儿童期谷丙转氨酶水平与心脏结构指标的关联

宋杨肖; 杨丽丽; 赵敏; 席波

doi:10.16835/j.cnki.1000-9817.2024310

儿童期谷丙转氨酶水平与心脏结构指标的关联

doi: 10.16835/j.cnki.1000-9817.2024310

宋杨肖^{1, 2},
杨丽丽^{1, 2},
赵敏³,
席波^{1, 2, ,}

1.
山东大学齐鲁医学院公共卫生学院流行病学系/儿少卫生与妇幼保健学系，济南 250012
2.
山东大学儿童心血管研究中心
3.
山东大学齐鲁医学院公共卫生学院营养与食品卫生学系

基金项目:

国家自然科学基金项目 81673195

国家自然科学基金项目 82173538

详细信息

作者简介:
宋杨肖(2001-)，女，安徽宿州人，在读硕士，主要研究方向为儿童心血管流行病学

通讯作者:
席波，E-mail: xibo2010@sdu.edu.cn

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R179 R446.11⁺² R322.1⁺¹
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- 被引次数: 0
出版历程
- 收稿日期: 2024-05-08
- 修回日期: 2024-07-23
- 网络出版日期: 2024-11-02
- 刊出日期: 2024-10-25

Association between alanine aminotransferase levels and cardiac structure in childhood

SONG Yangxiao^{1, 2},
YANG Lili^{1, 2},
ZHAO Min³,
XI Bo^{1, 2
, ,}

1.
Department of Maternal, Child and Adolescent Health, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan (250012), Shandong Province, China

摘要

摘要: 目的探讨儿童期谷丙转氨酶(ALT)水平与心脏结构指标的关联，为促进儿童心脏健康提供科学依据。方法研究数据基于2017年11月—2018年1月开展的“桓台儿童心血管健康随访队列”基线调查，将数据完整的1 340名儿童纳入研究。采用问卷调查儿童的人口学信息和生活方式，并通过体格检查和血生化检测获取儿童的体质量指数(BMI)、血压、空腹血糖(FPG)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)和谷丙转氨酶(ALT)等指标，通过超声检查测量儿童的左心室舒张末期内径(LVDD)、左心室收缩末期内径(LVSD)、左心室后壁厚度(LVPWT)以及舒张末期室间隔厚度(IVST)，并计算相对室壁厚度(RWT)、左心室质量(LVM)和左心室质量指数(LVMI)。采用多元线性回归模型分析ALT水平对左心室结构指标的影响，采用限制性立方样条(RCS)模型探讨ALT水平与左心室结构指标的剂量-反应关系。结果不同ALT水平组儿童LVDD、LVSD、IVST、LVPWT、LVM、LVMI、RWT等心脏指标差异均有统计学意义(F值分别为78.69，60.08，72.86，74.89，83.14，36.70，20.46，P值均 < 0.05)。多元线性回归模型分析显示，调整可能协变量后，ALT水平与LVDD、LVSD、IVST、LVPWT、LVM、LVMI存在正相关(β值分别为0.10，0.20，0.16，0.16，0.23，0.18，P值均 < 0.05)。RCS模型分析显示，调整可能协变量后，儿童ALT水平与LVDD、LVSD、IVST和LVMI均存在线性剂量-反应关系(P_非线性值均>0.05)；ALT水平与LVPWT、LVM均存在非线性剂量反应关系(P_非线性值均 < 0.05)。结论儿童期ALT水平与心脏多数结构指标呈正相关，且存在线性或非线性剂量-反应关系。
- 谷丙转氨酶 /
- 心脏 /
- 回归分析 /
- 儿童
Abstract: Objective To explore the association between alanine aminotransferase (ALT) levels and cardiac structure in childhood, so as to provide scientific evidence to promote childhood cardiac health. Methods Data were obtained from the baseline survey of the "Huantai Childhood Cardiovascular Health Cohort Study" conducted from November 2017 to January 2018. A total of 1 340 children with complete data were included in the study. Demographic information and lifestyle factors were collected through questionnaires. Physical examinations and blood biochemical tests were performed to obtain children's body mass index (BMI), blood pressure, fasting plasma glucose (FPG), triglyceride (TG), high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), and ALT levels. Further, cardiac structural indicators such as left ventricular end-diastolic diameter (LVDD), left ventricular end-systolic diameter (LVSD), left ventricular posterior wall thickness (LVPWT), and interventricular septal thickness (IVST) were measured by ultrasound. Relative wall thickness (RWT), left ventricular mass (LVM), and left ventricular mass index (LVMI) were calculated. Multivariate linear regression models were used to analyze the relationship between ALT levels and cardiac structural indicators. Restricted cubic spline (RCS) models were used to explore the dose-response relationship between ALT levels and cardiac structural indicators. Results There were significant differences in LVDD, LVSD, IVST, LVPWT, LVM, LVMI and RWT in different ALT level groups (F=78.69, 60.08, 72.86, 74.89, 83.14, 36.70, 20.46, P < 0.05). Multivariate linear regression analysis showed that ALT levels were positively associated with LVDD, LVSD, IVST, LVPWT, LVM, and LVMI (β=0.10, 0.20, 0.16, 0.16, 0.23, 0.18, P < 0.05) after adjusting for potential covariates. The RCS showed a linear dose-response relationship between ALT levels and LVDD, LVSD, IVST, and LVMI after adjusting for potential covariates (P_non-linear>0.05). In contrast, a non-linear dose-response relationship was found between ALT levels and LVPWT and LVM (P_non-linear < 0.05). Conclusions ALT levels in childhood are positively associated with the majority of cardiac structural indicators, presenting a linear or non-linear dose-response relationship.
- Alanine aminotransferase /
- Heart /
- Regression analysis /
- Child
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

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图 1 儿童ALT水平与心脏结构指标的剂量反应关系

Figure 1. Dose-response relationship between ALT levels and cardiac structural indicators in children

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表 1 不同ALT水平组儿童人口学信息、生活方式、体格检查及血生化指标比较(x±s)

Table 1. Comparison of different demographic information, lifestyle, physical examination and blood biochemical parameters in children among different ALT levels of groups(x±s)

组别	人数	年龄/岁	身高/cm	体重/kg	BMI/ (kg·m^-2)	收缩压/ mmHg	舒张压/ mmHg	睡眠时间/ (h·d^-1)
ALT低水平组	424	8.04±1.55	133.06±10.53	29.88±7.76	16.63±2.39	104.09±8.96	62.35±6.36	9.34±0.47
ALT中水平组	410	8.46±1.51^b	136.51±10.77^b	33.69±9.04^b	17.80±2.85^b	106.03±8.30^b	63.30±6.48	9.34±0.49
ALT高水平组	506	8.73±1.51^bc	139.10±9.99^bc	39.17±11.49^bc	19.89±3.94^bc	108.66±9.28^bc	65.01±6.77^bc	9.32±0.49
总体	1 340	8.43±1.55	136.40±10.70	34.55±10.44	18.22±3.47	106.41±9.08	63.65±6.64	9.33±0.48
F/H值		23.45	38.95	108.14	125.66	30.97	19.85	0.20
P值		< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	0.82

组别	人数	视屏时间/ (h·d^-1)^a	体力活动时间/ (h·d^-1)^a	FPG/ (mmol·L^-1)	TG/ (mmol·L^-1)^a	HDL-C/ (mmol·L^-1)	LDL-C/ (mmol·L^-1)
ALT低水平组	424	0.64(0.64)	1.20(1.50)	4.66±0.57	0.62(0.30)	1.59±0.36	2.21±0.63
ALT中水平组	410	0.64(0.84)	1.20(1.30)	4.70±0.53	0.64(0.32)	1.61±0.38	2.22±0.69
ALT高水平组	506	0.64(0.81)	1.35(1.70)	4.82±0.56^bc	0.74(0.47)^bc	1.55±0.38^c	2.37±0.70^bc
总体	1 340	0.64(0.78)	1.20(1.50)	4.73±0.56	0.67(0.38)	1.58±0.38	2.27±0.68
F/H值		2.76	1.35	11.26	50.26	4.03	7.86
P值		0.25	0.51	< 0.01	< 0.01	0.02	< 0.01
注：^a偏态分布，用中位数(四分位数间距)表示；1 mmHg=0.133 kPa；^b与ALT低水平组相比，P < 0.05；^c与ALT中水平组相比，P < 0.05。

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表 2 不同ALT水平组儿童各心脏结构指标比较(x±s)

Table 2. Comparison of different cardiac structural indicators in children among different ALT levels of groups(x±s)

年龄/岁	ALT水平	人数	统计值	LVDD/mm	LVSD/mm	IVST/mm	LVPWT/mm	LVM/g	LVMI/(g·m^-2.7)	RWT
6~8	低	262		37.50±1.07	23.90±1.37	5.47±0.26	5.62±0.26	52.30±5.09	27.75±3.23	0.30±0.01
	中	187		38.02±1.49^a	24.22±1.46^a	5.58±0.36^a	5.71±0.33^a	54.92±7.47^a	28.41±3.74	0.30±0.01
	高	191		38.59±1.85^ab	24.59±1.70^ab	5.74±0.50^ab	5.87±0.49^ab	58.60±10.91^ab	28.79±3.97^b	0.30±0.02^ab
			F值	30.99	11.88	27.65	27.01	35.09	4.83	8.10
			P值	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01
9~11	低	162		40.16±2.15	25.65±1.93	6.23±0.55	6.42±0.55	70.02±13.37	26.47±4.28	0.31±0.02
	中	223		40.87±3.04	26.04±2.03	6.26±0.53	6.46±0.55	72.73±15.66	27.21±4.83	0.31±0.02
	高	315		42.25±3.43^ab	27.05±2.55^ab	6.58±0.72^ab	6.81±0.73^ab	82.91±22.23^ab	30.32±6.33^ab	0.32±0.02^b
			F值	28.76	24.87	25.14	27.72	33.42	34.93	4.28
			P值	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	0.01
总体	低	424		38.51±2.04	24.56±1.82	5.76±0.54	5.92±0.56	59.07±12.58	27.26±3.71	0.30±0.02
	中	410		39.57±2.84^a	25.21±2.00^a	5.95±0.57^a	6.12±0.60^a	64.61±15.41^a	27.76±4.40	0.30±0.02
	高	506		40.87±3.43^ab	26.12±2.56^ab	6.26±0.77^ab	6.45±0.79^ab	73.73±22.17^ab	29.74±5.61^ab	0.31±0.02^ab
			F值	78.69	60.08	72.86	74.89	83.14	36.70	20.46
			P值	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01
注：^a与ALT低水平组相比，P < 0.05；^b与ALT中水平组相比，P < 0.05。

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表 3 ALT水平与儿童心脏结构指标的多元线性回归分析(n=1 340)

Table 3. Multivariate linear regression analysis of ALT levels and cardiac structural indicators in children(n=1 340)

自变量	模型1			模型2			模型3
自变量	β值	标准误	P值	β值	标准误	P值	β值	标准误	P值
6~8岁
LVDD	0.20	0.03	< 0.01	0.20	0.03	< 0.01	0.06	0.03	0.04
LVSD	0.39	0.07	< 0.01	0.39	0.08	< 0.01	0.14	0.07	0.05
IVST	0.43	0.07	< 0.01	0.44	0.07	< 0.01	0.16	0.06	< 0.01
LVPWT	0.40	0.06	< 0.01	0.41	0.06	< 0.01	0.15	0.06	< 0.01
LVM	0.36	0.05	< 0.01	0.36	0.05	< 0.01	0.13	0.04	< 0.01
LVMI	0.22	0.06	< 0.01	0.22	0.06	< 0.01	0.13	0.06	0.04
RWT	0.15	0.04	< 0.01	0.15	0.04	< 0.01	0.07	0.04	0.09
9~11岁
LVDD	0.40	0.04	< 0.01	0.40	0.04	< 0.01	0.12	0.04	< 0.01
LVSD	0.65	0.07	< 0.01	0.65	0.07	< 0.01	0.22	0.06	< 0.01
IVST	0.59	0.07	< 0.01	0.59	0.07	< 0.01	0.16	0.06	< 0.01
LVPWT	0.62	0.07	< 0.01	0.62	0.07	< 0.01	0.17	0.06	< 0.01
LVM	0.78	0.07	< 0.01	0.78	0.07	< 0.01	0.26	0.06	< 0.01
LVMI	0.56	0.06	< 0.01	0.55	0.06	< 0.01	0.20	0.05	< 0.01
RWT	0.07	0.04	0.11	0.07	0.05	0.13	0.00	0.05	0.97
总体
LVDD	0.34	0.03	< 0.01	0.34	0.03	< 0.01	0.10	0.02	< 0.01
LVSD	0.57	0.05	< 0.01	0.57	0.05	< 0.01	0.20	0.05	< 0.01
IVST	0.55	0.05	< 0.01	0.55	0.05	< 0.01	0.16	0.04	< 0.01
LVPWT	0.56	0.05	< 0.01	0.56	0.05	< 0.01	0.16	0.04	< 0.01
LVM	0.65	0.05	< 0.01	0.66	0.05	< 0.01	0.23	0.04	< 0.01
LVMI	0.45	0.05	< 0.01	0.45	0.05	< 0.01	0.18	0.04	< 0.01
RWT	0.10	0.03	< 0.01	0.10	0.03	< 0.01	0.02	0.03	0.54
注：模型1，调整性别、年龄；模型2，在模型1基础上调整视屏时间、睡眠时间、体力活动时间、蔬菜水果摄入情况和碳酸饮料摄入情况；模型3，在模型2基础上调整BMI、收缩压、舒张压、FPG、TG、HDL-C、LDL-C；进行多元线性回归前对连续性变量进行归一化处理。

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