γ-谷氨酰转移酶在预测代谢综合征中的意义

The Significance of γ- glutamyl Transpeptidase Enzyme in Predicting Metabolic Syndrome

目的分析代谢综合征(MS)患者的危险因素,研究γ-谷氨酰转移酶(GGT)对MS的预测价值。方法选择2007年11月在首都医科大学附属北京世纪坛医院体检中心参加全面体检的铁道部机关在职人员471例,2008—2010年连续观察,每年11月于本院随访一次,随访3年。观察患者一般资料(包括性别、年龄、饮酒史、吸烟史、既往疾病史及家族史等)及随访时检测丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)、GGT、尿素氮(BUN)、肌酐(Cr)、尿酸(UA)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、空腹血糖(FPG)水平,计算稳态模型胰岛素抵抗指数(HOMA-IR)。结果入组时MS患病率为25.1%(118/471)。男性患病率为27.5%(104/378),高于女性的15.1%(14/93)(χ2=6.171,P=0.013)。新发MS组BMI、WC、SBP、DBP、TC、TG、LDL、UA、HOMA-IR、ALT、ALP、GGT较无MS组高,HDL水平较无MS组低(P<0.05);但两组年龄、FPG、AST比较,差异无统计学意义(P>0.05)。多因素Logistic回归分析显示,腰围增大、GGT升高、TC升高、HDL升高是MS发生的影响因素(P<0.05)。GGT的曲线下面积大于ALT、AST、SBP、DBP、TG、HDL、FPG的曲线下面积,而WC的曲线下面积大于GGT的曲线下面积(P<0.05)。随着GGT水平升高灵敏度降低,特异度升高;当灵敏度为0.803,特异度为0.599时,约登(Youden)指数最大为0.402,GGT预测MS的最佳临界值为20.5 U/L。结论 GGT对MS的预测具有较高的灵敏度和特异度,为临床诊断提供了参考依据。

Objective To analyze the risk factors for patients with metabolic syndrome,and to explore the predictive value of γ - glutamyl transpeptidase（GGT）for metabolic syndrome（MS）. Methods 471 serving officers of railway ministry departments who received physical examination in Department of Endocrinology,Beijing Shijitan Hospital Affiliated to Capital Medical University in November 2007,were selected as study subjects,and they were followed up from 2008 to 2010,that is, they received reexamination in the same hospital per year for 3 years. During follow - up,general informations（ gender,age, history of drinking,history of cigarette smoking,history of diseases and family medical history）of cases,and their alanine aminotransferase（ ALT ）, aspartate aminotransferase （ AST ）, alkaline phosphatase （ ALP ）, GGT, blood urea nitrogen （BUN）,creatinine （ Cr ）, uric acid （ UA ）, total cholesterol （ TC ）, triacylglycerol （ TG ）, high density lipoprotein （HDL）,low density lipoprotein（LDL）,fasting blood - glucose（FPG）were recorded. The homeostasis model assessment of insulin resistance（HOMA - IR）was calculated. Results Prevalence of MS in baseline was 25. 1% （118 / 471）. Prevalence of MS among male cases〔27. 5% （104 / 378）〕was significantly higher than that among female cases〔15. 1% （14 / 93）〕（χ2 =6. 171,P = 0. 013）. BMI,WC,SBP,DBP,TC,TG,LDL,UA,HOMA - IR,ALT,ALP and GGT level of cases in MS group was significantly higher than that in non - MS group,respectively,while HDL level of cases in MS group was significantly lower than that in non - MS group（P ﹤ 0. 05）. There was no significant difference in age,FPG and AST between two groups（P for occurrence of MS（ P ﹤ 0. 05）. Area under the curve（ AUC）for GGT was significantly bigger than that for ALT,AST, SBP,DBP,TG,HDL and FPG,AUC for WC was significantly bigger than that for GGT（P ﹤ 0. 05）. As GGT level rised, sensitivity decreased,specificity increased. When sensitivity reached 0. 803,and specificity reached 0. 599,Youden index reached the biggest value 0. 402,the optimal critical value of GGT was 20. 5 U/ L when it was used to diagnose MS. Conclusion GGT has relatively higher sensitivity and specificity in the diagnosis of metabolic syndrome.