Abstract：Objective To explore whether elevated alanine aminotransferase(ALT), aspartate aminotransferase(AST), or γ-glutamyltranspeptidase(GGT) are risk factors for impaired glucose regulation(IGR) or diabetes mellitus(DM) and whether these hepatic enzymes are associated with insulin resistance or insulin secretion in Chinese. Methods Totally, 5 375 people (58.3±9.4 years of age) from three communities in Nanjing City were enrolled in the study, including 3 010 with normal glucose tolerance (NGT),1707 with IGR and 658 with DM. Their serum ALT, AST and GGT were measured and HOMA_IR and HOMA_% B were calculated. Results Non conditional Logistic regression analysis showed, that with elevated ALT or GGT, the risk of IGR and DM were both increased gradually (all P<0.001), however, AST was not statistically correlated with the risk of IGR and DM. Multiple linear regression analysis showed that, with elevated ALT or GGT, the level of HOMA_IR increased gradually (standardized regression coefficient β were 0.12 and 0.1 respectively, both P <0.001). With elevated ALT, the level of HOMA_%B gradually elevated (standardized regression coefficient β=0.05, P = 0.003). Linear trend was not found between GGT and HOMA_%B(β=-0.04,P=0.25). Conclusions Elevated ALT and GGT may be early predictors for IGR and DM.
[1] Xu Y, Wang L, He J, et al. Prevalence and control of diabetes in Chinese adults[J]. JAMA,2013,310(9):948-959. [2] Alberti K G, Zimmet P Z. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation[J]. Diabet Med,1998,15(7):539-553. [3] 张家驹编译. 临床内分泌生理学[M]. 北京:中国医药科技出版社,1990:290-300. [4] Ahn H R, Shin M H, Nam H S, et al. The association between liver enzymes and risk of type 2 diabetes: the Namwon study[J]. Diabetol Metab Syndr,2014,6(1):14. [5] Monami M, Bardini G, Lamanna C, et al. Liver enzymes and risk of diabetes and cardiovascular disease: results of the Firenze Bagno a Ripoli (FIBAR) study[J]. Metabolism,2008,57(3):387-392. [6] Tao L, Li X, Zhu H, et al. Association between gamma-glutamyl transferase and metabolic syndrome: a cross-sectional study of an adult population in Beijing[J]. Int J Environ Res Public Health,2013,10(11):5523-5540. [7] Schneider A L, Lazo M, Ndumele C E, et al. Liver enzymes, race, gender and diabetes risk: the Atherosclerosis Risk in Communities (ARIC) Study[J]. Diabet Med,2013,30(8):926-933. [8] Doi Y, Kubo M, Yonemoto K, et al. Liver enzymes as a predictor for incident diabetes in a Japanese population: the Hisayama study[J]. Obesity (Silver Spring),2007,15(7):1841-1850. [9] Bonnet F, Ducluzeau P H, Gastaldelli A, et al. Liver enzymes are associated with hepatic insulin resistance, insulin secretion, and glucagon concentration in healthy men and women[J]. Diabetes,2011,60(6):1660-1667. [10] 范建高. 中国非酒精性脂肪性肝病诊疗指南(2010年修订版)[J]. 中国医学前沿杂志(电子版),2012(07):4-10. [11] Wallace T M, Levy J C, Matthews D R. Use and abuse of HOMA modeling[J]. Diabetes Care,2004,27(6):1487-1495. [12] Fraser A, Harris R, Sattar N, et al. Alanine aminotransferase, gamma-glutamyltransferase, and incident diabetes: the British Women's Heart and Health Study and meta-analysis[J]. Diabetes Care,2009,32(4):741-750. [13] 严言,孙敏,王知笑,等. 40岁以上人群肝酶与糖耐量的相关性研究[J]. 内科理论与实践,2012(04):265-270. [14] Vozarova B, Stefan N, Lindsay R S, et al. High alanine aminotransferase is associated with decreased hepatic insulin sensitivity and predicts the development of type 2 diabetes[J]. Diabetes,2002,51(6):1889-1895. [15] Ryoo J H, Oh C M, Kim H S, et al. Clinical association between serum gamma-glutamyltransferase levels and the development of insulin resistance in Korean men: a 5-year follow-up study[J]. Diabet Med,2013. [16] Kotronen A, Juurinen L, Hakkarainen A, et al. Liver fat is increased in type 2 diabetic patients and underestimated by serum alanine aminotransferase compared with equally obese nondiabetic subjects[J]. Diabetes Care,2008,31(1):165-169. [17] 卞华,颜红梅,夏明锋,等. 不同糖代谢人群肝酶与肝脏脂肪含量的关系[J]. 中华医学 杂志,2010,90(48):3385-3390. [18] 文祯,姜涛,宋秀霞,等. 不同糖调节水平非酒精性脂肪性肝病患者肝脏脂肪含量与胰岛β细胞功能及胰岛素抵抗的关系[J]. 中国糖尿病杂志,2014(02):100-103. [19] Lee D H, Blomhoff R, Jacobs D J. Is serum gamma glutamyltransferase a marker of oxidative stress?[J]. Free Radic Res,2004,38(6):535-539. [20] Hsieh P S, Hsieh Y J. Impact of liver diseases on the development of type 2 diabetes mellitus[J]. World J Gastroenterol,2011,17(48):5240-5245. [21] 付建芳,姬秋和,张锐,等. 2型糖尿病患者血糖和氧化应激水平相关性研究[J]. 实用预防医学,2011(04):604-605.
2015, Vol. 22 
