| Objective:This study aimed to investigate the association between Systolic blood pressure(SBP),Diastolic blood pressure(DBP),body mass index(BMI)and alanine aminotransferase(ALT)in Chinese children with short stature at different growth hormone(GH)levels.Methods:A total of 1491 patients diagnosed with short stature in the Shandong Growth Disorders Cohort Follow-up Study were included in this study,and general data were collected and anthropometric and biochemical parameters were measured.All patients with short stature underwent growth hormone stimulation test to determine growth hormone peak levels,and all subjects were divided into three groups according to GH peak levels:GH peak<5ng/mL,5ng/mL ≤GH peak<10ng/mL and GH peak≥10ng/mL,and to analyze the correlation between SBP,DBP,BMI and ALT in children with short stature at different GH levels.Results:1.Serum ALT levels were significantly higher in the GH peak<5 ng/mL and 5 ng/mL ≤GH peak<10 ng/mL groups compared with the GH peak≥10 ng/mL group(P=0.001).SBP and body mass index standard deviation score(BMI SDS)increased significantly among the GH peak>10 ng/mL,5 ng/mL≤GH peak<10 ng/mL,and GH peak<5 ng/mL(P<0.05).There was no significant difference in DBP among the three groups(P>0.05).2.Patients with short stature were stratified according to GH peak levels,and univariate analysis of clinical indicators with blood ALT showed that:(1)In short stature patients with GH peak<5 ng/mL,SBP,DBP and BMI SDS were positively correlated with ALT(P<0.05).(2)In short stature patients with 5 ng/mL ≤GH peak<10 ng/mL,SBP was positively correlated with blood ALT(P<0.05),while DBP and BMI SDS were not significantly correlated with blood ALT(P>0.05).(3)In short stature patients with GH peak>10 ng/mL,there was no significant correlation between SBP,DBP,BMI SDS and blood ALT(P>0.05).3.In short stature patients,after adjusting the possible confounding factors,smooth curve fitting found that there was a non-linear relationship between SBP,BMI SDS and ALT.(1)Further analysis using threshold effects revealed that SBP was not correlated with ALT when SBP<115 mmHg(β-0.05,95%CI:-0.12,0.02,P=0.160),and was positively correlated with ALT when SBP≥115 mmHg(β0.23,95%CI.0.09,0.37,P=0.001).Stratified analysis according to GH peak levels showed that SBP was non-linearly related to blood ALT in two groups of short stature patients with GH peak<5 ng/mL and 5 ng/mL ≤GH peak<10 ng/mL.However,in the GH peak≥10 ng/mL group,the linear relationship between SBP and serum ALT level was not significant(P>0.05).(2)Further analysis using threshold effects found no correlation between BMI SDS and ALT when BMI SDS<0.2(β-0.33,95%CI:-1.13,0.47,P=0.22)and a positive correlation between BMI SDS and ALT when BMI SDS≥0.2(β2.00,95%CI:0.78,3.22,P=0.001).Stratified analysis based on GH peak levels revealed a nonlinear relationship between BMI SDS and ALT in short stature patients in the GH peak≥10 ng/mL group.There was no correlation between BMI SDS and serum ALT levels in the 5 ng/mL ≤GH peak<10 ng/mL group(P>0.05).There was a significant linear positive correlation between BMI SDS and ALT in the groups with GH peak<5 ng/mL(β 1.13,95%CI:0.26,2.01,P=0.011).4.After adjusting the possible confounding factors,multiple piecewise linear regression analysis showed that there was no significant relationship between DBP and blood ALT levels in patients with short stature(P>0.05).Stratified analysis of patients with short stature according to the peak level of GH showed that the results of the three groups were roughly the same as those of the total population.Conclusions:This study shows that in Chinese short stature children,the SBP,BMI and ALT of children in the low GH peak group were higher than those in the high GH peak group;SBP and BMI had significant positive correlation with blood ALT level in the low GH peak group.Therefore,we should pay attention to the risk factors of metabolic-related fatty liver disease in children with short stature and growth hormone deficiency,such as hypertension and obesity. |
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