Zhongguo cuzhong zazhi (Feb 2023)
血清丙氨酸转氨酶与急性缺血性脑血管病临床结局的相关性研究 Correlation of Serum Alanine Aminotransferase with Clinical Outcomes in Acute Ischemic Cerebrovascular Disease
Abstract
目的 探索血清丙氨酸转氨酶（alanine aminotransferase，ALT）水平与急性缺血性脑血管病不良临床结局的关系。 方法 以中国国家卒中登记研究Ⅱ中丙氨酸转氨酶（alanine aminotransferase，ALT）水平<120 U/L的急性缺血性卒中或TIA患者为研究对象。随访研究对象的1年全因死亡、复发性卒中（包括缺血性卒中、脑出血及蛛网膜下腔出血）、复合终点事件和不良功能结局，其中复合终点事件包括复发性卒中和全因死亡，不良功能结局定义为mRS 3～6分。根据入组患者的血清ALT水平由低到高进行ALT五分位数分层（Q1～Q5），采用多因素logistic回归分析评估血清ALT水平与1年全因死亡、卒中复发、复合终点事件和不良功能结局的相关性。 结果 研究共纳入17 178例患者，平均年龄（64.8±11.9）岁，女性6368例（37.1%）。多因素logistic回归分析结果显示，相对于ALT最低五分位数患者，最高五分位数患者1年内全因死亡风险降低45%（OR 0.55，95%CI 0.43～0.70，P＜0.01）、卒中复发风险降低39%（OR 0.61，95%CI 0.45～0.83， P＜0.01）、复合终点事件风险降低38%（OR 0.62，95%CI 0.49～0.77，P＜0.01），不良功能结局风险降低33%（OR 0.67，95%CI 0.56～0.80，P＜0.01）。年龄、性别、糖尿病、血脂异常和饮酒对ALT与各结局指标之间的相关性无交互作用。 结论 血清ALT水平与AIS或TIA患者1年全因死亡率、卒中复发、复合终点事件和功能不良结局的风险呈负相关。 Abstract: Objective To investigate the correlation of serum alanine aminotransferase (ALT) level with poor clinical outcomes in acute ischemic stroke (AIS) or transient ischemic attack (TIA) patients. Methods Patients with AIS or TIA and having serum ALT level < 120 U/L from the China National Stroke RegistryⅡ(CNSRⅡ) were included in the current analysis.The clinical outcomes included recurrent stroke (including ischemic stroke, intracranial hemorrhage and subarachnoid hemorrhage), composite endpoint events, all-cause death and poor functional outcome within one year. Composite endpoint included recurrent stroke and all-cause death. Poor functional outcome was defined as a mRS score of 3-6. Multivariable logistic regression analysis was used to evaluate the correlation of serum ALT level with the risk of 1-year all-cause death, recurrent stroke, composite endpoint and poor functional outcome, according to the sex-specific quintile of serum ALT level. Results A total of 17 178 patients were included, with a mean age of 64.8±11.9 years old and 6368 females (37.1%). Compared with the lowest ALT (corresponding to the lowest serum ALT level), the adjusted odds ratio with 95% confidence interval of the highest quintile were 0.55 (0.43-0.70) for all-cause mortality (P＜0.01）, 0.61 (0.45-0.83) for recurrent stroke (P＜0.01）, 0.62 (0.49-0.77) for composite endpoint (P＜0.01）, and 0.67 (0.56-0.80) for poor functional outcome (P＜0.01）. There was no significant interaction of ALT with age, sex, diabetes, dyslipidemia and alcohol consumption for all outcomes. Conclusions The serum ALT level may be negatively correlated with the risk of 1-year all-cause mortality, recurrent stroke, and poor functional outcome in AIS or TIA patients.
Keywords
