本文選題：谷丙轉氨酶　切入點：谷草轉氨酶　出處：《大連醫(yī)科大學》2017年碩士論文

【摘要】：目的:探討谷丙轉氨酶(Alanine transaminase,ALT)、谷草轉氨酶(Aspartate transaminase,AST)的動態(tài)變化與代謝綜合征(Metabolic Syndrome,MetS)發(fā)生的關聯(lián),為利用ALT、AST的動態(tài)變化預測MetS的發(fā)生提供依據(jù)。方法:回顧收集1119例健康體檢者2010~2013年連續(xù)4年的體檢數(shù)據(jù),根據(jù)隨訪體檢期間是否發(fā)生MetS將目標人群分為發(fā)生MetS組和未發(fā)生MetS組,比較兩組ALT、AST指標的年平均變化率是否存在差異;利用R語言建立線性混合效應模型分析發(fā)生MetS者與未發(fā)生MetS者ALT、AST指標的動態(tài)變化趨勢。利用SPSS17.0軟件進行單因素以及多因素Logistic回歸分析ALT、AST年平均變化率與MetS發(fā)生的關聯(lián)。結果:最終收集到1119例健康體檢者的體檢數(shù)據(jù)。3年間80例發(fā)生MetS,MetS累計發(fā)病率為7.1%。未發(fā)生MetS組與發(fā)生MetS組的ALT、AST年平均變化率差異均有統(tǒng)計學意義(ALT:Z=-3.85,P=0.000;AST:Z=-3.96,P=0.000);ALT年平均變化率在2010、2011年診斷為MetS組與未發(fā)生MetS組差異均有統(tǒng)計學意義(P0.008);AST年平均變化率在2012年診斷為MetS組與未發(fā)生MetS組的差異有統(tǒng)計學意義(P0.008)。ALT的線性混合效應模型結果顯示,在基線時,基線年齡為37歲的未發(fā)生MetS者logALT平均水平為1.2701U/L(1.258~1.282,P0.001),而發(fā)生MetS者的logALT要平均升高0.156U/L(0.101~0.211,P0.001);在未發(fā)生MetS者中,基線年齡每加1歲,logALT水平平均升高0.0034U/L(0.001~0.005,P0.001);基線年齡與MetS狀態(tài)的負交互作用有統(tǒng)計學意義,即發(fā)生MetS者基線年齡每增加1歲,logALT水平反而減小0.0041U/L(-0.006~-0.002,P=0.005),說明基線年齡較小的發(fā)生MetS者,其logALT水平要高于年齡大者;測量時間點與MetS狀態(tài)存在正交互作用,隨訪期間發(fā)生MetS者的logALT水平,在診斷為MetS前每年平均增加0.0307U/L(0.004~0.058,P0.05),而未發(fā)生MetS者,隨訪期間logALT水平幾乎不隨測量時點改變。AST的線性混合效應模型顯示,基線時,基線年齡為37歲的未發(fā)生MetS者logAST均值為1.3159U/L(1.308~1.324,P0.001),而發(fā)生MetS者logAST水平平均升高0.0426U/L(0.012~0.074,P=0.008);未發(fā)生MetS者基線年齡每增加1歲logAST值增加0.0023U/L(0.001~0.003,P0.001);未發(fā)生MetS者,隨訪期間logAST水平每年平均下降0.0049U/L(-0.009~-0.001,P=0.002);由于基線年齡與MetS狀態(tài)的負交互作用有統(tǒng)計學意義,發(fā)生MetS者基線年齡每增加1歲,logAST水平反而平均降低0.0019U/L(-0.004~0.000,P=0.017)。單因素Logistic回歸結果得出基線年齡增加、ALT基線水平升高、ALT與AST年平均變化率增加均是MetS發(fā)生的危險因素。多因素Logistic回歸結果顯示基線年齡(OR值為1.042,1.025~1.059,P0.001)、ALT基線水平(OR值為1.037,1.022~1.052,P0.001)以及ALT年平均變化率(OR值為1.108,1.076~1.141,P0.001)與MetS的發(fā)生相關聯(lián)�；�年齡增加、ALT水平升高、ALT年平均變化率升高是MetS發(fā)生的危險因素。結論:發(fā)生MetS者在診斷為MetS之前,血清ALT與AST水平均高于未發(fā)生MetS者,且呈現(xiàn)明顯的逐年上升趨勢;ALT年均變化率升高是MetS發(fā)生的危險因素;當ALT與AST呈現(xiàn)出逐年的增長趨勢,即使未超出正常參考值上限,也應該警惕肝臟代謝紊亂以及MetS的發(fā)生。
[Abstract]:Objective: To investigate the effects of alanine aminotransferase (Alanine, transaminase, ALT), aspartate aminotransferase (Aspartate transaminase, AST) and the dynamic changes of metabolic syndrome (Metabolic Syndrome, MetS) the Association for the use of ALT, to predict the dynamic changes of the AST provide the basis for the occurrence of MetS. Methods: retrospectively collected medical data of 1119 cases of healthy persons 2010~2013 for 4 consecutive years, according to whether the follow-up examination occurred during the MetS of the target population is divided into MetS group and non MetS group, compared with two groups of ALT, the average annual rate of change of AST index whether there are differences; the use of R language to establish the linear mixed model analysis of MetS and non MetS ALT, dynamic the change trend of AST index. Use SPSS17.0 software for single factor and multi factor Logistic regression analysis of ALT, AST average annual change rate associated with the occurrence of MetS. Results: collected 1119 cases of physical examination The physical examination data of.3 from 80 cases of MetS, MetS cumulative incidence rate of 7.1%. occurred in MetS group and MetS group ALT, AST average annual change rate differences were statistically significant (ALT:Z=-3.85, P=0.000; AST:Z=-3.96, P=0.000; ALT) the annual average change rate in 20102011 years was diagnosed as MetS group and non MetS group the differences were statistically significant (P0.008); AST average annual change rate in 2012 for the diagnosis of the difference between MetS group and non MetS group was statistically significant (P0.008) results.ALT linear mixed effects model showed that at baseline, baseline age was 37 without MetS logALT the average level of 1.2701U/L (1.258~1.282, P0.001), and occurrence of MetS logALT 0.156U/L (0.101~0.211, P0.001 average increase); in did not occur in MetS, each with 1 years of age at baseline, logALT levels increased by an average of 0.0034U/L (0.001~0.005, P0.001); baseline age and MetS status A statistically significant negative interaction, namely the occurrence of MetS baseline for each additional 1 years of age, the level of logALT decreased 0.0041U/L (-0.006~-0.002, P=0.005), an MetS baseline age is small, the level of logALT is higher than that of older persons; there is a positive interaction. The measurement time points and MetS state, MetS occurred during follow-up the level of logALT in the diagnosis of MetS before the annual average increase of 0.0307U/L (0.004~0.058, P0.05), but not MetS, the follow-up period model of linear mixed effects logALT level hardly with the measuring point change.AST display, baseline, baseline age was 37 without MetS logAST mean 1.3159U/L (1.308~1.324 P0.001, MetS logAST), and the level of the average increase of 0.0426U/L (0.012~0.074, P=0.008); no increase in MetS per person age at baseline was 1 logAST increase in the value of 0.0023U/L (0.001~0.003, P0.001); no MetS During the follow-up period, the average annual decline of 0.0049U/L logAST levels (-0.009~-0.001, P=0.002); due to significant negative interaction between baseline age and MetS status, MetS baseline each additional 1 years of age, but the average level of logAST decreased 0.0019U/L (-0.004~0.000, P=0.017). The single factor Logistic regression results of baseline age, increased ALT at baseline, ALT and AST average annual change rate increases are the risk factors of MetS. Multivariate Logistic regression analysis showed that age at baseline (OR = 1.042,1.025~1.059, P0.001), ALT base line level (OR = 1.037,1.022~1.052, P0.001) ALT and the annual average change rate (OR = 1.108,1.076~1.141, P0.001) associated with the occurrence of MetS. The baseline age, elevated levels of ALT, ALT average annual change rate is the risk factors of MetS. Conclusion: the incidence of MetS in the diagnosis of MetS, serum AL T and AST levels were higher than those without MetS, and the obvious increasing trend; ALT average annual change rate is the risk factors of MetS; when ALT and AST showed a growth trend year by year, even if does not exceed the upper limit of normal reference values, should also be alert to the metabolic disorder of the liver and the occurrence of MetS.

【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R589

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