丙氨酸氨基转移酶高值与动脉粥样硬化形成危险因素的关系。
Association between high-normal levels of alanine aminotransferase and risk factors for atherogenesis.
机构信息
Division of Gastroenterology and Hepatology, Virginia Commonwealth University, Richmond, Virginia.
出版信息
Gastroenterology. 2013 Dec;145(6):1271-9.e1-3. doi: 10.1053/j.gastro.2013.08.036. Epub 2013 Aug 21.
BACKGROUND & AIMS: Liver disease has been associated with cardiovascular disorders, but little is known about the relationship between serum levels of alanine aminotransferase (ALT) and markers of atherogenesis. We investigated the relationship between low-normal and high-normal levels of ALT and an extended panel of cardiovascular risk factors among individuals with no known diseases in a primary care setting.
METHODS
We performed a retrospective analysis of data collected from 6442 asymptomatic patients at wellness visits to a primary care setting in central Virginia from 2010 through 2011. Serum levels of ALT were compared with levels of lipids and lipoproteins, as well as metabolic, inflammatory, and coagulation-related factors associated with risk for cardiovascular disease.
RESULTS
Serum levels of ALT were higher than 40 IU/L in 12% of subjects, and in the high-normal range (19-40 IU/L in women and 31-40 IU/L in men) in 25% of subjects. ALT level was associated with the apolipoprotein B level, concentration and particle size of very-low-density lipoproteins, concentration of low-density lipoprotein (LDL) particles (LDL-P), and percentages of small dense LDL (sdLDL) and sdLDL-cholesterol (sdLDL-C) (P < .0001 for all). A high-normal level of ALT was associated with higher levels of LDL-C, LDL-P, sdLDL-C, and sdLDL particles (P < .001 for all). These effects were independent of age, body mass index, and hyperinsulinemia. Increasing levels of ALT and fasting hyperinsulinemia (>12 μU/mL) synergized with increasing levels of triglycerides, very-low-density lipoprotein particles, LDL-P, sdLDL-C, and percentage of sdLDL-C. Levels of APOA1, high-density lipoprotein-cholesterol, and high-density lipoprotein-class 2 were associated inversely with serum level of ALT (P < .0001 for all).
CONCLUSIONS
In an analysis of asymptomatic individuals, increased serum levels of ALT (even high-normal levels) are associated with markers of cardiovascular disease.
背景与目的
肝脏疾病与心血管疾病有关，但对于丙氨酸氨基转移酶（ALT）血清水平与动脉粥样硬化形成标志物之间的关系知之甚少。我们在弗吉尼亚州中部的一个初级保健机构中，在没有已知疾病的个体中，研究了低正常值和高正常值 ALT 与一系列心血管危险因素之间的关系。
方法
我们对 2010 年至 2011 年期间在弗吉尼亚州中部一家初级保健机构进行健康检查的 6442 名无症状患者的数据进行了回顾性分析。将血清 ALT 水平与血脂和脂蛋白水平以及与心血管疾病风险相关的代谢、炎症和凝血相关因素进行了比较。
结果
12%的受试者血清 ALT 水平超过 40IU/L，25%的受试者 ALT 水平处于高正常值范围（女性 19-40IU/L，男性 31-40IU/L）。ALT 水平与载脂蛋白 B 水平、极低密度脂蛋白的浓度和颗粒大小、低密度脂蛋白（LDL）颗粒浓度（LDL-P）以及小而密 LDL（sdLDL）和 sdLDL 胆固醇（sdLDL-C）的百分比（所有 P<.0001）相关。高正常值 ALT 与 LDL-C、LDL-P、sdLDL-C 和 sdLDL 颗粒水平升高相关（所有 P<.001）。这些作用独立于年龄、体重指数和高胰岛素血症。ALT 和空腹高胰岛素血症（>12μU/mL）水平升高与甘油三酯、极低密度脂蛋白颗粒、LDL-P、sdLDL-C 和 sdLDL-C 百分比升高协同作用。APOA1、高密度脂蛋白胆固醇和高密度脂蛋白 2 类与 ALT 血清水平呈负相关（所有 P<.0001）。
结论
在对无症状个体的分析中，血清 ALT 水平升高（即使是高正常值）与心血管疾病标志物相关。
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