血清丙氨酸氨基转移酶与代谢综合征的相关性

Correlation between Elevated Serum Alanine Aminotransferase and the Metabolic Syndrome

目的评价血清丙氨酸氨基转移酶(ALT)与代谢综合征(MS)的相关性。方法根据MS的组分数将351例患者分为MS1组、MS2组和MS3组;根据糖代谢情况分为正常糖耐量(NGT)组、空腹血糖受损(IFG)/糖耐量减低(IGT)组和糖尿病(T2DM)组,观察各组间ALT及AST/ALT比值的差异及其与MS的关系,并评价ALT升高对患MS的危险性。结果随着MS的进展,从MS1到MS3组,ALT逐渐升高,AST/ALT逐渐降低(P<0.01);MS3与MS1患者的ALT及AST/ALT比值间差异有统计学意义(P<0.01);MS3和MS2组仅AST/ALT比值间差异有统计学意义(P<0.05)。NGT组、IGT/IFG及T2DM组的ALT水平间差异有统计学意义(P=0.01),3组间AST/ALT比值逐渐降低,但差异无统计学意义(P>0.05)。其中T2DM组与NGT组相比ALT升高,差异有统计学意义(P<0.01)。ALT水平及AST/ALT比值与胰岛素抵抗指数(HOMA-IR)、空腹血浆真胰岛素及腰围存在相关性(P<0.01)。根据ALT水平进行四分位分组分析,四组Oddratio(95%可信区间)分别为0.325(0.115-0.915),1.805(1.368-2.382),1.982(1.562-2.515)和1.985(1.554-2.536),ALT水平较高的人群比ALT低的人群患MS的危险性相对较高。结论ALT升高与MS的发生、发展密切相关,对于MS高危人群需正确认识位于参考值范围上限附近的ALT水平。ALT水平与其他MS指标相结合有利于正确评价MS的进展情况。

Objective To evaluate the correlativity of elevated serum alanine aminotransferases （ALT） to metabolic syndrome （MS） in Chinese. Methods Totally 351 subjects were divided as MS1, MS2 and MS3 groups according to the number of components of the MS, and normal glucose tolerance （NGT） , impaired fasting glycaemia and impaired glucose tolerance （IFG/IGT） and type 2 diabetes mellitus （T2DM） groups according to the levels of serum glucose, respectively. The differences of ALT level and the aspartate amonotransferase （AST） /ALT ratio each group were investigated. And the relative risk of development of the MS due to the increase of ALT was estimated. Results The activity of ALT increased and AST/ALT ratio decreased with the progression of the MS from group MS1 to MS3 （ P 〈 0.01 ）. There were statistically significant differences in ALT activity and AST/ALT ratio between MS3 and MS1 （ P 〈0. 01 ）, while only in AST/ALT ratio between MS3 and MS2 （ P 〈0. 05）. There was statistically significant difference in ALT activity among NGT, IGT/IFG and T2DM groups （ P =0. 01 ）, AST/ALT ratio gradually decreased from group NGT to IGT/IFG and T2DM, but there was no significant difference （ P 〉 0. 05）. ALT activity of the T2DM group significantly elevated as compared with the NGT group （ P 〈0. 01 ）. ALT activity and AST/ALT ratio were closely correlated with the index of insulin resistance （ HOMA - IR） , fasting true insulin concentration and the waist circumference （ P 〈0. 01 ）. The odd ratios （95% confidence interval） were 0. 325 （0. 115 -0. 915） , 1. 805 （ 1. 368 -2. 382）, 1. 982 （ 1. 562 -2. 515） and 1. 985 （ 1. 554 -2. 536） respectively in the four groups divided according to quartiles of ALT level, the subjects with higher ALT level had higher risk of development of the MS compared with those with lower ALT level. Conclusion Elevated activity of ALT are closely correlated with the occurrence and development of the MS. The ALT level near to the upper limit of normal range for the subjects with higher risk needs to be reviewed. The condition of MS progression should be correctly evaluated according to the ALT level combined with other indexes of MS.