丙氨酸转移酶升高的2型糖尿病患者伴有更多的心血管风险因素

Higher cardiovascular risks in type 2 diabetic patients with raised alanine aminotransferase

根据血丙氨酸转氨酶（ALT）水平将4 509例2型糖尿病患者分为A组（n=449,ALT增高）和B组（n=4 060,ALT正常）,ALT升高的患者为10%.与B组患者相比,A组患者相对年龄更轻[（48.5±11.3对55.7±11.4）岁,P＜0.01]、糖尿病病程更短[（36.8±45.0对56.2±58.8）个月,P＜0.01]、体重指数以及腰臀比更大[（27.7±3.9对25.8±3.4）kg/m2,P＜0.01;0.95±0.06对0.93±0.07,P＜0.01].两组之间的血压存在差别[收缩压（132±19对131±21）mm Hg,1 mm Hg=0.133 kPa,P=0.60;舒张压（78±10对75±10）mm Hg,P＜0.01].A组的空腹血糖[（9.04±2.91对8.63±3.05）mmol/L,P=0.008]、餐后血糖[（13.85±4.67对13.07±4.92）mmol/L,P=0.002]、HbA1C（8.11%±1.82%对7.74%±1.96%,P＜0.01）、空腹胰岛素[（10.59±7.31对7.97±7.18）mU/L,P＜0.01]和餐后胰岛素[（48.96±43.80对35.25±32.37）mU/L,P＜0.01]及稳态模型评估的胰岛素抵抗指数（HOMA-IR,4.11±2.85对3.00±2.92,P＜0.01）、甘油三酯[（2.77±2.50对2.19±2.99）mmoL/L,P＜0.01]明显增高,高密度脂蛋白胆固醇[HDL-C,（1.20±0.30对1.29±0.83）mmol/L,P=0.01]更低.Logistic回归分析说明,HbA1C、餐后胰岛素、HOMA-IR、尿酸和尿白蛋白与ALT水平正相关,HDL-C则为负相关.提示ALT增高的2型糖尿病患者发病年龄更轻,有更严重的胰岛素抵抗和更多的心血管危险因素.

According to the alanine aminotransferase （ALT）level, 4 509 patients were assigned into group A （n=449, with raised ALT）and group B （n=4 060, normal ALT）. Between the patients of group A and B, differences existed in age [（48.5 ± 11.3 vs 55.7 ± 11.4） years, P〈0.01], duration of diabetes [（ 36.8 ±45.0 vs 56.2±58.8 ） months, P〈0. 01], body mass index[BMI, （27.7±3.9 vs 25.8±3.4） kg/m2, P〈0.01], waist-tohip ratio （0.95±0.06 vs 0. 93±0.07, P〈0. 01 ）, diastolic blood pressure [（ 78± 10 vs 75± 10） mm Hg, 1 mm Hg=0. 133 kPa, P〈0. 01], fasting blood glucose [（9.04±2.91 vs 8.63 ±3.05 ） mmol/L, P = 0. 008], 2 h blood glucose after meal[（ 13.85±4.67 vs 13.07 ± 4. 92 ） mmol/L, P=0. 002], HbA1c（8. 11% ± 1.82% vs 7.74% ±1.96%, P〈0. 01 ）, fasting serum insulin[（ 10.59±7.31 vs 7.97±7.18） mU/L, P〈0. 01], postprandial insulin [（48.96±43.80 vs 35.25 ±32.37 ） mU/L, P〈0. 01], homeostasis model assessment for insulin resistance （ HOMA-IR, 4.11±-2.85 vs 3.00 ± 2.92, P〈 0. 01 ）、 triglycerides [（ 2.77 ± 2.50 vs 2. 19 ± 2.99 ） mmol/L, P〈0. 01], and high-density lipoprotein-cholesterol [HDL-C, （ 1.20 ± 0. 30 vs 1.29 ± 0. 83 ） mmol/L, P = 0. 01].Logistic regression analysis showed that HbA1C, postprandial insulin, and HOMA-IR, uric acid and urinary albumin were positively, and HDL-C negatively related with the ALT level. It suggests that raised ALT seems to be an index related to the clustering of cardiovascular risk factors, insulin resistance, and earlier onset of type 2 diabetes.