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目的探讨糖尿病高危人群在不同糖代谢状态下血清丙氨酸转氨酶(ALT)的变化及其相关因素。方法对871例门诊行糖耐量筛查患者,按照糖代谢状况分为新诊断的T2DM组285例,糖调节受损(IGR)组407例,正常糖耐量(NGT)组179例,比较各组血清ALT的变化,分析ALT的相关因素及其与T2DM患病率的关系。结果 (1)在校正了年龄、BMI、腰围、TG和HDL-C的影响后,血清ALT水平T2DM组和IGR组均高于NGT组(P=0.001,P=0.032)。(2)血清ALT水平与BMI、腰围及HOMA-IR关系最为密切(r分别是0.303、0.316、0.322)。(3)在校正了性别、年龄、BMI和腰围的影响后,随着血清ALT水平的增加,T2DM患病率明显增加,其中第四分位组患T2DM的危险性是第一分位组的2.16倍(95%CI1.41～3.32)。在进一步校正了血脂和HOMA-IR的影响后,这种关联仍存在,但有所减弱。结论血清ALT水平的升高与T2DM的发生有关联,且这种相关可能独立于肥胖、血脂、胰岛素敏感性和分泌功能而存在。
Objective To investigate the changes of serum alanine aminotransferase (ALT) and its related factors under different glycometabolism in high-risk diabetic population. Methods A total of 285 patients with T2DM, newly diagnosed T2DM, 407 patients with impaired glucose regulation (IGR) and 179 with normal glucose tolerance (NGT) were enrolled in the 871 outpatients with glucose tolerance screening. Serum ALT changes, analysis of ALT related factors and the prevalence of T2DM. Results (1) After adjusting for age, BMI, waist circumference, TG and HDL-C, serum ALT levels in T2DM group and IGR group were significantly higher than those in NGT group (P = 0.001, P = 0.032). (2) Serum ALT levels were most closely related to BMI, waist circumference and HOMA-IR (r = 0.303,0.316,0.322 respectively). (3) After adjusting for gender, age, BMI and waist circumference, the prevalence of T2DM increased significantly with the increase of serum ALT level. The risk of T2DM in the fourth quintile was the highest in the first quintile 2.16 times (95% CI 1.41 ~ 3.32). After further corrections of the effects of lipids and HOMA-IR, this correlation persists but diminishes. Conclusions The elevation of serum ALT level is associated with the occurrence of T2DM, and this correlation may exist independent of the obesity, blood lipid, insulin sensitivity and secretory function.