青少年血清丙氨酸氨基转移酶水平与左心室肥厚的关联

贾鹏; 赵敏; 孙嘉鸿; 席波

doi:10.16835/j.cnki.1000-9817.2025258

青少年血清丙氨酸氨基转移酶水平与左心室肥厚的关联

doi: 10.16835/j.cnki.1000-9817.2025258

贾鹏^{1, 2},
赵敏³,
孙嘉鸿^4, ,,
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
4.
广东医科大学公共卫生学院预防医学系

基金项目:

国家自然科学基金项目 81673195

详细信息

作者简介:
贾鹏(1998-)，男，山东日照人，在读硕士，主要研究方向为儿童心血管健康

通讯作者:
孙嘉鸿，E-mail：jiahongsun1990@126.com

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 R714.252 R446.11⁺²
计量
- 文章访问数: 9
- HTML全文浏览量: 6
- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2025-02-24
- 修回日期: 2025-04-15
- 网络出版日期: 2025-08-30
- 刊出日期: 2025-08-25

Association of serum alanine aminotransferase level with left ventricular hypertrophy in adolescents

JIA Peng^{1, 2},
ZHAO Min³,
SUN Jiahong^{4
, ,},
XI Bo^{1, 2
, ,}

1.
Department of Epidemiology/Maternal and Child Health, School of Public Health, Cheeloo College of Medicine, Shandong University, Ji'nan 250012, Shandong Province, China

摘要

摘要: 目的探讨青少年血清丙氨酸氨基转移酶(ALT)与左心室肥厚(LVH)的关联，为心脏结构损害的早期筛查及干预提供科学依据。方法数据来源于“桓台儿童心血管健康随访队列”的2023年10月第3次随访调查数据，共纳入1 156名12~17岁具有完整信息的青少年。将样本人群同性别、同年龄别ALT水平按照三分位数进行低水平(Q1组)、中水平(Q2组)、高水平(Q3组)分组，组间比较采用方差分析和趋势检验，采用多元Logistic回归模型分析青少年ALT水平与LVH的关联，并按性别和年龄组进行分层分析。结果随着ALT分位水平的增加，青少年LVH检出率(Q1：3.7%；Q2：10.6%；Q3：16.7%)呈现增加趋势(Z=5.89，P < 0.01)。调整潜在协变量后，多元Logistic回归模型分析结果显示，与ALT Q1组相比，Q3组增加青少年LVH发生风险(OR=2.09，95%CI=1.21~4.12)；性别和年龄亚组分析结果显示，ALT Q3组与青少年LVH仅在男生和12~14岁年龄组中存在关联[OR值(95%CI)分别为2.64(1.04~7.67)，3.24(1.35~9.06)](P值均 < 0.05)。结论青少年血清ALT升高增加LVH发生风险，及早发现并控制异常的血清ALT有助于减少青少年早期心脏结构损害，进而预防不良心血管事件的发生。
- 丙氨酸氨基转移酶 /
- 肥大，左心室 /
- 生长和发育 /
- 回归分析 /
- 青少年
Abstract: Objective To investigate the association of serum alanine aminotransferase (ALT) with left ventricular hypertrophy (LVH) in adolescents, and to provide scientific evidence for the early screening and intervention strategy of cardiac structure damage. Methods Data were obtained from the third follow-up survey (October 2023) of the "Huantai Childhood Cardiovascular Health Cohort Study", including 1 156 healthy adolescents aged 12-17 with complete information. The sample population was stratified into low (Q1 group), medium (Q2 group), and high (Q3 group) ALT levels based on tertiles within the same gender and age groups. Inter-group comparisons were conducted using analysis of variance and trend test. A multivariate Logistic regression model was used to analyze the association between ALT levels and LVH, and stratified analyses were performed by gender and age groups. Results With the increase of ALT quantile level, the detection rate of LVH showed an increasing trend (Q1: 3.7%; Q2: 10.6%; Q3: 16.7%, Z=5.89, P < 0.01). After adjusting for potential covariates, compared with the ALT group (Q1), the group (Q3) increased the risk of developing LVH in adolescents (OR=2.09, 95%CI=1.21-4.12). Stratified analyses by age and sex showed a significant association only in boys and younger individuals aged 12 to 14 years [OR (95%CI) were 2.64(1.04-7.67) and 3.24(1.35-9.06), both P < 0.05)]. Conclusion Elevated serum ALT levels are associated with an increased risk of LVH in adolescents, and early detection and control of abnormal liver enzyme levels can help reduce early vascular structural damage and prevent adverse cardiovascular events.
- Alanine aminotransferase /
- Hypertrophy, left ventricular /
- Growth and development /
- Regression analysis /
- Adolescent
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

HTML全文

表 1 不同性别青少年基本指标比较(x ±s)

Table 1. Comparison of basic characteristics among adolescents by sex(x ±s)

性别	人数	BMI/ (kg·m^-2)	SBP/ mmHg	DBP/ mmHg	睡眠时间/ (h·d^-1)	视屏时间/ (h·d^-1)^*	FPG/ (mmol·L^-1)	HDL-C/ (mmol·L^-1)	LDL-C/ (mmol·L^-1)	TG/ (mmol·L^-1)	ALT/ (U·L^-1)^*	LVMI/ (g·m^-2.7)
男生	604	22.90±4.95	121.40±12.10	61.60±7.47	7.40±1.30	0.86(0.29，1.52)	4.73±0.48	1.46±0.28	2.15±0.72	0.89±0.45	16.10(12.70, 20.63)	32.47±5.20
女生	552	21.94±4.41	110.80±10.32	61.55±7.07	7.35±0.89	0.64(0.29，1.29)	4.66±0.43	1.55±0.29	2.22±0.68	0.96±0.39	11.80(9.70, 15.00)	30.76±4.86
总体	1 156	22.44±4.72	116.34±12.46	61.57±7.28	7.38±1.12	0.64(0.29，1.43)	4.70±0.46	1.50±0.29	2.18±0.70	0.92±0.42	13.80(10.80, 18.10)	31.66±5.11
t值		3.47	16.08	0.08	0.83	3.03	2.38	5.27	1.65	2.64	8.83	5.77
P值		< 0.01	< 0.01	0.94	0.41	< 0.01	0.02	< 0.01	0.10	0.01	< 0.01	< 0.01
注：^*为M(P₂₅，P₇₅)。

下载: 导出CSV

表 2 不同ALT水平青少年LVMI水平和LVH检出率比较

Table 2. Comparison of LVMI levels and detection rates of LVH in different ALT level groups of adolescents

组别	选项	Q1			Q2			Q3			F_LVMI值	Z_LVH值
组别	选项	人数	LVMI/(g·m^-2.7)	LVH检出人数	人数	LVMI/(g·m^-2.7)	LVH检出人数	人数	LVMI/(g·m^-2.7)	LVH检出人数	F_LVMI值	Z_LVH值
性别	男	198	31.20±4.42	6(3.0)	202	31.97±4.85	17(8.4)	204	34.20±5.77	40(19.6)	19.32	5.82
	女	181	29.75±4.53	8(4.4)	185	30.89±4.86	24(13.0)	186	31.62±5.00	25(13.4)	7.08	2.83
年龄/岁	12~14	209	30.72±4.10	6(2.9)	214	32.00±5.04	24(11.2)	215	32.93±5.64	36(16.7)	10.44	4.69
	15~17	170	30.23±5.00	8(4.7)	173	30.77±4.60	17(9.8)	175	33.03±5.49	29(16.6)	15.09	3.61
总体		379	30.51±4.53	14(3.7)	387	31.45±4.88	41(10.6)	390	32.98±5.56	65(16.7)	23.81	5.89
注：()内数字为检出率/%；P值均 < 0.01。

下载: 导出CSV

表 3 不同ALT水平与青少年LVH关联的Logistic回归分析

Table 3. Logistic regression analysis of the association between different ALT levels and LVH among adolescents

自变量	选项	ALT水平	人数	模型1		模型2		模型3
自变量	选项	ALT水平	人数	OR值(95%CI)	P值	OR值(95%CI)	P值	OR值(95%CI)	P值
年龄/岁	12~14	Q1	209	1.00		1.00		1.00
		Q2	214	4.28(1.82~11.75)	< 0.01	4.58(1.93~12.68)	< 0.01	3.31(1.35~9.38)	0.01
		Q3	215	6.80(3.00~18.30)	< 0.01	7.11(3.12~19.24)	< 0.01	3.24(1.35~9.06)	0.02
	15~17	Q1	170	1.00		1.00		1.00
		Q2	173	2.20(0.95~5.53)	0.08	2.25(0.97~5.68)	0.07	1.55(0.58~4.39)	0.39
		Q3	175	4.02(1.86~9.68)	< 0.01	4.07(1.88~9.84)	< 0.01	1.13(0.44~3.06)	0.81
性别	男生	Q1	198	1.00		1.00		1.00
		Q2	202	2.94(1.19~8.30)	0.03	3.24(1.30~9.20)	0.02	2.20(0.83~6.52)	0.13
		Q3	204	7.81(3.47~20.92)	< 0.01	8.36(3.69~22.5)	< 0.01	2.64(1.04~7.67)	0.03
	女生	Q1	181	1.00		1.00		1.00
		Q2	185	3.22(1.47~7.85)	0.01	3.24(1.47~7.90)	0.01	2.66(1.12~6.88)	0.03
		Q3	186	3.36(1.53~8.16)	< 0.01	3.40(1.33~8.28)	< 0.01	1.45(0.60~3.78)	0.42
总体		Q1	379	1.00		1.00		1.00
		Q2	387	3.09(1.70~5.96)	< 0.01	3.19(1.75~6.18)	< 0.01	2.35(1.23~4.71)	0.01
		Q3	390	5.21(2.96~9.84)	< 0.01	5.34(3.03~10.10)	< 0.01	2.09(1.21~4.12)	0.03
注：模型1调整性别和年龄，模型2在模型1基础上调整睡眠时间、视屏时间、身体活动水平、碳酸饮料摄入频率、蔬菜水果摄入、FPG、HDL-C、LDL-C、TG，模型3在模型2基础上调整超重肥胖、SBP和DBP。

下载: 导出CSV

参考文献(27)

[1]	孙宁玲, JAW W C, 王继光, 等. 亚洲高血压合并左心室肥厚诊治专家共识[J]. 中华高血压杂志, 2016, 24(7): 600, 619-627. SUN N L, JAW W C, WANG J G, et al. Expert consensus on diagnosis and treatment of hypertension complicated with left ventricular hypertrophy in Asia[J]. Chin J Hypertens, 2016, 24(7): 600, 619-627. (in Chinese)
[2]	MICELI F, PRESTA V, CITONI B, et al. Conventional and new electrocardiographic criteria for hypertension-mediated cardiac organ damage: a narrative review[J]. J Clin Hypertens (Greenwich), 2019, 21(12): 1863-1871. doi: 10.1111/jch.13726
[3]	GOTTDIENER J S, KOP W J. Body and heart: effects of weight gain and loss on left ventricular size and function[J]. Circ Cardiov Imaging, 2017, 10(3): e006084.
[4]	ESLAM M, SANYAL A J, GEORGE J, et al. MAFLD: a consensus-driven proposed nomenclature for metabolic associated fatty liver disease[J]. Gastroenterology, 2020, 158(7): 1999-2014. e1. doi: 10.1053/j.gastro.2019.11.312
[5]	LEE C O, LI H L, TSOI M F, et al. Association between the liver fat score (LFS) and cardiovascular diseases in the National Health and Nutrition Examination Survey 1999-2016[J]. Ann Med, 2021, 53(1): 1065-1073.
[6]	ZHAO Y, YU Y, LI H, et al. The association between metabolic syndrome and biochemical markers in Beijing adolescents[J]. Int J Environ Res Public Health, 2019, 16(22): 4557. doi: 10.3390/ijerph16224557
[7]	LANG R M, BIERIG M, DEVEREUX R B, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology[J]. J Am Soc of Echocardiogr, 2005, 18(12): 1440-1463. doi: 10.1016/j.echo.2005.10.005
[8]	DEVEREUX R B, ALONSO D R, LUTAS E M, et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings[J]. Am J Cardiol, 1986, 57(6): 450-458. doi: 10.1016/0002-9149(86)90771-X
[9]	DE SIMONE G, DANIELS S R, DEVEREUX R B, et al. Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight[J]. J Am Coll Cardiol, 1992, 20(5): 1251-1260. doi: 10.1016/0735-1097(92)90385-Z
[10]	中华人民共和国国家卫生健康委员会. 学龄儿童青少年超重与肥胖筛查: WS/T 586-2018[S]. 北京: 中国标准出版社, 2018. National Health Commission of the PRC. Screening for overweight and obesity among school-age children and adolescents: WS/T 586-2018[S]. Beijing: Standards Press of China, 2018. (in Chinese)
[11]	BUJANG M A, BAHARUM N. A simplified guide to determination of sample size requirements for estimating the value of intraclass correlation coefficient: a review[J]. Arch Orofac Sci, 2017, 12(1): 1-11.
[12]	WANG D D, LI Y, BHUPATHIRAJU S N, et al. Fruit and vegetable intake and mortality: results from 2 prospective cohort studies of US men and women and a Meta-analysis of 26 cohort studies[J]. Circulation, 2021, 143(17): 1642-1654. doi: 10.1161/CIRCULATIONAHA.120.048996
[13]	WHO. Global recommendations on physical activity for health[EB/OL]. (2024-06-26)[2024-07-22]. https://www.who.int/newsroom/fact-sheets/detail/physical/activity.
[14]	STRASBURGER V C. Preface, children, adolescents, and the media[J]. Pediatr Clin North Am, 2012, 59(3): Ⅺ.
[15]	YANG L, BOVET P, LIU Y, et al. Consumption of carbonated soft drinks among young adolescents aged 12 to 15 years in 53 low- and middle-income countries[J]. Am J Public Health, 2017, 107(7): 1095-1100. doi: 10.2105/AJPH.2017.303762
[16]	王明明, 张艳青, 张云飞, 等. 儿童期视屏时间与左心室肥厚的关系[J]. 中国儿童保健杂志, 2019, 27(11): 1167-1170. WANG M M, ZHANG Y Q, ZHANG Y F, et al. Association between screen time and left ventricular hypertrophy in childhood[J]. Chin J Child Health Care, 2019, 27(11): 1167-1170. (in Chinese)
[17]	SAITO Y, OKUMURA Y, NAGASHIMA K, et al. Low alanine aminotransferase levels are independently associated with mortality risk in patients with atrial fibrillation[J]. Sci Rep, 2022, 12(1): 12183. doi: 10.1038/s41598-022-16435-5
[18]	JOHANSEN M J, GADE J, STENDER S, et al. The effect of overweight and obesity on liver biochemical markers in children and adolescents[J]. J Clin Endocrinol Metab, 2020, 105(2): dgz010.
[19]	ZHU L, FANG Z, JIN Y, et al. Association between serum alanine and aspartate aminotransferase and blood pressure: a cross-sectional study of Chinese freshmen[J]. BMC Cardiovasc Disord, 2021, 21(1): 472.
[20]	LINGYU M, HONGGUANG L, MINGDONG Z, et al. Aminotransferases as causal factors for metabolic syndrome: a bidirectional Mendelian randomization study[J]. PLoS One, 2024, 19(4): e0302209.
[21]	HEISKANEN J S, ROUHONEN S, ROVIO S P, et al. Determinants of left ventricular diastolic function: the cardiovascular risk in young Finns study[J]. Echocardiography, 2019, 36(5): 854-861.
[22]	SIMONE G D, DEVEREUX R B, IZZO R, et al. Lack of reduction of left ventricular mass in treated hypertension: the strong heart study[J]. J Am Heart Assoc, 2013, 2(3): e000144.
[23]	SIMONE G D, DEVEREUX R B, CHINAIL M, et al. Sex differences in obesity-related changes in left ventricular morphology: the strong heart study[J]. J Hypertens, 2011, 29(7): 1431-1438.
[24]	朱曙光, 王连奎, 周福家, 等. 少年儿童心脏发育及功能指标的研究[J]. 中国学校卫生, 1995, 26(4): 259-260. ZHU S G, WANG L K, ZHOU F J, et al. Study on the indexes of heart development and function in children[J]. Chin J Sch Health, 1995, 26(4): 259-260. (in Chinese)
[25]	FAN J, WANG H, ZHANG Y, et al. Myocardial work alterations with progressive left ventricular hypertrophy in patients with hypertension[J]. J Clin Hypertens (Greenwich), 2024, 26(9): 1045-1053.
[26]	CAI A, LIU L, ZHOU D, et al. Obesity and risk of incident left ventricular hypertrophy in community-dwelling populations with hypertension: an observational study[J]. J Am Heart Assoc, 2024, 13(12): e033521.
[27]	KHAROD A M, RAMLOGAN S R, KUMAR S, et al. Childhood obesity increases left-ventricular mass irrespective of blood pressure status[J]. Pediatr Cardiol, 2014, 35(2): 353-360.