本文關(guān)鍵詞：成年人群血清肝酶與代謝綜合征的相關(guān)性研究　出處：《天津醫(yī)科大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 代謝綜合征 丙氨酸轉(zhuǎn)氨酶 天冬氨酸氨基轉(zhuǎn)移酶 堿性磷酸酶 谷氨酰轉(zhuǎn)肽酶

【摘要】：目的:本研究旨在通過(guò)研究血清肝酶水平與代謝綜合征的關(guān)聯(lián),從而確定肝酶水平診斷代謝綜合征(metabolic syndrome,MS)的最佳臨界點(diǎn),為代謝綜合征早期臨床診斷提供參考。方法:本研究為橫斷面研究,基于2007-2014年“天津人群慢性炎癥與健康促進(jìn)隊(duì)列研究(TCLSIHealth)”的部分基線人群,根據(jù)納入和排除標(biāo)準(zhǔn),簽署知情同意后最終12454人被納入研究中。本研究所涉及變量包括年齡、性別、身體質(zhì)量指數(shù)(body mass index,BMI)、腰圍、收縮壓(systolic blood pressure,SBP)、舒張壓(diastolic blood pressure,DBP)、吸煙情況、飲酒情況、家族疾病史(心血管疾病(cardiovascular disease,CVD)、高血壓、糖尿病和高脂血癥)、個(gè)人疾病史、總膽固醇(total cholesterol,TC)、高密度脂蛋白膽固醇(high density lipoprotein cholesterol,HDL-C)、低密度脂蛋白膽固醇(low density lipoprotein cholesterol,LDL-C)、甘油三酯(triglycerides,TG)、空腹血糖(fasting plasma glucose,FBG)、餐后兩小時(shí)血糖(2 hour-postprandial plasma glucose,2h PG)、血清丙氨酸轉(zhuǎn)氨酶(alanine transaminase,ALT)、天冬氨酸氨基轉(zhuǎn)移酶(aspartate aminotransferase,AST)、堿性磷酸酶(alkaline phosphatase,ALP)、谷氨酰轉(zhuǎn)肽酶(gamma glutamyl transpeptidase,GGT)等。本研究采用2013年中華醫(yī)師協(xié)會(huì)糖尿病分會(huì)制定的《中國(guó)2型糖尿病防治指南》作為代謝綜合征診斷標(biāo)準(zhǔn),滿足以下五項(xiàng)中的任意三項(xiàng)以上即被診斷為代謝綜合征,包括腹部肥胖(男性腰圍≥90cm,女性腰圍≥85cm)、TG≥1.70mmol/L、HDL1.04mmol/L、血壓升高(SBP≥130mm Hg,DBP≥80mm Hg)和血糖水平(FBG≥6.1mmol/L或2h PG≥7.8mmol/L)。在調(diào)整年齡、性別、BMI、吸煙情況、飲酒情況、家族史后,采用Spearman偏相關(guān)分析血清肝酶ALT,AST,ALP,GGT與代謝綜合征各組分的相關(guān)性,多元logistic回歸評(píng)估血清肝酶與代謝綜合征的關(guān)聯(lián),通過(guò)受試者工作曲線(receiver operating characteristic curve,ROC)分析,確定血清肝酶水平預(yù)測(cè)代謝綜合征的最佳臨界值。結(jié)果:1.本研究人群中MS患病率為26.92%(男性34.91%,女性15.75%)。其中MS各組分的人群患病情況分別為中心型肥胖48.88%(男58.29%,女性35.75%),血壓升高48.01%(男性52.35%,女性41.94%),高TG血癥37.84%(男性47.31%,女性24.62%),低HDL-C血癥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.校正年齡、性別、BMI、吸煙情況、飲酒情況、家族史后,Spearman偏相關(guān)分析顯示,在總?cè)巳褐蠥LT,AST,ALP,GGT水平與腰圍、SBP、DBP、TG、HDL-C、FBG顯著相關(guān)(P0.05)。在男性研究對(duì)象中,得出了與總?cè)巳合嗨频慕Y(jié)果。而女性研究對(duì)象,血清ALT水平與SBP,AST水平與腰圍、SBP無(wú)顯著相關(guān)。3.在研究人群中,MS的患病率隨著肝酶水平的升高而增加。多元logistic回歸分析顯示,以肝酶水平第一分位組為基準(zhǔn),在校正年齡、BMI、性別、吸煙情況、飲酒情況以及家族史后,ALT,AST,ALP,GGT第四分位組患MS的比值比(odds ratio,OR)及其95%可信區(qū)間(confidence interval,CI)分別為2.57(2.22,2.99),1.26(1.12,1.43),2.47(2.15,2.83),4.72(4.00,5.59)(趨勢(shì)性P值均0.001)。在男性人群中,ALT,AST,ALP,GGT第四分位組患MS的OR值,與第一分位相比,分別為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)(趨勢(shì)性P值均P0.001)。在女性人群中,ALT、AST、ALP和GGT第四分位組,與第一分位組相比,OR值分別為1.86(1.46,2.39),3.41(2.48,4.77)和5.16(3.88,6.95)(其中AST趨勢(shì)性P=0.502,其余三者趨勢(shì)性P值均0.001)。4.ALT,AST,ALP,GGT診斷MS的ROC曲線的曲線下面積(areas under curve,AUC),在總?cè)巳褐蠥UC(95%CI)分別為0.68(0.67,0.69)、0.58(0.57,0.59)、0.61(0.60,0.62),0.73(0.72,0.74);男性研究對(duì)象中AUC(95%CI)分別為0.64(0.62,0.65)、0.55(0.54,0.57),0.57(0.55,0.58)、0.67(0.66,0.69);女性研究對(duì)象中AUC(95%CI)分別為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曲線分析得出ALT,AST,ALP,GGT診斷MS最佳臨界值(靈敏度,特異度),在總?cè)巳褐?分別為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);男性研究對(duì)象中,最佳臨界值(靈敏度,特異度)分別為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);女性研究對(duì)象中,最佳臨界值(靈敏度,特異度)分別為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)。結(jié)論:1.隨著肝酶水平的增加MS患病率增加,且二者具有相關(guān)性。2.肝酶水平預(yù)測(cè)MS的價(jià)值:總?cè)巳褐蠫GTALTALPAST;男性研究對(duì)象中GGTALTALPAST;女性研究對(duì)象中GGTALPALTAST。3.在本研究人群中,血清肝酶水平對(duì)MS具有診斷價(jià)值。4.需要更多的研究探討是否下調(diào)臨床肝酶水平去輔助診斷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?qiáng)鍏?5%鍙俊鍖洪棿(confidence interval,CI)鍒嗗埆涓，

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