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Article(id=1325521378635559907, tenantId=1146029695717560320, journalId=1256213402557890569, issueId=1325521023759691810, articleNumber=null, orderNo=null, doi=10.16835/j.cnki.1000-9817.2025193, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1746547200000, receivedDateStr=2025-05-07, revisedDate=1750089600000, revisedDateStr=2025-06-17, acceptedDate=null, acceptedDateStr=null, onlineDate=1793958523662, onlineDateStr=2026-11-06, pubDate=1753372800000, pubDateStr=2025-07-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793958523662, onlineIssueDateStr=2026-11-06, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793958523662, creator=13701087609, updateTime=1793958523662, updator=13701087609, issue=Issue{id=1325521023759691810, tenantId=1146029695717560320, journalId=1256213402557890569, year='2025', volume='46', issue='7', pageStart='913', pageEnd='1064', issueExtLink='null', onlineDate='null', pubDate='1753372800000', pubDateStr='2025-07-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793958439054, creator='13701087609', updateTime=1793958439054, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=1042, endPage=1045, ext={EN=ArticleExt(id=1325521381101810660, articleId=1325521378635559907, tenantId=1146029695717560320, journalId=1256213402557890569, language=EN, title=Association between serum alanine transaminase levels and carotid intima-media thickness in adolescents, columnId=1325500884406379444, journalTitle=Chinese Journal of School Health, columnName=Disease Control, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the relationship between serum alanine transaminase (ALT) and carotid intima-media thickness (cIMT) in adolescents, providing evidence for early prevention and control strategies for cardiovascular structural abnormalities in adolescents.

Methods

Data were obtained from the third follow-up survey (from October to November 2023) of the "Huantai Children Cardiovascular Health Cohort", including 1 153 healthy adolescents with complete information. Analysis of variance (ANOVA) was used to compare cIMT across different ALT level groups, and multiple linear regression was employed to analyze the relationship between serum ALT levels and cIMT.

Results

Significant differences in cIMT were observed among Q1, Q2, and Q3 ALT level groups [(0.56±0.04) (0.57±0.04) (0.59±0.04)mm, respectively; F=3.61, P < 0.01]. After adjusting for covariates, multiple linear regression revealed a positive correlation between ALT levels and cIMT (β=0.18, P < 0.01). Gender subgroup analysis showed similar results in males (β=0.19, P < 0.01), but no statistically significant association was found in females (β=0.07, P=0.54).

Conclusions

Elevated serum ALT levels are associated with an increased risk of vascular structural damage in adolescents, especially in boys. Early detection and control of abnormal serum ALT levels can help to reduce early vascular structural damage and further reduce the risk of adverse cardiovascular events.

, authors=Sisi HUANG1, Min ZHAO2, Jiahong SUN*, 3, Bo XI*, 1, authorsList=Sisi HUANG, Min ZHAO, Jiahong SUN, Bo XI, authorCompany=null, correspAuthors=Jiahong SUN, Bo XI, authorNote=null, correspAuthorsNote=null, copyrightStatement=Copyright ©2025 Chinese Journal of School Health. All rights reserved., copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1325521383630975973, articleId=1325521378635559907, tenantId=1146029695717560320, journalId=1256213402557890569, language=CN, title=青少年血清谷丙转氨酶水平与颈动脉内中膜厚度的关联, columnId=1325500884628677558, journalTitle=中国学校卫生, columnName=疾病控制, runingTitle=null, highlight=null, articleAbstract=
目的

探讨青少年血清谷丙转氨酶(ALT)水平与颈动脉内中膜厚度(cIMT)的关系，为制定青少年心血管结构异常的早期防控策略提供依据。

方法

数据源于2023年10—11月开展的“桓台儿童心血管健康队列”第3次随访调查数据，共纳入1 153名具有完整信息的健康青少年。采用方差分析比较不同ALT水平组青少年的cIMT，采用多元线性回归分析血清ALT水平与cIMT的关系。

结果

Q1，Q2，Q3 ALT水平组青少年的cIMT[(0.56±0.04)(0.57±0.04)(0.59±0.04)mm]差异有统计学意义(F=3.61，P < 0.01)。调整相关协变量后，多元线性回归分析结果显示，ALT水平与cIMT存在正相关(β=0.18，P < 0.01)。性别亚组分析结果显示，男生与总体结果相似(β=0.19，P < 0.01)，而女生中关联无统计学意义(β=0.07，P=0.54)。

结论

青少年血清ALT水平升高会增加血管结构损害的风险，在男生中尤为明显。及早发现并控制血清异常ALT水平有助于减少早期血管结构损害，降低不良心血管事件的发生风险。

, authors=黄思思1, 赵敏2, 孙嘉鸿*, 3, 席波*, 1, authorsList=黄思思, 赵敏, 孙嘉鸿, 席波, authorCompany=null, correspAuthors=孙嘉鸿, 席波, authorNote=

黄思思(2000-)，女，安徽淮北人，在读硕士，主要研究方向为儿童心血管健康

, correspAuthorsNote=
孙嘉鸿，E-mail：
席波，E-mail：
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Atherosclerosis, 2016, 254: 42-51., articleTitle=null, refAbstract=null)], funds=[Fund(id=1325521412672335895, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521378635559907, awardId=null, language=CN, fundingSource=国家自然科学基金项目(81673195，82173538，82204066)；山东省自然科学基金青年基金项目(ZR20210H272), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1325521386235638758, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521378635559907, xref=1, ext=[AuthorCompanyExt(id=1325521386285970407, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521378635559907, companyId=1325521386235638758, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1Department of Epidemiology/Maternal and Child Health/Children's Cardiovascular Research Centre, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China), AuthorCompanyExt(id=1325521386604737512, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521378635559907, companyId=1325521386235638758, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=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/儿童心血管研究中心，济南 250012)]), AuthorCompany(id=1325521387451986921, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521378635559907, xref=2, ext=[AuthorCompanyExt(id=1325521387506512874, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521378635559907, companyId=1325521387451986921, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2山东大学齐鲁医学院公共卫生学院营养与食品卫生学系)]), AuthorCompany(id=1325521387837862891, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521378635559907, xref=3, ext=[AuthorCompanyExt(id=1325521387863028716, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521378635559907, companyId=1325521387837862891, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3广东医科大学公共卫生学院预防医学系)])], figs=[ArticleFig(id=1325521404204036111, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521378635559907, language=EN, label=Tab.1, caption=

Comparison of basic characteristics of students in different genders(x±s)

, figureFileSmall=null, figureFileBig=null, tableContent=
性别人数年龄/岁身高/cm体重/kgBMI/(kg·m-2)SBP/mmHgDBP/mmHgcIMT/mmALT/(U·L-1)每日睡眠时间/h
男60314.1±1.5171.1±8.767.5±17.122.9±4.9121.4±12.161.6±7.50.58±0.0419.6±15.27.4±1.3
女55014.2±1.5162.4±5.658.1±13.022.0±4.4110.8±10.361.5±7.10.56±0.0413.4±7.77.3±0.9
总计1 15314.1±1.5167.0±8.563.0±16.022.4±4.7116.4±12.561.6±7.30.57±0.0416.6±12.67.4±1.1
t值-0.4520.4510.563.4116.000.139.828.810.98
P值0.65< 0.01< 0.01< 0.01< 0.010.90< 0.01< 0.010.33
), ArticleFig(id=1325521404594106384, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521378635559907, language=CN, label=表1, caption=

不同性别学生基本特征比较(x±s)

, figureFileSmall=null, figureFileBig=null, tableContent=
性别人数年龄/岁身高/cm体重/kgBMI/(kg·m-2)SBP/mmHgDBP/mmHgcIMT/mmALT/(U·L-1)每日睡眠时间/h
男60314.1±1.5171.1±8.767.5±17.122.9±4.9121.4±12.161.6±7.50.58±0.0419.6±15.27.4±1.3
女55014.2±1.5162.4±5.658.1±13.022.0±4.4110.8±10.361.5±7.10.56±0.0413.4±7.77.3±0.9
总计1 15314.1±1.5167.0±8.563.0±16.022.4±4.7116.4±12.561.6±7.30.57±0.0416.6±12.67.4±1.1
t值-0.4520.4510.563.4116.000.139.828.810.98
P值0.65< 0.01< 0.01< 0.01< 0.010.90< 0.01< 0.010.33
), ArticleFig(id=1325521404988370961, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521378635559907, language=EN, label=Tab.2, caption=

Report of demographic basic characteristics of students in different genders

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性别人数超重肥胖视屏时间≥2 h/d体力活动不足蔬菜摄入不足水果摄入不足每周含糖饮料摄入≥1次父亲过去或现在饮酒母亲过去或现在饮酒
男603287(47.6)98(16.2)174(28.9)551(91.4)567(94.0)155(25.7)534(88.6)218(36.2)
女550185(33.6)66(12.0)273(49.6)529(96.2)531(96.6)88(16.0)480(87.3)234(42.5)
总计1 153472(40.9)164(14.2)447(38.7)1 080(93.7)1 098(95.2)243(21.1)1 014(87.9)452(39.2)
χ2值22.613.9251.4510.403.4715.710.334.67
P值< 0.010.05< 0.01< 0.010.06< 0.010.560.03
), ArticleFig(id=1325521406678675474, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521378635559907, language=CN, label=表2, caption=

不同性别学生人口学特征报告率情况

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性别人数超重肥胖视屏时间≥2 h/d体力活动不足蔬菜摄入不足水果摄入不足每周含糖饮料摄入≥1次父亲过去或现在饮酒母亲过去或现在饮酒
男603287(47.6)98(16.2)174(28.9)551(91.4)567(94.0)155(25.7)534(88.6)218(36.2)
女550185(33.6)66(12.0)273(49.6)529(96.2)531(96.6)88(16.0)480(87.3)234(42.5)
总计1 153472(40.9)164(14.2)447(38.7)1 080(93.7)1 098(95.2)243(21.1)1 014(87.9)452(39.2)
χ2值22.613.9251.4510.403.4715.710.334.67
P值< 0.010.05< 0.01< 0.010.06< 0.010.560.03
), ArticleFig(id=1325521407135854611, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521378635559907, language=EN, label=Tab.3, caption=

Comparison of cIMT levels in adolescents among different ALT groups/mm

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ALT分组男生女生总体
人数x±s人数x±s人数x±s
Q12040.57±0.041850.56±0.043890.56±0.04
Q21990.57±0.041820.56±0.043810.57±0.04
Q32000.59±0.04ab1830.57±0.04a3830.59±0.04ab
F值47.6323.443.61
P值< 0.01< 0.010.03
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不同ALT组间青少年cIMT水平比较/mm

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ALT分组男生女生总体
人数x±s人数x±s人数x±s
Q12040.57±0.041850.56±0.043890.56±0.04
Q21990.57±0.041820.56±0.043810.57±0.04
Q32000.59±0.04ab1830.57±0.04a3830.59±0.04ab
F值47.6323.443.61
P值< 0.01< 0.010.03
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Multiple linear regression analysis of the association between serum ALT levels and cIMT in adolescents

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性别模型1模型2模型3
β值标准误P值β值标准误P值β值标准误P值
男(n=603)0.480.07< 0.010.230.07< 0.010.190.07< 0.01
女(n=550)0.420.12< 0.010.110.120.340.070.120.54
总体(n=1 153)0.470.06< 0.010.220.06< 0.010.180.05< 0.01
), ArticleFig(id=1325521409677602838, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521378635559907, language=CN, label=表4, caption=

青少年血清ALT水平与cIMT关联的多元线性回归分析

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性别模型1模型2模型3
β值标准误P值β值标准误P值β值标准误P值
男(n=603)0.480.07< 0.010.230.07< 0.010.190.07< 0.01
女(n=550)0.420.12< 0.010.110.120.340.070.120.54
总体(n=1 153)0.470.06< 0.010.220.06< 0.010.180.05< 0.01
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青少年血清谷丙转氨酶水平与颈动脉内中膜厚度的关联
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黄思思 1 , 赵敏 2 , 孙嘉鸿 *, 3 , 席波 *, 1
中国学校卫生 | 疾病控制 2025,46(7): 1042-1045
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中国学校卫生 |疾病控制 2025 , 46 (7) : 1042 -1045
青少年血清谷丙转氨酶水平与颈动脉内中膜厚度的关联
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黄思思1, 赵敏2, 孙嘉鸿*, 3 , 席波*, 1
作者信息
  • 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/儿童心血管研究中心，济南 250012
  • 2山东大学齐鲁医学院公共卫生学院营养与食品卫生学系
  • 3广东医科大学公共卫生学院预防医学系
通讯作者:
孙嘉鸿，E-mail：
席波，E-mail：
作者简介:

黄思思(2000-)，女，安徽淮北人，在读硕士，主要研究方向为儿童心血管健康

Association between serum alanine transaminase levels and carotid intima-media thickness in adolescents
Sisi HUANG1, Min ZHAO2, Jiahong SUN*, 3 , Bo XI*, 1
Affiliations
  • 1Department of Epidemiology/Maternal and Child Health/Children's Cardiovascular Research Centre, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China
出版时间: 2025-07-25 doi: 10.16835/j.cnki.1000-9817.2025193
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摘要
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目的

探讨青少年血清谷丙转氨酶(ALT)水平与颈动脉内中膜厚度(cIMT)的关系，为制定青少年心血管结构异常的早期防控策略提供依据。

方法

数据源于2023年10—11月开展的“桓台儿童心血管健康队列”第3次随访调查数据，共纳入1 153名具有完整信息的健康青少年。采用方差分析比较不同ALT水平组青少年的cIMT，采用多元线性回归分析血清ALT水平与cIMT的关系。

结果

Q1，Q2，Q3 ALT水平组青少年的cIMT[(0.56±0.04)(0.57±0.04)(0.59±0.04)mm]差异有统计学意义(F=3.61，P < 0.01)。调整相关协变量后，多元线性回归分析结果显示，ALT水平与cIMT存在正相关(β=0.18，P < 0.01)。性别亚组分析结果显示，男生与总体结果相似(β=0.19，P < 0.01)，而女生中关联无统计学意义(β=0.07，P=0.54)。

结论

青少年血清ALT水平升高会增加血管结构损害的风险，在男生中尤为明显。及早发现并控制血清异常ALT水平有助于减少早期血管结构损害，降低不良心血管事件的发生风险。

谷氨酸转氨酶  /  颈动脉  /  血管中膜  /  回归分析  /  青少年
Objective

To investigate the relationship between serum alanine transaminase (ALT) and carotid intima-media thickness (cIMT) in adolescents, providing evidence for early prevention and control strategies for cardiovascular structural abnormalities in adolescents.

Methods

Data were obtained from the third follow-up survey (from October to November 2023) of the "Huantai Children Cardiovascular Health Cohort", including 1 153 healthy adolescents with complete information. Analysis of variance (ANOVA) was used to compare cIMT across different ALT level groups, and multiple linear regression was employed to analyze the relationship between serum ALT levels and cIMT.

Results

Significant differences in cIMT were observed among Q1, Q2, and Q3 ALT level groups [(0.56±0.04) (0.57±0.04) (0.59±0.04)mm, respectively; F=3.61, P < 0.01]. After adjusting for covariates, multiple linear regression revealed a positive correlation between ALT levels and cIMT (β=0.18, P < 0.01). Gender subgroup analysis showed similar results in males (β=0.19, P < 0.01), but no statistically significant association was found in females (β=0.07, P=0.54).

Conclusions

Elevated serum ALT levels are associated with an increased risk of vascular structural damage in adolescents, especially in boys. Early detection and control of abnormal serum ALT levels can help to reduce early vascular structural damage and further reduce the risk of adverse cardiovascular events.

Alanine transaminase  /  Carotid arteries  /  Tunica media  /  Regression analysis  /  Adolescent
黄思思, 赵敏, 孙嘉鸿, 席波. 青少年血清谷丙转氨酶水平与颈动脉内中膜厚度的关联. 中国学校卫生, 2025 , 46 (7) : 1042 -1045 . DOI: 10.16835/j.cnki.1000-9817.2025193
Sisi HUANG, Min ZHAO, Jiahong SUN, Bo XI. Association between serum alanine transaminase levels and carotid intima-media thickness in adolescents[J]. Chinese Journal of School Health, 2025 , 46 (7) : 1042 -1045 . DOI: 10.16835/j.cnki.1000-9817.2025193
正文
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谷丙转氨酶(alanine transaminase，ALT)是评估肝脏功能的常用生化指标，其水平升高是肝脏损伤的重要标志，与肝脏脂肪累积密切相关[1]。近年来，越来越多的研究表明肝脏功能与心血管健康密切相关，肝脏代谢异常可导致糖和脂质代谢紊乱，诱发胰岛素抵抗和代谢综合征，同时加剧氧化应激过程并促进动脉粥样硬化的发生发展，进而增加不良心血管事件的发生风险[2-3]。颈动脉内中膜厚度(carotid intima-media thickness，cIMT)作为亚临床动脉粥样硬化的敏感指标，能够有效反映儿童期血管结构的早期损伤[4]，且对远期心血管及死亡事件具有独立预测价值[5-6]。目前关于青少年血清ALT水平与早期动脉粥样硬化之间的关系仍存在争议。印度的一项横断面研究发现，超重肥胖儿童的血清ALT中位水平与cIMT呈正相关[7]。而另一项来自荷兰的横断面研究显示，儿童青少年ALT升高与cIMT增厚和动脉壁硬度之间未见关联[8]。本研究旨在进一步探讨ALT水平与颈动脉内中膜厚度之间的关系，揭示肝脏代谢健康在心血管疾病早期预防中的潜在重要性，为科学制定青少年心血管结构异常的早期防控策略，有效降低青少年群体心血管疾病的发生风险提供依据。
1　对象与方法
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1.1　对象
数据来源于2023年10—11月开展的“桓台儿童心血管健康队列”第3次随访调查数据[9]，共收集到1 200名12~17岁青少年的随访信息，排除超声显示肝脏异常者，血清ALT、cIMT和相应协变量存在缺失的受访者后，最终共纳入1 153名体检数据完整的健康学生进行统计分析。其中男生603名，女生550名，平均年龄(14.1±1.5)岁。本研究通过山东大学公共卫生学院伦理委员会批准(批号：20160308)。所有调查均获得受试者本人及其父母或其他监护人的知情同意。
1.2　方法
1.2.1　问卷调查
采用自制标准化调查问卷，收集受试对象的性别、年龄、电子设备视屏时间、低中高身体活动水平、每日睡眠时间、膳食习惯(食用蔬菜水果、饮用含糖饮料的频率)和父/母饮酒状况等信息。将研究对象的视屏时间分为 < 2和≥2 h/d[10]；根据每天低强度、中等强度和高强度活动时间之和，将体力活动水平分为不足(< 1 h/d)和适宜(≥1 h/d)[11]；蔬菜和水果摄入频率分为不足(< 5次/周)和适宜(≥5次/周)[12]；含糖饮料摄入频率分为 < 1和≥1次/周[13]；由于父母饮酒行为与子代饮酒行为存在较强的关联性[14]，本研究采用“父/母亲是否饮酒?”问题评估父/母亲的饮酒状况，并将其分为“从未饮酒”和“过去或现在饮酒”，以控制饮酒行为对血清ALT水平的非特异性影响。
1.2.2　身体测量
(1) 身高和体重：使用HGM-300型身高体重仪测量受试者的身高和体重。测量时脱去鞋帽和外套，双脚自然分开，保持身体直立，眼睛平视前方，待仪器示数稳定后进行测量，身高和体重分别精确至0.1 cm和0.1 kg，连续测量2次后取平均值作为受试对象身高和体重的最终测量值，并计算体质量指数(body mass index，BMI)=体重(kg)/[身高(m)]2。(2)血压：使用经校准后的欧姆龙电子血压计(型号为HBP-1300)测量受试者的收缩压(systolic blood pressure，SBP)和舒张压(diastolic blood pressure，DBP)。测量时要求受试对象双脚并拢平放在地上，保持平静呼吸。每名受试对象连续测量3次，且任意2次之间的测量结果相差不得超过10 mmHg(1 mmHg=0.133 kpa)，若超过该范围需暂停重新测量，直至结果符合要求，取后2次测量值的平均值作为最终血压值。(3)cIMT：采用飞利浦CX30型彩色多普勒超声诊断仪测量cIMT。测量时，受试者取仰卧位，头向后微仰并向对侧偏转约45°，充分暴露颈前侧，保持平稳呼吸，避免吞咽与讲话。由超声医生使用4-12 MHz线阵探头，分别测量受试者左右两侧颈总动脉窦近端前、后壁的内中膜厚度，取4次测量的平均值作为受试者的cIMT值，数据精确至0.01 mm。
1.2.3　血生化检测
受试者禁食10 h后，于第2天清晨由护士采集5 mL空腹静脉血，离心半径13.5 cm，转速3 000 r/min，离心15 min，经离心分装后放置-80℃冰箱保存。采用AU480型全自动生化分析仪进行血样检测，采用丙氨酸底物法测量研究对象血清ALT水平。
1.2.4　分类标准
参照《学龄儿童青少年超重与肥胖筛查》(WS/T 586—2018)标准[15]，将BMI小于相应性别、年龄别对应的超重界值定义为正常体重，大于等于相应性别、年龄别对应的超重界值定义为超重肥胖。参照既往文献[16]，本研究将血清ALT水平按照三分位数进行分组(Q1~Q3)。
1.3　质量控制
调研开始前，所有调查员均通过严格的标准化培训和考核。调研过程中对回收的调查问卷多次进行逻辑核查，并随机抽取13名学生在1周后重复填写问卷，结果表明膳食情况调查条目一致性良好(Kappa值>0.8)。为确保测量结果的准确性和可靠性，所有测量仪器均经校准后统一使用。调查数据使用EpiData 3.1软件进行双人双录入，并进行一致性检验。
1.4　统计学分析
使用R 4.3.3统计软件对数据进行整理分析。分类变量采用频数和率表示，组间差异比较采用χ2检验；使用Quantile-Quantile plot对连续变量进行正态性检验，符合正态分布的数据用(x±s)表示，组间比较采用独立样本t检验。采用单因素方差分析比较不同ALT水平组间青少年cIMT，组间两两比较采用Tukey's Honestly Significant Difference显著性差异检验法。调整性别、年龄、体重状态、每日睡眠时间、体力活动水平、视屏时间、含糖饮料摄入、蔬菜水果摄入、父/母饮酒状况、SBP和DBP等各种潜在协变量，采用多元线性回归模型分析ALT水平与cIMT的关联，并按性别分层进行亚组分析。P < 0.05为差异有统计学意义。
2　结果
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2.1　研究对象基本特征
男、女生在身高、体重、BMI、SBP、cIMT、ALT、超重肥胖、适宜体力活动、适宜摄入蔬菜、母亲饮酒等指标差异均有统计学意义(P值均 < 0.05)。见表1~2。
2.2　不同ALT水平分性别青少年cIMT的比较
调查对象平均cIMT为(0.57±0.04)mm，男生为(0.58±0.04)mm，女生为(0.56±0.04)mm。不同ALT组间的cIMT水平差异有统计学意义，且Q3组均大于Q2和Q1组(P值均 < 0.01)。按性别进行分层分析，结果与总体相似。见表3。
2.3　青少年ALT水平与cIMT的关联
见表4。
调整性别、年龄、体重状态、每日睡眠时间、体力活动水平、视屏时间、含糖饮料摄入、蔬菜水果摄入、父/母饮酒状况、SBP和DBP后，多元线性回归分析结果显示，ALT水平与颈动脉内中膜厚度呈正相关(P < 0.01)。按性别亚组分析显示，仅男生血清ALT水平与cIMT呈正相关(P < 0.01)，
3　讨论
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本研究结果显示，青少年高血清ALT水平与较高的cIMT相关，在男生中有统计学意义。目前关于青少年血清ALT水平与cIMT的关联研究结论不一，一项纳入109名9~15岁土耳其儿童青少年的病例对照研究发现，cIMT与肝脏脂肪变性分级和血清ALT水平相关[17]；而另一项来自荷兰的横断面研究显示，在儿童青少年中未发现cIMT与ALT之间的关联[18]。以往研究多关注血清ALT水平与心血管代谢危险因素的关联，如丹麦一项纳入2 155名6~18岁儿童青少年的队列研究结果显示，血清ALT浓度升高的儿童青少年发生超重肥胖的风险增加[19]，而超重肥胖与儿童青少年cIMT增厚以及其他心血管结构改变密切相关[20-21]。一项纳入5 586名12~19岁青少年的美国国家健康与营养调查第三期(National Health and Nutrition Examination Survey III，NHANES-III)结果显示，ALT水平与BMI、腰围和胰岛素抵抗之间存在正相关[22]，提示心血管风险增加的潜在可能性。意大利一项纳入803名10~16岁青少年的病例对照研究显示，ALT水平升高的青少年更易出现胰岛素抵抗和血脂异常，如甘油三酯、总胆固醇和低密度脂蛋白胆固醇水平升高[23]。本研究发现，青少年ALT水平与cIMT呈正相关，提示青少年中ALT水平可能与早期动脉粥样硬化进程相关，强调了监测青少年血清ALT水平的重要性。
本研究中观察到的性别差异，与欧洲一项针对10~18岁青少年的横断面研究结果一致[24]，该研究表明，仅在男生中发现ALT与血压、胰岛素抵抗和血脂存在关联；另外一项对中国11 573名35岁及以上农村人群的横断面研究显示，仅在男性中发现血清ALT水平升高与心血管代谢危险因素存在关联[25]。男女差异可能与性别之间激素水平的不同有关，有研究表明女性雌激素对心血管系统具有保护效应，主要表现在延缓冠状动脉粥样硬化的进展、增强内皮依赖性舒张功能以及调节血管平滑肌张力等[26]。
关于血清ALT与cIMT增厚关联可能的生物学机制包括内皮功能障碍、系统性氧化应激、炎症反应、胰岛素抵抗以及线粒体氧化损伤等[27-28]。ALT水平升高与肝脏脂肪变性及促炎细胞因子的产生密切相关，这些改变可增强免疫细胞募集，促进胰岛素抵抗，激活炎症通路和氧化应激反应，继而导致内皮功能障碍，降低一氧化氮生物利用度，使血管内皮抗动脉粥样硬化特性丧失和舒张功能受损[29]。此外，脂肪酸摄入和合成增加会导致肝细胞内甘油三酯超载增生长链脂酰辅酶A，为非氧化代谢途径及有毒代谢物形成提供底物，导致线粒体功能障碍和活性氧产生，在促炎症环境中进一步增加致动脉粥样硬化刺激[30]。
尽管本研究结果显示ALT水平与cIMT之间存在正相关关系，并表明“肝-心-血管轴”在心血管结构重塑中发挥着重要作用。然而，仍需注意的是，作为肝细胞损伤的血清学标志物，ALT水平升高可能提示潜在的代谢异常，如非酒精性脂肪性肝病、胰岛素抵抗，这些都是动脉粥样硬化的重要危险因素[31-32]。因此，ALT更可能是心血管代谢紊乱的伴随生物标志物，而非介导血管结构改变的直接驱动因子。
本研究仍有以下局限性：第一，横断面调查无法验证血清ALT水平与cIMT之间的因果关系；第二，调查对象仅来自该地区1所学校，样本的代表性有限，影响结果的外推性；第三，研究样本量仅1 153名，统计效能偏低。在今后的研究中需要扩大样本量，采用前瞻性队列研究设计结合因果推断方法，进一步探讨和验证儿童青少年血清ALT水平对远期血管结构损害的影响。
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  • 国家自然科学基金项目(81673195，82173538，82204066)；山东省自然科学基金青年基金项目(ZR20210H272)
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2025年第46卷第7期
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doi: 10.16835/j.cnki.1000-9817.2025193
  • 接收时间：2025-05-07
  • 首发时间：2026-11-06
  • 出版时间：2025-07-25
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  • 收稿日期：2025-05-07
  • 修回日期：2025-06-17
基金
国家自然科学基金项目(81673195，82173538，82204066)；山东省自然科学基金青年基金项目(ZR20210H272)
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    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/儿童心血管研究中心，济南 250012
    2山东大学齐鲁医学院公共卫生学院营养与食品卫生学系
    3广东医科大学公共卫生学院预防医学系

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