老年人丙氨酸氨基转移酶和天冬氨酸氨基转移酶/丙氨酸氨基转移酶与2型糖尿病及代谢综合征的相关性研究

Association of Alanine Transaminase and Aspartate Aminotransferase/Alanine Transaminase Ratio with Type 2 Diabetes and Metabolic Syndrome in the Elderly

背景血清丙氨酸氨基转移酶(ALT)和天冬氨酸氨基转移酶(AST)是常见的肝酶指标,但目前对于肝酶指标和2型糖尿病(T2DM)及代谢综合征(MS)患病间的关系研究较少。目的探讨血清ALT、AST/ALT与T2DM、MS在社区体检老年人中的相关性。方法选取2018年在武汉市6个区共19家社区卫生服务中心进行免费体检的≥65岁30060例老年人为研究对象,收集受试者的人口学资料、生活方式、既往病史、体格检查、生化检测资料。根据ALT四分位数将受试者分为4组,即Q1组(ALT≤11 U/L,n=8116)、Q2组(11 U/L<ALT≤14 U/L,n=7008)、Q3组(14 U/L<ALT≤19 U/L,n=7438)、Q4组(ALT>19 U/L,n=7498);又根据AST/ALT四分位数将受试者分为4组,即q1组(AST/ALT≤1.06,n=7386)、q2组(1.06<AST/ALT≤1.31,n=7698)、q3组(1.31<AST/ALT≤1.62,n=7529)、q4组(AST/ALT>1.62,n=7447)。采用趋势χ^(2)检验比较T2DM、MS、腹型肥胖、高血糖、高血压、三酰甘油(TG)升高、高密度脂蛋白胆固醇(HDL-C)降低患病率随ALT和AST/ALT变化的趋势;采用多因素Logistic回归探究不同ALT和AST/ALT水平与T2DM和MS的相关性。结果30060例受试者年龄65~99岁,平均年龄(71.7±5.6)岁,其中男13381例,女16679例;T2DM患病率为18.26%(5488/30060),MS患病率为29.73%(8938/30060)。T2DM受试者经常锻炼比例、BMI、腰围、收缩压、舒张压、ALT、TG、空腹血糖(FPG)高于非T2DM受试者,吸烟、饮酒比例、AST、AST/ALT、总胆固醇(TC)、HDL-C、低密度脂蛋白胆固醇(LDL-C)低于非T2DM受试者(P<0.01)。MS受试者经常锻炼比例、BMI、腰围、收缩压、舒张压、ALT、TC、TG、FPG高于非MS受试者,男性、吸烟、饮酒比例、AST/ALT、HDL-C、LDL-C低于非MS受试者(P<0.01)。T2DM、MS、腹型肥胖、高血糖、高血压、高血糖、TG升高、HDL-C降低患病率随ALT水平升高而升高,随AST/ALT水平升高而降低(P<0.01)。多因素Logistic回归分析结果显示,与Q1组相比,Q2~Q4组患T2DM、MS的风险均增加(P<0.01);与q1组相比,q2~q4组患T2DM、MS的风险均降低(P<0.01)。结论血清ALT和AST/ALT水平与T2DM和MS均存在相关性,ALT的升高和AST/ALT的降低可能增加T2DM和MS患病风险。

Background Serum alanine transaminase(ALT)and aspartate aminotransferase(AST)are common liver enzymes,but there are few studies on the correlation of these enzymes with the prevalence of type 2 diabetes mellitus(T2DM)and metabolic syndrome(MS).Objective To explore the association of serum ALT and AST/ALT ratio with T2DM and MS in older physical examinees in the community.Methods From January to December,2018,30060 elderly people(≥65 years)who underwent free physical examination in 19 community health centers of 6 districts in Wuhan were chosen as the subjects.Their demographic data,life style,previous medical history,and results of physical examination and biochemical test were collected.Subjects were divided into quartile groups of ALT〔Q1(ALT≤11 U/L,n=8116),Q2(11 U/L<ALT≤14 U/L,n=7008),Q3(14 U/L<ALT≤19 U/L,n=7438),Q4(ALT>19 U/L,n=7498)〕,or quartile groups of AST/ALT ratio〔q1(AST/ALT≤1.06,n=7386),q2(1.06<AST/ALT≤1.31,n=7698),q3(1.31<AST/ALT≤1.62,n=7529),q4(AST/ALT>1.62,n=7447)〕.Cochranχ^(2) test was used to compare the prevalence trend of T2DM,MS,abdominal obesity,hypertension,elevated triglycerides(TG)and lowered high-density lipoprotein cholesterol(HDL-C)with the change of ALT level and AST/ALT ratio.Multivariate Logistic regression analysis was used to explore the correlation of prevalence of T2DM and MS with ALT level and AST/ALT ratio.Results The age of 30060 subjects(13381 men and 16679 women)was 65-99 years old,and the average age was(71.7±5.6)years old.The prevalence of T2DM and MS was 18.76%(5488/30060)and 29.73%(8938/30060),respectively.The regular exercise rate,BMI,waist circumference,systolic pressure,diastolic pressure,ALT,TG and fasting plasma glucose(FPG)were significantly higher and smoking rate,drinking rate,AST,AST/ALT ratio,total cholesterol(TC),HDL-C,low-density lipoprotein cholesterol(LDL-C)were significantly lower in T2DM subjects compared to non-T2DM subjects(P<0.01).MS subjects had significantly higher regular exercise rate,BMI,waist circumference,systolic pressure,diastolic pressure,ALT,TC,TG and FPG,and significantly lower male ratio,smoking rate,drinking rate,AST/ALT ratio,HDL-C and LDL-C than non-MS subjects(P<0.01).The prevalence of T2DM,MS,abdominal obesity,hypertension,elevated TG and lowered HDL-C increased with the increase of ALT level,and decreased with the increase of AST/ALT ratio(P<0.01).Multivariate Logistic regression analysis showed that compared with group Q1,the risk of T2DM and MS in group Q2-Q4 was increased(P<0.01),and the risk of T2DM and MS in group Q2-Q4 was decreased compared with group q1(P<0.01).The prevalence risk of T2DM and MS was increased in Q2-Q4 groups compared to Q1 group,and in contrast,the risk was decreased in q2-q4 groups when comparing to q1 group(P<0.01).Conclusion Serum ALT have an association with the prevalence of T2DM and MS,as well as AST/ALT ratio.Either elevated ALT or lowered AST/ALT ratio may increase the risk of prevalence of T2DM and MS.