高血糖与高尿酸血症对丙氨酸氨基转移酶异常的交互作用

翟文海; 李雪梅; 汪鋆植; 林文源

doi:10.16462/j.cnki.zhjbkz.2019.11.014

高血糖与高尿酸血症对丙氨酸氨基转移酶异常的交互作用

doi: 10.16462/j.cnki.zhjbkz.2019.11.014

1.
443003 宜昌, 三峡大学医学院
2.
443002 宜昌, 宜昌市第二人民医院

基金项目:

湖北省科技厅重大专项 2016ABA107

详细信息

中图分类号: R181
计量
- 文章访问数: 338
- HTML全文浏览量: 96
- PDF下载量: 18
- 被引次数: 0
出版历程
- 收稿日期: 2019-06-23
- 修回日期: 2019-09-30
- 刊出日期: 2019-11-10

Interactive effect of Hyperglycemia and Hyperuricemia on abnormal alanine aminotransferase

1.
The Medical College of China Three Gorges University, Yichang 443003, China
2.
The Second People's Hospital Of Yichang, Yichang 443002, China

Funds:

Hubei Science and Technology Department Major Project 2016ABA107

摘要

摘要: 目的研究高血糖与高尿酸血症的交互作用对丙氨酸氨基转移酶（alanine aminotransferase，ALT）异常的影响。方法选取湖北宜昌地区2018年3-11月健康体检人群5 223名资料完整者进行研究，比较分析508例ALT异常组和513例正常组人群的代谢特征。应用Logistic回归模型研究危险因素的独立效应，应用相加模型、相乘模型对危险因素间的交互作用进行分析。结果 ALT异常组的尿酸、甘油三脂、总胆固醇、低密度脂蛋白胆固醇、空腹血糖、收缩压、舒张压、体重指数、天冬氨酸氨基转移酶水平均高于对照组，差异有统计学意义（均有P < 0.05）。控制混杂因素后，多因素Logistic回归分析模型结果显示，高血糖及高尿酸血症并存时的ALT异常风险为血糖及尿酸正常者的5.62倍（95% CI：1.65~19.73，P=0.004）。ALT异常危险因素的交互作用分析显示，高血糖及高尿酸之间不存在相乘交互作用，但具有相加交互作用，交互作用指数、相对超危险度比、归因比、纯因子归因交互效应百分比分别为3.02、3.09、54.98%、66.87%。结论 ALT异常患者同时存在多种代谢指标异常，高血糖及高尿酸血症的正交互作用是其重要危险因素之一，两者共存可增加患病风险。
- 高尿酸血症 /
- 高血糖症 /
- 丙氨酸氨基转移酶 /
- 交互作用
Abstract: Objective To investigate interaction effect of hyperglycemia and hyperuricemia on the patients with abnormal alanine aminotransferase(ALT). Methods From March to November 2018, 5 223 cases with complete and suitable data were enrolled in the physical medical examination in Yichang, Hubei Province of China. The metabolic characteristics of the two groups (508 ALT anomaly cases and 513 normal cases) were compared and analysed, Logistic regression model was used to study the independent effects of risk factors, and the interaction between risk factors was analyzed by additive model and multiplicative model. Results Levels of uric acid, triglyceride, total cholesterol, low density lipoprotein-cholesterol, fasting blood glucose, systolic blood pressure, diastolic blood pressure, body mass index, aspartate aminotransferase were significantly higher than that of the control group(all P < 0.05). After adjusting some confounding factors, multivariate Logistic regression analysis showed that risk of abnormal ALT was 5.62 times higher in subjects with hyperglycemia and hyperuricemia than in subjects without them(95% CI: 1.65-19.73, P=0.004). Interaction analysis of risk factors for abnormal ALT showed that there was no multiplicative interaction between hyperglycemia and hyperuricemia, but with additive interaction, the synergy index was 3.02, the relative excess risk due to interaction was 3.09, the attributable proportion due to interaction was 54.98% and pure factor attribution interaction was 66.87%. Conclusions There are several abnormal metabolic indices in individuals with abnormal ALT. The positive interaction between hyperglycemia and hyperuricemia are among the important risk factors for abnormal ALT patients. They can significantly increase the risk of illness.
- Hyperuricemia /
- Hyperglycemia /
- Alanine aminotransferase /
- Interaction

HTML全文

表 1 ALT异常在性别、各年龄段间的比较[n(%)]

Table 1. Comparison of abnormal ALT patients between sex and age groups[n(%)]

年龄(岁)	男性	女性	例数	χ²值	P值
< 40	167(21.92)	21(2.46)	188(11.65)	147.882	< 0.001
40~	134(16.92)	28(4.43)	162(11.38)	54.178	< 0.001
50~	83(16.60)	19(4.92)	102(11.51)	29.160	< 0.001
60~	26(6.60)	15(5.47)	41(6.14)	0.355	0.625
> 70	11(2.39)	4(2.33)	15(2.38)	0.003	0.958
合计	421(14.48)	87(3.76)	508(9.72)	168.894	< 0.001

下载: 导出CSV

表 2 两组人群生化和临床指标的比较(x±s)

Table 2. Comparison of clinical and biochemical indexes of two groups(x±s)

变量	病例组	对照组	t/χ²/Z值	P值
性别(男/女)	423/85	427/86	< 0.001^b	0.989
脂肪肝(%)	376(74.0)^d	157(30.5)^d	194.2^b	< 0.001
年龄(岁)	43(36, 52)^c	44(36, 53)^c	-0.21^a	0.901
甘油三酯(mmol/L)	1.9(1.3, 2.8)^c	1.1(0.9, 1.4)^c	15.55^a	< 0.001
直接胆红素(μmol/L)	4.3(3.5, 5.6)^c	3.7(2.7, 5.1)^c	4.91^a	0.001
总胆红素(μmol/L)	15.1±5.8	14.8±5.5	0.77	0.441
尿酸(μmol/L)	327.6±89.6	263.3±78.2	10.51	< 0.001
总蛋白(g/L)	73.5±4.01	71.5±3.77	6.65	< 0.001
总胆固醇(mmol/L)	5.78±1.10	4.82±0.73	13.97	< 0.001
HDL-c(mmol/L)	1.43±0.22	1.45±0.31	-0.80	0.413
LDL-c(mmol/L)	3.45±0.91	2.76±0.61	12.16	< 0.001
空腹血糖(mmol/L)	5.70±1.35	5.31±0.71	5.06	< 0.001
体重指数(kg/m²)	26.78±3.19	23.55±3.27	14.05	< 0.001
收缩压(mmHg)	76.78±9.87	71.87±9.78	7.01	< 0.001
舒张压(mmHg)	119.52±15.6	114.96±15.2	4.22	0.006
AST(u/L)	42.3±19.2	28.1±5.7	13.86	< 0.001
ALT(u/L)	58.23±27.47	20.94±6.78	25.13	< 0.001
注：^a为Z值，^b为χ²值，^c为M(P₂₅, P₇₅)，^d括号中为患病率。

下载: 导出CSV

表 3 高血糖及高尿酸血症对ALT异常者的相加交互作用[n(%)]

Table 3. The additive interaction of hyperglycemia and hyperuricemia on abnormal ALT patients[n(%)]

高血糖	高尿酸血症	ALT正常组	异常组	单因素		多因素
高血糖	高尿酸血症	ALT正常组	异常组	OR(95% CI)值	P值	OR(95% CI)值	P值
无	无	4 293(91.0)	408(80.3)	1.00		1.00
有	无	223(4.7)	39(7.7)	1.91(1.08~2.99)	0.023	1.68(0.95~2.89)	0.081
无	有	184(3.9)	51(10.0)	2.86(1.79~4.55)	< 0.001	1.85(1.03~3.00)	0.046
有	有	15(0.32)	10(1.97)	7.51(2.36~23.89)	0.001	5.62(1.65~19.73)	0.004

下载: 导出CSV

表 4 高血糖及高尿酸血症对ALT异常者的相乘交互作用

Table 4. The multiplicative interaction between hyperglycemia and hyperuricemia on abnormal ALT patients

变量	OR(95% CI)值^a	P值^a	OR(95% CI)值^b	P值^b
高血糖	1.99(1.26~3.15)	0.003	1.90(1.19~3.04)	0.007
高尿酸	3.07(1.99~4.72)	< 0.001	3.02(1.95~3.67)	0.001
高血糖×高尿酸	1.46(0.39~5.52)	0.577	1.33(0.27~6.51)	0.725
注：^a无调整变量，^b调整年龄、性别、总胆固醇、甘油三酯、收缩压、舒张压、体重指数变量

下载: 导出CSV

参考文献(21)

[1]	Castro MC, Massa ML, Del Zotto H, et al. Rat liver uncoupling protein 2: changes induced by a fructose-rich diet[J]. Life Sci, 2011, 89(17/18): 609-614. DOI: 10.1016/j.lfs.2011.07.024.
[2]	刘安楠, 潘洁, 王蕾蕾, 等. 血尿酸与非酒精性脂肪性肝病发生风险相关性四年随访观察研究[J]. 中华健康管理学杂志, 2017, 11(5): 453-457. doi: 10.3760/cma.j.issn.1674-0815.2017.05.010 Liu AN, Pan J, Wang LL, et al. Four-year follow-up observation on the relationship between serum uric acid and the risk of nonalcoholic fatty liver disease[J]. Chin J Health Manage, 2017, 11(5): 453-457. doi: 10.3760/cma.j.issn.1674-0815.2017.05.010
[3]	Xu L, Jiang CQ, Ling CM, et al. Liver enzymes and incident diabetes in China: a prospective analysis of 10764 participants in the Guangzhou Biobank Cohort Study[J]. J Epidemiol Community Health, 2015, 69(11): 1040-1044. DOI: 10.1136/jech-2015-205518.
[4]	Yu TY, Jee JH, Bae JC, et al. Serum uric acid: a strong and independent predictor of metabolic syndrome after adjusting for body com position[J]. Metabolism, 2016, 65(4): 432-440. DOI: 10.1016/j.metabol.2015.11.003.
[5]	牟忠卿, 李晓博, 陈丽. 糖尿病大鼠肝脏组织中氧化应激标志物的表达变化及意义[J]. 山东医药, 2015, 55(7): 26-28. DOI: 10.3969/j.issn.1002-266X.2015.07.009. Mu ZQ, Li XB, Chen L. Expression and significance of oxidative stress markers in liver tissue of diabetic rats[J]. Shandong Medicine Journal, 2015, 55(7): 26-28. DOI: 10.3969/j.issn.1002-266X.2015.07.009.
[6]	袁悦, 李楠, 任爱国, 等. 流行病学研究中相加和相乘尺度交互作用的分析[J]. 现代预防医学, 2015, 42(6): 961-965, 975. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF201506001.htm Yuan Y, Li N, Ren AG, et al. Analysis of the application of the additive model and the multiplicative statistical model in biologial interaction[J]. Modern Preventive Medicine, 2015, 42(6): 961-965, 975. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF201506001.htm
[7]	Krishnan E, Pandya BJ, Chung L, et al. Hyperuricemia in young adults and risk of insulin resistance, prediabetes, and diabetes: a 15 year follow-up study[J]. Am J Epidemiol, 2012, 176: 108-116. DOI: 10.1093/aje/kws002.
[8]	Zhao Y, Yang K, Wang F, et al. Associations between metabolic syndrome and syndrome components and retinal microvascular signs in arural Chinese population: the Handan Eye Study[J]. Graefe's Arch Clin Exp Ophthalmol, 2012, 250(12): 1755-1763. DOI: 10.1007/s00417-012-2109-2.
[9]	拾莉, 龚莹, 刘学奎, 等. 谷丙转氨酶与空腹血糖受损的相关性分析[J]. 中华内分泌代谢杂志, 2015, 31(12): 1034-1037. doi: 10.3760/cma.j.issn.1000-6699.2015.12.006 Shi L, Gong Y, Liu XK, et al. Analysis on the relationship between serum alanine aminotransferase and impaired fasting glucose[J]. Chin J Endocrinol Metab, 2015, 31(12): 1034-1037. doi: 10.3760/cma.j.issn.1000-6699.2015.12.006
[10]	林增辉, 谢娟. 社区老年人血清丙氨酸氨基转移酶与代谢综合征的相关性研究[J]. 中国慢性病预防与控制, 2018, 26(3): 180-184. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMXB201803005.htm Lin ZH, Xie J. The correlation between serum alanine aminotransferase and metabolic syndrome in the community elderly[J]. Chin J Prev Contr Chron Dis, 2018, 26(3): 180-184. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMXB201803005.htm
[11]	胡淑娟, 孙训明, 李淑元, 等. 血清丙氨酸转氨酶在汉族中年人群中随年龄的变化趋势[J]. 复旦学报(医学版), 2015, 42(5): 584-588. doi: 10.3969/j.issn.1672-8467.2015.05.004 Hu SJ, Sun XM, Li SY, et al. Trends analysis of serum alanine aminotransferase levels with age in middle-aged Han ethnic population[J]. Fudan Univ J Med Sci, 2015, 42(5): 584-588. doi: 10.3969/j.issn.1672-8467.2015.05.004
[12]	赵立芸, 李雪, 冯任南, 等. 肝脏转氨酶与空腹血糖受损和2型糖尿病的关系研究[J]. 中华疾病控制杂志, 2013, 17(1): 1-4. https://www.cnki.com.cn/Article/CJFDTOTAL-JBKZ201301002.htm Zhao LY, Li X, Feng RN, et al. Study on the relationship between impaired fasting glucose and type 2 diabetes mellitus with serum aminotransferase activities[J]. Chin J Dis Control Prev, 2013, 17(1): 1-4. https://www.cnki.com.cn/Article/CJFDTOTAL-JBKZ201301002.htm
[13]	Petta S, Cammà C, Cabibi D, et al. Hyperuricemia is associated with histological liver damage in patients with non-alcoholicfatty liver disease[J]. Aliment Pharmacol Ther, 2011, 34(7): 757-766. DOI: 10.1111/j.1365-2036.2011.04788.x.
[14]	Hwang IC, Suh SY, Sub AR, et al. The relationship between normal serum uric acid and nonalcoholic fatty liver disease[J]. J Korean Med Sci, 2011, 26: 386-391. DOI: 10.3346/jkms.2011.26.3.386.
[15]	Chen S, Guo X, Yu S, et al. Association between serum uric acid and elevated alanine aminotransferase in the general population[J]. Int J Environ Res Public Health, 2016, 13(3): 841. DOI: 10.3390/ijerph13090841.
[16]	Vozarova B, Stefan N, Lindsay RS, et al. High alanine aminotransferase is associated with decreased hepatic insulin sensitivity and predict the development of type 2 diabetes[J]. Diabetes, 2002, 51(3): 1889-1895. DOI: 10.2337/diabetes.51.6.1889.
[17]	张正, 孙中明, 张芹, 等. 2型糖尿病人群肝功能异常影响因素分析[J]. 中国慢性病预防与控制, 2017, 25(2): 81-84. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMXB201702001.htm Zhang Z, Sun ZM, Zhang Q, et al. Analysis on influencing factors of type 2 diabetes mellitus with liver dysfunction[J]. Chin J Prev Contr Chron Dis, 2017, 25(2): 81-84. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMXB201702001.htm
[18]	张莉, 王丽英, 张敏. 血糖波动与糖尿病肾病患者机体炎症及肝肾功能的关系[J]. 中国实验诊断学, 2018, 23(12): 2057-2060. doi: 10.3969/j.issn.1007-4287.2018.12.005 Zhang L, Wang LY, Zhang M. Relationship between glycemic excursion in diabetic nephropathy patients and inflammation/hepatorenal function[J]. Chin J Lab Diagn, 2018, 23(12): 2057-2060. doi: 10.3969/j.issn.1007-4287.2018.12.005
[19]	何源. 大连高校教职工高尿酸血症患病情况及危险因素分析[J]. 中国学校卫生, 2017, 38(10): 1594-1596. https://www.cnki.com.cn/Article/CJFDTOTAL-XIWS201710054.htm He Y. Prevalence and risk factors of hyperuricemia about the faculties of Dalian University[J]. Chin J Sch Health, 2017, 38(10): 1594-1596. https://www.cnki.com.cn/Article/CJFDTOTAL-XIWS201710054.htm
[20]	Xu YL, Xu KF, Bai JL, et al. Elevation of serum uric acid and incidence of type 2 diabetes: a systematic review and meta-analysis[J]. Chronic Dis Transl Med, 2016, 2(2): 81-91. DOI: 10.1016/j.cdtm.2016.09.003.
[21]	邹迪莎, 于健, 谢梦婷, 等. 高尿酸血症及高血糖与老年人高血压患病的交互作用[J]. 中华老年医学杂志, 2016, 35(8): 839-842. doi: 10.3760/cma.j.issn.0254-9026.2016.08.010 Zou DS, Yu J, Xie MT, et al. Interactive effect of hyperuricemia and hyperglycemia on the hypertension incidence in elderly patients[J]. Chin J Geriatr, 2016, 35(8): 839-842. doi: 10.3760/cma.j.issn.0254-9026.2016.08.010