目的：防治心血管疾病是職業醫學上重要的課題。近年越來越多研究顯示肝功能當中 的麩胺酸丙酮酸轉氨基酵素(alanine aminotransferase)ALT與心血管疾病風險有關聯。本研究 藉著分析醫院員工的體檢資料，找尋可能影響勞工心血管疾病風險的相關因子，並進一步 探討ALT與心血管疾病風險之間的相關性。 方法：此為橫斷性研究，收錄台灣北部某醫院員工年度健檢報告。心血管疾病風險以 佛萊明罕風險指數(Framingham risk score)估算。研究中以ALT數值大於36U/L定義為肝功能 偏高，將全體人員分為肝功能正常與偏高兩組別，以卡方檢定和獨立樣本T檢定來分析兩組 別間類別及連續變項的差異。最後再利用多項式羅吉斯回歸(multivariable logistic regression) 來分析肝功能與心血管疾病風險的關聯性。 結果：本研究共收錄849人，平均年齡43.3歲，男性佔39.9%。結果發現肝功能正常與 偏高兩族群之間血壓、身體質量指數、腰圍、佛萊明罕風險指數、血糖、膽固醇、三酸甘 油脂、尿酸等心血管疾病相關數值都有統計上顯著的差異。進一步以多變項回歸分析，發 現影響未來十年內心血管疾病風險的因素包含抽菸(OR=29.42, 95%CI 10.42-83.03, p<0.001) ， 高血壓(OR=3.56, 95%CI 1.44-8.82, p=0.01) 與肝功能偏高(OR=2.52, 95%CI 1.14-5.61, p=0.02)。 結論： 本研究顯示醫療人員肝功能偏高與心血管疾病風險有相關性。對於肝功能偏高 的勞工，醫師應提醒心血管疾病風險的相關衛教。

Background and Purpose: Alanine aminotransferase (ALT) is an enzyme found in the liver, heart, kidney and muscle. It is often refered as the liver function test. Elevated ALT usually indicates liver cell injury or cholestasis. Recent studies have shown association between elevated ALT and metabolic disorders and even risk of cardiovascular disease (CVD). However, studies determining whether ALT is associated with cardiovascular risk is inconclusive. Therefore, the aim of this study is to explore the relationship of ALT and CVD risk in hospital workers in northern Taiwan. Methods: This is a cross-sectional study, with enrollment of northern Taiwan hospital workers. We collected annual health checkup data, and divided workers into two groups, according to ALT levels. T-test and Chi-Square analysis were used to compare health risk difference between the two groups. Finally, multivariate logistic regression analysis was performed to establish the relationship between ALT level and CVD risk. Elevated ALT is determined as a level above 36 U/L and moderate- to-high CVD risk is determined as 10 year CVD risk over 10% using Framingham risk score. Results: A total of 849 hospital workers were included, 39.9% were male, and their average age was 43.3 years old. Body composition and biochemical lab data revealed that body mass index (BMI), waist circumference, systolic and diastolic blood pressure(SBP, DBP), creatinine, fasting plasma glucose(FPG), triglyceride (TG), total cholesterol(TC), high-density lipoprotein- cholesterol(HDL-C), low-density lipoprotein-cholesterol(LDL-C), uric acid, and Framingham risk score were significantly different between the two groups (p<0.05). Elevated ALT had a crude odds ratio of 3.2, 95% confidence interval (CI)=2.06-4.98, p<0.001 for moderate-to-high CVD risk. After adjusting confounding factors, elevated ALT still had an odds ratio of 2.52, 95% CI=1.14-5.61, p=0.02 for moderate-to-high CVD risk. Conclusion: In this study, the results showed that ALT is associated with health condition and cardiovascular disease risk. However, elevated ALT is not uncommon between employees. Therefore, we suggest that health-care givers emphasize the importance of correcting CVD risk factors in workers with elevated ALT.