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

doi:10.3969/j.issn.1001-5256.2021.09.027

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

a.
青岛大学附属青岛市市立医院感染性疾病科，山东青岛 266011
b.
青岛大学附属青岛市市立医院临床研究中心，山东青岛 266011

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
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出版历程
- 收稿日期: 2021-02-22
- 录用日期: 2021-03-10
- 出版日期: 2021-09-20

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

a.
Department of Infectious Diseases, Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao, Shandong 266011, China
b.
Clinical Research Center, Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao, Shandong 266011, China

Research funding:

National Natural Science Foundation of China (31770837)

摘要

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。
- 非酒精性脂肪性肝病 /
- 高血压 /
- 天冬氨酸氨基转移酶类 /
- γ-谷氨酰转移酶 /
- 山东
Abstract: Objective To investigate whether there was a correlation between serum liver enzyme levels and blood pressure in the Chinese Han population with nonalcoholic fatty liver disease (NAFLD) in Shandong coastal regions in China. Methods A total of 269 NAFLD patients who lived in Shandong coastal regions and attended or underwent physical examination in Qingdao Municipal Hospital from December 2019 to June 2020 were enrolled, among whom 105 had hypertension and 164 did not have hypertension. Morning blood pressure was measured to calculate mean arterial pressure (MAP), and laboratory tests were performed to measure the serum levels of liver enzymes [alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (GGT), and alkaline phosphatase (ALP)] and fasting blood glucose (FBG). The independent samples t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. A Pearson correlation analysis was used to investigate the correlation of four liver enzymes with the indices including MAP, and a binary logistic regression model was used to analyze the impact of serum liver enzymes on hypertension. Results Compared with the non-hypertension group, the hypertension group had significantly higher body mass index (BMI), MAP, and GGT (all P < 0.05). For all NAFLD patients and the NAFLD patients without hypertension, male patients had significantly higher BMI, MAP, ALT, AST, and GGT than female patients (all P < 0.05), and for the NAFLD patients with hypertension, male patients had a significantly higher level of GGT than female patients (P < 0.05). There was a significant difference in the distribution of GGT between the hypertension group and the non-hypertension group, and compared with the non-hypertension group, the hypertension group had a significantly higher proportion of patients with GGT exceeding the normal range (χ²=4.781, P=0.029). Serum GGT level was correlated with MAP within the normal range (70-105 mm Hg) (r=0.178, P=0.011), while there was no significant correlation when MAP exceeded the normal range (P=0.415). After adjustment for age and sex, the binary logistic regression model showed that AST level was positively associated with hypertension in the population with NAFLD (odds ratio [OR]=1.011, 95% confidence interval [CI]: 1.000-1.022, P=0.040), and after further adjustment for BMI and FBG, the results showed that AST level was still positively associated with hypertension (OR=1.011, 95% CI: 1.000-1.022, P=0.044). Conclusion In Chinese Han population with NAFLD in Shandong coastal regions, higher levels of AST may predict an increased risk of hypertension.
- Non-Alcoholic Fatty Liver Disease /
- Hypertension /
- Aspartate Aminotransferases /
- Gamma-Glutamyltransferase /
- SHANDONG

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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)
指标	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。

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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值	P值
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)

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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
指标	r值	P值	r值	P值	r值	P值	r值	P值
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

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