摘要目的 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.

abstractsObjective 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.