2型糖尿病伴非酒精性脂肪肝患者丙氨酸转氨酶与动脉粥样硬化的关系

The relationship between ALT and atherosclerosis in Type 2 diabetic patients with non-alcoholic fatty liver

目的探讨2型糖尿病(T2DM)伴非酒精性脂肪肝(NAFLD)患者丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)与动脉粥样硬化(AS),代谢紊乱和炎症之间的关系。方法选择符合世界卫生组织(WHO)(1999年)糖尿病诊断标准的于2008年4月至12月内分泌科住院的T2DM患者121例为研究对象。根据肝脏B超结果分组,并发脂肪肝且ALT≥40U/L组40例、ALT<40U/L组45例,36例T2DM患者作为对照组。测定3组ALT、AST、体质量参数、血压、血脂、血糖、外周白细胞计数(WBC)水平,血清C反应蛋白(CRP)水平,并采用稳态模式(HOMA)评价胰岛素抵抗,颈部B超测定颈动脉内膜-中层厚度(IMT)。结果ALT及CRP3组间比较差异均有统计学意义,两者与IMT呈线性相关。结论ALT水平的升高与T2DM的心血管并发症关系密切,ALT升高的NAFLD患者肝内炎症程度严重,可作为预测动脉粥样硬化的独立危险因子。

Objective To explore the relationship between the alanine aminotransferase （ALT）, aspartate aminotransferase（AST） and the atherosclerosis（AS）, metabolic disorders or inflammation in type 2 diabetic patients with non-alcoholic fatty liver （nonalcoholic fatty liver disease, NAFLD）. Methods According to WHO （1999） diagnostic criteria for diabetes, we selected 121 cases of type 2 diabetes （from April to December, 2008）. According to the results of B type Ultrasound for liver, All of the cases are divided into three groups ： Diabetie patients with fatty liver whose ALT≥40 U/L as a group including 40 cases; Diabetic patients with fatty liver whose ALTO40 U/L as another group including 45 cases; 36 patients with type 2 diabetes as the control group. We measured the general clinical and biochemical indicators of of all cases, including ALT, AST, anthropometrie pa- rameters, blood pressure, blood lipids, blood glucose, peripheral white blood cell count （WBC） level and serum CRP levels. Then we used homeostasis model （HOMA） to evaluate insulin resistance, used neck B-ultrasound to measure the carotid artery intima--media thickness （IMT）. Results Among the three groups, there were statistically significant differences in ALT and CRP and both showed linear correlation with the IMT. Conclusion As an important indicator of evaluating liver function, the extent of levels of ALT is closely related to cardiovascular complications in type 2 diabetes. NAFLD patients with elevated ALT level have severe liver inflammation. ALT can be used as an independent risk factor to predict atherosclerosis.