醫療從業人員肝功能異常盛行率與其相關危險因子之評估探討

Prevalence of abnormal liver function test and related risk factors in hospital employees

陳怡如(I-Ju Chen) ； 陳亮憲(Liang-Sien Chen) ； 徐樂天(Le-Tien Hsu) ； 陳英仁(Ying-Jen Chen) ； 陳昭源(Jau-Yuan Chen)

《中華職業醫學雜誌》 26卷3期 (2019/07) Pp. 175-183

摘要

目的：有許多研究顯示，麩胺酸丙酮酸轉氨基酵素（alanine aminotransferase，ALT）異常不只意味著肝臟疾病，同時也和不良生活習慣、代謝症候群、高血脂、高血壓、第二型糖尿病等疾病相關。本研究藉由分析醫療人員的體檢資料，了解ALT異常的盛行率，並找尋可能的危險因子。方法：此為一橫斷性研究，蒐集台灣北部某醫院員工的健檢資料。以ALT數值大於36U／L定義為肝功能異常，將所有員工分為肝功能正常和異常兩組，以獨立樣本T檢定和卡方檢定來分析比較兩組別的變項；以皮爾森相關係數來衡量ALT與變項間的線性關聯性；最後以多項式羅吉斯回歸（multivariable logistic regression）來分析危險因子對於ALT異常的相關性。結果：本研究共收錄1312人，平均年齡42.39歲，男性佔501位（38.19％）。結果發現ALT正常與異常兩組之身體質量指數（body mass index，BMI）、抽菸狀態、血壓、血脂肪、血糖等及相關慢性疾病比例皆有統計上顯著的差異。ALT和血壓、BMI、三酸甘油脂／高密度膽固醇（triglycerides／high-density lipoprotein，TG／HDL）、血糖等呈正相關性。以回歸分析發現影響ALT的因素包括BMI（OR＝1.20，95％CI1.14－1.25，p＜0.001）和TG／HDL（OR＝1.12，95％CI1.03－1.22，p＝0.01）。結論：本研究顯示醫療人員肝功能異常與抽菸、BMI、血壓、血脂肪、血糖、罹患相關慢性疾病等因子有相關性。對於肝功能異常的勞工，醫師除了評估肝臟問題以外，也需了解生活型態和危險因子，以達到更全面的健康管理。

關鍵字

肝功能異常 ； ALT異常 ； 盛行率 ； 危險因子 ； 醫療人員

並列摘要

Background and Purpose: Many studies had showed that abnormal alanine aminotransferase (ALT) not only represented liver diseases, but was also related to unhealthy lifestyles, decreased glucose tolerance, metabolic syndrome, hyperlipidemia, hypertension, and type 2 diabetes, etc. This study analyzes the health checkup data of hospital employees to find out the prevalence of abnormal ALT and to explore risk factors. Methods: This is a cross-sectional study, with enrollment of hospital employees in northern Taiwan and collection of their health checkup data. Abnormal liver function test was defined as ALT ＞36U/L, and all subjects were divided into 2 groups, the normal and the abnormal liver function group. T-test and Chi-Square analysis were used to compare the continuous and categorical variables between 2 groups. Pearson's correlation was performed to analyze the relationship between ALT and specific continuous variables. Finally, multivariate logistic regression analysis was used to establish the relationship between abnormal ALT and related risk factors. Results: Total 1312 hospital employees were included, with average age of 42.39 years old and male accounting for 38.19%. The results showed that body mass index (BMI), smoking status, blood pressure (BP), lipid profile, fasting plasma glucose (FPG), and prevalence of related diseases were significantly different between the two groups (p＜0.05). Analysis of correlation between ALT and BP, BMI, triglycerides/high-density lipoprotein (TG/HDL), FPG showed positive correlation. Through logistic regression analysis and after adjusting confounding factors, we revealed that abnormal ALT was associated with BMI (OR=1.20, 95% CI 1.14-1.25, p＜0.001) and TG/HDL (OR=1.12, 95% CI 1.03-1.22, p=0.01). Conclusion: This study showed that in hospital employees, abnormal liver function test is associated with smoking status, BMI, BP, lipid profile, FPG and related diseases. For employees with abnormal liver function test, in addition to assessing common liver diseases, physicians would also need to find out one's lifestyle and related risk factors to achieve more comprehensive health management.

並列關鍵字

abnormal liver function test ； abnormal ALT ； prevalence ； risk factors ； health care workers