CAJ | 학술논문

目的了解肝脏酶学异常与中国成人胰岛素抵抗、胰岛素分泌和2型糖尿病(T2DM)患病是否存在独立的相关关系.方法研究人群来自2007年6月至2008年5月中国糖尿病和代谢综合征研究数据库,年龄≥20岁的中国成人共计16 035例(男6 611例,女9424例).受试者均测定身高、体重、腰围、血压、血脂谱、血清谷丙转氨酶(ALT)、谷草转氨酶(AST)和γ-谷氨酰转肽酶(GGT),并进行口服糖耐量试验,测定空腹和负荷后血糖和血清胰岛素.采用SUDAAN统计软件进行加权分析.结果除糖尿病患病率不随AST水平升高外,糖尿病前期和糖尿病的患病率均随ALT、GGT水平升高而呈显著上升趋势(糖尿病患病率在ALT三分位组由低到高分别为5.1％、6.9％和12.7％,P＜0.001).ALT和GGT从最低三分位到最高三分位,胰岛素抵抗指数(HOMA-IR)呈显著上升趋势(1.3、1.4和1.7,P＜0.001),胰岛素敏感指数(Mutsuda ISI)呈显著下降趋势(8.8、7.9和6.7,P＜0.001).ALT、AST和GGT水平与胰岛素分泌指数无明显关系.在分别进行的Logistic回归分析模型中,调整了年龄、性别、饮酒、体质指数、腰围后,显示ALT和GGT最高三分位组较最低三分位组患糖尿病前期的优势比(OR)分别为1.69(95％CI 1.27～ 2.26)和3.33(2.00～ 5.53),患糖尿病的OR值分别为2.70(1.87～ 3.90),1.99(1.05～ 3.77),但AST各组间糖尿病前期和糖尿病OR值无显著差异.结论肝酶ALT和GGT异常与中国成年人胰岛素抵抗和糖尿病患病独立相关.
목적 료해간장매학이상여중국성인이도소저항、이도소분비화2형당뇨병(T2DM)환병시부존재독립적상관관계.방법 연구인군래자2007년6월지2008년5월중국당뇨병화대사종합정연구수거고,년령≥20세적중국성인공계16 035례(남6 611례,녀9424례).수시자균측정신고、체중、요위、혈압、혈지보、혈청곡병전안매(ALT)、곡초전안매(AST)화γ-곡안선전태매(GGT),병진행구복당내량시험,측정공복화부하후혈당화혈청이도소.채용SUDAAN통계연건진행가권분석.결과 제당뇨병환병솔불수AST수평승고외,당뇨병전기화당뇨병적환병솔균수ALT、GGT수평승고이정현저상승추세(당뇨병환병솔재ALT삼분위조유저도고분별위5.1％、6.9％화12.7％,P＜0.001).ALT화GGT종최저삼분위도최고삼분위,이도소저항지수(HOMA-IR)정현저상승추세(1.3、1.4화1.7,P＜0.001),이도소민감지수(Mutsuda ISI)정현저하강추세(8.8、7.9화6.7,P＜0.001).ALT、AST화GGT수평여이도소분비지수무명현관계.재분별진행적Logistic회귀분석모형중,조정료년령、성별、음주、체질지수、요위후,현시ALT화GGT최고삼분위조교최저삼분위조환당뇨병전기적우세비(OR)분별위1.69(95％CI 1.27～ 2.26)화3.33(2.00～ 5.53),환당뇨병적OR치분별위2.70(1.87～ 3.90),1.99(1.05～ 3.77),단AST각조간당뇨병전기화당뇨병OR치무현저차이.결론 간매ALT화GGT이상여중국성년인이도소저항화당뇨병환병독립상관.
Objective To understand whether independent relationships exist between elevated hepatic enzymes and insulin resistance,insulin secretion and type 2 diabetes in Chinese adult population.Methods Subjects in this study were participants in China National Diabetes and Metabolic Disorders Study,involving 16 035 residents aged ≥20 years (6 611 males and 9 424 females) from June 2007 to May 2008.All participants were measured for weight,height,waist circumference,oral glucose tolerance test,lipid profiles,and serum activities of alanine aminotransferase (ALT),aspartate aminotransferase (AST),and gamma-glutamyltransferase (GGT).Indices for insulin resistance and insulin secretion were calculated.SUDAAN software was used to perform all weighted statistical analyses,with P＜0.05 considered statistically significant.Results The prevalence of pre-diabetes and diabetes increased with hepatic enzymes levels increasing (except diabetes not increasing with AST).The prevalence of diabetes from the lowest tertile to the highest tertile for ALT was 5.1％,6.9％ and 12.7％,respectively (P＜0.001).With increasing of serum level of ALT and GGT from the lowest tertile to the highest tertile,the insulin resistance index tended to increase(1.3,1.4 and 1.7,P＜0.001) and the insulin sensitivity index tended to decrease(8.8,7.9 and 6.7,all P trend＜0.001).Hepatic enzymes were not related to indices for the insulin secretion.In separate logistic regression models adjusting for age,sex,alcohol consumption,BMI,and waist circumference,participants in the highest tertiles of ALT and GGT,but not AST,showed significantly higher odds ratio(OR) of pre-diabetes (1.69(95％CI 1.27-2.26),3.33(2.00-5.53) for ALT and GGT,respectively) and diabetes (2.70(1.87-3.90),1.99(1.05-3.77) for ALT and GGT,respectively) compared with those in the lowest tertiles.Conclusion Our findings indicate that markers of liver dysfunction,i.e ALT and GGT are independently associated with insulin resistance and presence of diabetes mellitus in Chinese population.