中国全科医学 ›› 2023, Vol. 26 ›› Issue (29): 3645-3649.DOI: 10.12114/j.issn.1007-9572.2023.0028

所属专题: 内分泌代谢性疾病最新文章合集 老年人群健康最新文章合集 老年问题最新文章合集

• 论著 • 上一篇    下一篇

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

周小琦, 刘新会, 张微, 李长风, 严亚琼*()   

  1. 430024 湖北省武汉市疾病预防控制中心慢性非传染性疾病防制所
  • 收稿日期:2022-11-08 修回日期:2023-02-08 出版日期:2023-10-15 发布日期:2023-02-17
  • 通讯作者: 严亚琼

  • 作者贡献:周小琦提出研究选题方向,负责组织开展调查,收集整理分析数据,并撰写论文初稿;刘新会负责调查的开展与质控;张微进行调查数据的收集和整理;李长风负责论文的修订;严亚琼负责文章的质量控制及审校,对文章整体负责;所有作者确认了论文的最终稿。
  • 基金资助:
    武汉市卫生健康委科研项目(WG19Z02); 湖北省卫生计生委联合基金项目(WJ2018H242)

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

ZHOU Xiaoqi, LIU Xinhui, ZHANG Wei, LI Changfeng, YAN Yaqiong*()   

  1. Institute of Noncommunicable Disease Control and Prevention, Wuhan Center for Disease Control & Prevention, Wuhan 430024, China
  • Received:2022-11-08 Revised:2023-02-08 Published:2023-10-15 Online:2023-02-17
  • Contact: YAN Yaqiong

摘要: 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30 060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=8 116)、Q2组(11 U/L<ALT≤14 U/L,n=7 008)、Q3组(14 U/L<ALT≤19 U/L,n=7 438)、Q4组(ALT>19 U/L,n=7 498);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=7 386)、q2组(1.06<AST/ALT≤1.31,n=7 698)、q3组(1.31<AST/ALT≤1.62,n=7 529)、q4组(AST/ALT>1.62,n=7 447)。采用趋势χ2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 30 060例受试者年龄65~99岁,平均年龄(71.7±5.6)岁,其中男13 381例,女16 679例;T2DM患病率为18.26%(5 488/30 060),MS患病率为29.73%(8 938/30 060)。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。

关键词: 糖尿病, 2型, 代谢综合征, 丙氨酸氨基转移酶, 天冬氨酸氨基转移酶, 老年人, 相关性研究

Abstract:

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, 30 060 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=8 116), Q2 (11 U/L<ALT≤14 U/L, n=7 008), Q3 (14 U/L<ALT≤19 U/L, n=7 438), Q4 (ALT>19 U/L, n=7 498) 〕, or quartile groups of AST/ALT ratio〔q1 (AST/ALT≤1.06, n=7 386), q2 (1.06<AST/ALT≤1.31, n=7 698), q3 (1.31<AST/ALT≤1.62, n=7 529), q4 (AST/ALT>1.62, n=7 447) 〕. Cochran χ2 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 30 060 subjects (13 381 men and 16 679 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% (5 488/30 060) and 29.73% (8 938/30 060), 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.

Key words: Diabetes mellitus, type 2, Metabolic syndrome, Alanine transaminase, Aspartate aminotransferase, Aged, Correlation study