MAP>105 mm Hg 0.065 0.603 0.049 0.696 0.102 0.415 0.193 0.121
    年龄 -0.231 <0.001 -0.057 0.349 -0.080 0.189 0.308 <0.001
    BMI 0.264 <0.001 0.147 0.016 0.276 <0.001 -0.102 0.096
    FBG 0.025 0.690 -0.007 0.912 0.069 0.261 0.181 0.003
    下载: 导出CSV
  • [1] ESTES C, RAZAVI H, LOOMBA R, et al. Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease[J]. Hepatology, 2018, 67(1): 123-133. DOI: 10.1002/hep.29466.
    [2] COTTER TG, RINELLA M. NAFLD 2020: The state of the disease[J]. Gastroenterology, 2020, 158(7): 1851-1864. DOI: 10.1053/j.gastro.2020.01.052.
    [3] BYRNE CD, TARGHER G. NAFLD: A multisystem disease[J]. J Hepatol, 2015, 62(1 Suppl): s47-s64. DOI: 10.1016/j.jhep.2014.12.012.
    [4] LIU P, TANG Y, GUO X, et al. Bidirectional association between nonalcoholic fatty liver disease and hypertension from the Dongfeng-Tongji cohort study[J]. J Am Soc Hypertens, 2018, 12(9): 660-670. DOI: 10.1016/j.jash.2018.06.013.
    [5] ANENI EC, ONI ET, MARTIN SS, et al. Blood pressure is associated with the presence and severity of nonalcoholic fatty liver disease across the spectrum of cardiometabolic risk[J]. J Hypertens, 2015, 33(6): 1207-1214. DOI: 10.1097/HJH.0000000000000532.
    [6] WANG Z, CHEN Z, ZHANG L, et al. Status of hypertension in China: Results from the China hypertension survey, 2012-2015[J]. Circulation, 2018, 137(22): 2344-2356. DOI: 10.1161/CIRCULATIONAHA.117.032380.
    [7] LEWINGTON S, LACEY B, CLARKE R, et al. The burden of hypertension and associated risk for cardiovascular mortality in China[J]. JAMA Intern Med, 2016, 176(4): 524-532. DOI: 10.1001/jamainternmed.2016.0190.
    [8] KOKUBO Y, MATSUMOTO C. Hypertension is a risk factor for several types of heart disease: Review of prospective studies[J]. Adv Exp Med Biol, 2017, 956: 419-426. DOI: 10.1007/5584_2016_99.
    [9] LI Z, LIU X, ZHANG Z, et al. Epidemiology of hypertension in a typical state-level poverty-stricken county in China and evaluation of a whole population health prevention project intervention[J]. Int J Hypertens, 2019, 2019: 4634823. DOI: 10.1155/2019/4634823.
    [10] CLARK JM, BRANCATI FL, DIEHL AM. The prevalence and etiology of elevated aminotransferase levels in the United States[J]. Am J Gastroenterol, 2003, 98(5): 960-967. DOI: 10.1111/j.1572-0241.2003.07486.x.
    [11] HANLEY AJ, WILLIAMS K, FESTA A, et al. Elevations in markers of liver injury and risk of type 2 diabetes: The insulin resistance atherosclerosis study[J]. Diabetes, 2004, 53(10): 2623-2632. DOI: 10.2337/diabetes.53.10.2623.
    [12] CLARK JM, DIEHL AM. Nonalcoholic fatty liver disease: An underrecognized cause of cryptogenic cirrhosis[J]. JAMA, 2003, 289(22): 3000-3004. DOI: 10.1001/jama.289.22.3000.
    [13] KUNUTSOR SK, APEKEY TA, KHAN H. Liver enzymes and risk of cardiovascular disease in the general population: A meta-analysis of prospective cohort studies[J]. Atherosclerosis, 2014, 236(1): 7-17. DOI: 10.1016/j.atherosclerosis.2014.06.006.
    [14] LEE DH, JACOBS DR Jr, GROSS M, et al. Gamma-glutamyltransferase is a predictor of incident diabetes and hypertension: The coronary artery risk development in young Adults (CARDIA) study[J]. Clin Chem, 2003, 49(8): 1358-1366. DOI: 10.1373/49.8.1358.
    [15] ONAT A, CAN G, ÖRNEK E, et al. Serum γ-glutamyltransferase: Independent predictor of risk of diabetes, hypertension, metabolic syndrome, and coronary disease[J]. Obesity (Silver Spring), 2012, 20(4): 842-848. DOI: 10.1038/oby.2011.136.
    [16] Chinese Medical Association, Chinese Medical Journals Publishing House, Chinese Society of General Practice, et al. Guideline for primary care of hypertension(2019)[J]. Chin J Gen Pract, 2019, 18(4): 301-313. DOI: 10.3760/cma.j.issn.1671-7368.2019.04.002.

    中华医学会, 中华医学杂志社, 中华医学会全科医学分会, 等. 高血压基层诊疗指南(2019年)[J]. 中华全科医师杂志, 2019, 18(4): 301-313. DOI: 10.3760/cma.j.issn.1671-7368.2019.04.002.
    [17] Group of Fatty Liver and Alcoholic Liver Diseases, Society of Hepatology, Chinese Medical Association. Guidelines for Management of non-alcoholic fatty liver disease[J]. J Clin Hepatol, 2010, 26(2): 120-124. https://www.cnki.com.cn/Article/CJFDTOTAL-SYNK201903008.htm

    中华医学会肝脏病学分会脂肪肝和酒精性肝病学组. 非酒精性脂肪性肝病诊疗指南[J]. 临床肝胆病杂志, 2010, 26(2): 120-124. https://www.cnki.com.cn/Article/CJFDTOTAL-SYNK201903008.htm
    [18] STRANGES S, TREVISAN M, DORN JM, et al. Body fat distribution, liver enzymes, and risk of hypertension: Evidence from the Western New York Study[J]. Hypertension, 2005, 46(5): 1186-1193. DOI: 10.1161/01.HYP.0000185688.81320.4d.
    [19] ZHU Y, GONG Y, ZHU R, et al. Relationship between serum gamma-glutamyltransferase levels and prehypertension in Chinese adults: The cardiometabolic risk in Chinese study[J]. J Clin Hypertens (Greenwich), 2014, 16(10): 760-765. DOI: 10.1111/jch.12381.
    [20] HONG X, WONGTONGKAM N, WARD PR, et al. An association of serum ALT with elevated blood pressure in senior adults: A case-control study[J]. Clin Exp Hypertens, 2016, 38(8): 691-695. DOI: 10.1080/10641963.2016.1200608.
    [21] RAHMAN S, ISLAM S, HAQUE T, et al. Association between serum liver enzymes and hypertension: A cross-sectional study in Bangladeshi adults[J]. BMC Cardiovasc Disord, 2020, 20(1): 128. DOI: 10.1186/s12872-020-01411-6.
    [22] GUO T, HU B, YI WM, et al. Research advances in the serological diagnosis of nonalcoholic fatty liver disease[J]. J Clin Hepatol, 2020, 36(11): 2579-2583. DOI: 10.3969/j.issn.1001-5256.2020.11.041.

    郭滔, 胡波, 易为民, 等. 血清学诊断非酒精性脂肪性肝病的研究进展[J]. 临床肝胆病杂志, 2020, 36(11): 2579-2583. DOI: 10.3969/j.issn.1001-5256.2020.11.041.
    [23] ORE A, AKINLOYE OA. Oxidative stress and antioxidant biomarkers in clinical and experimental models of non-alcoholic fatty liver disease[J]. Medicina (Kaunas), 2019, 55(2): 10.3390/medicina55020026. http://www.preprints.org/manuscript/201809.0268/v1/download
    [24] JIANG YZ, NIE HM, WANG R. Research advances in the pathogenesis of nonalcoholic fatty liver disease[J]. J Clin Hepatol, 2019, 35(11): 2588-2591. DOI: 10.3969/j.issn.1001-5256.2019.11.044.

    姜煜资, 聂红明, 汪蓉. 非酒精性脂肪性肝病的发病机制[J]. 临床肝胆病杂志, 2019, 35(11): 2588-2591. DOI: 10.3969/j.issn.1001-5256.2019.11.044.
    [25] TOUYZ RM. Reactive oxygen species, vascular oxidative stress, and redox signaling in hypertension: What is the clinical significance?[J]. Hypertension, 2004, 44(3): 248-252. DOI: 10.1161/01.HYP.0000138070.47616.9d.
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  • 收稿日期:  2021-02-22
  • 录用日期:  2021-03-10
  • 出版日期:  2021-09-20
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