糖尿病高危人群血清丙氨酸氨基转移酶水平变化及其与糖尿病发病的相关性研究

Association between Serum Alanine Aminotransferase Level and Diabetes Mellitus in High-risk Population

目的探讨糖尿病高危人群血清丙氨酸氨基转移酶(ALT)水平变化及其与糖尿病相关指标的相关性,以探讨血清ALT水平与糖尿病发病的关系。方法选取2009年12月—2012年6月在我院进行葡萄糖耐量试验(OG-TT)并确诊为糖代谢异常的患者62例和健康者31例(NGT组),然后按照糖代谢状况将糖代谢异常患者分为2型糖尿病(T2DM)组32例和糖耐量减低(IGT)组30例。记录并比较3组受检者的糖尿病相关指标及血清ALT水平,并将各指标与血清ALT水平进行相关分析。然后将所有受检者按照血清ALT水平分为4组:第一分位组(ALT<15 U/L)、第二分位组(ALT 15～20 U/L)、第三分位组(ALT 21～30 U/L)和第四分位组(ALT>30 U/L),计算各组糖尿病患病率。采用Logistic回归方程分析血清ALT水平与糖尿病发病的关系。结果 (1)NGT、IGT、T2DM组血清ALT水平分别为(18±11)、(25±16)、(31±20)U/L,组间两两比较差异均有统计学意义(P<0.05)。(2)除了总胆固醇(TC),血清ALT水平与体质指数(BMI)、腰围、收缩压、舒张压、空腹血浆血糖(FPG)、糖负荷后2 h血浆葡萄糖(2 h PG)、空腹胰岛素(FINS)、糖负荷后2 h胰岛素(2 h INS)、糖化血红蛋白(HbA1c)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、胰岛素抵抗指数(HOMA-IR)均呈正相关(P<0.05),与性别、年龄、高密度脂蛋白胆固醇(HDL-C)均呈负相关(P<0.01);在控制BMI和腰围的影响后,血清ALT水平与收缩压、2 h INS、TC、LDL-C无相关性(P均>0.05),与其他指标仍存在相关性,但相关性均减弱。(3)Logistic回归分析显示,在调整了性别、年龄、BMI和腰围的影响后,第四分位组患T2DM的危险性是第一分位组的2.16倍;在进一步调整了TC、TG、LDL-C、HDL-C和HOMA-IR的影响后,第四分位组患T2DM的危险性是第一分位组的1.72倍。结论健康者、IGT患者、T2DM患者血清ALT水平逐渐升高;血清ALT水平的变化与T2DM的发生风险有关,且这种相关性可能不受肥胖、血脂和胰岛素分泌功能的影响。

Objective To explore the association between serum alanine aminotransferase （ALT） level and diabetes mellitus （DM） - related indicators in the high - risk population. Methods Ninety - three cases undergoing a 75 g oral glucose tolerance test （OGTr） in our hospital between December 2009 and June 2012 were selected. They were divided into three groups： normal glucose tolerance （NGT） group （n = 31 ）, impaired glucose tolerance （IGT） group （n = 30） and type 2 DM （T2DM） group （n = 32） according to the condition of their glucose metabolism. DM -related indicators and serum ALT level in each group were recorded and compared. Correlation analysis was conducted between each indicator and serum ALT level for each group. All subjects were divided into four groups according to serum ALT levels ： the first quartile group （ ALT 〈 15 U/L）, the second quartile group （ ALT 15 - 20 U/L）, the third quartile group （ ALT 21 - 30 U/L）, and the fourth quartile group （ ALT 〉 30 U/L）. T2DM prevalence in each group was calculated. Logistic analysis was used to evaluate the relationship between serum ALT level and the prevalence of T2DM. Results Significant differences in serum ALT levels were observed between each two of the NGT group （ 18 ± 11 ） U/L, IGT group （25 ± 16） U/L, and T2DM group （31 ± 20） U/L （ P 〈 0. 05 ）. Serum ALT level was positively correlated with body mass index （BMI）, waist circumference, systolic blood pressure （SBP）, diastolic blood pressure （DBP）, fasting plasma glucose （FPG）, 2 h postprandial glucose （2 h PG）, fasting insulin （FINS）. 2 h postprandial insulin （2 h INS）, glycosylated hemoglobin （ HbA,o ）, triglyceride （ TG）, low - density lipoprotein cholesterol （LDL- C）, and insulin resistance index （HOMA- IR） （P 〈 0.05 ）, while negatively correlated with gender, age, and high -density lipoprotein cholesterol （HDL- C） （P 〈 0.01 ）. The SBP, 2 h INS, TC, and LDL- C had no correlation with serum ALT level （ all P 〉 0.05 ）, and the correlation with other indicators weakened after controlling the influence of BMI and waist circumference. The T2DM risk of patients in the fourth quartile group was 2. 16 times that of the patients in the first quartile group after adjusting for gender, age, BMI, and waist circumference. The T2DM risk of the fourth group was 1.72 times that of the first group after adjusting for TC, TG, LDL - C, HDL - C, and HOMA - IR. Conclusion T2DM patients have the highest level of serum ALT, followed by IGT patients and healthy population. Serum ALT level might be associated with the occurrence of T2DM independent of obesity, serum lipids, and secretion function.