·糖尿病临床研究·

　　齐婷 刘彦君 许樟荣 曹明君 王玉珍 杨小平

　　作者单位：100101北京，解放军第306医院全军糖尿病诊治中心、内分泌科

　　通讯作者：许樟荣，E-mail: xzr1021@vip.sina.com

　　【摘要】目的研究T2DM患者正常值范围内的血清谷丙转氨酶(ALT)水平与代谢综合征(MS)的相关性。方法收集2004年至2009年资料齐全的T2DM患者4744例，排除酒精、药物、肝炎等可能导致脂肪肝或转氨酶升高的患者。选取ALT在正常范围内(ALT≤40 U/L)的4295例患者由低到高进行四分位分组(1组到4组)，比较各组腰围、BMI、血糖、胰岛素及胰岛素抵抗指数(HOMA-IR)、HbA1c、血脂、肾功、尿蛋白/肌酐(Alb/Cr)等指标，以及MS及其组分的患病率。结果ALT处于正常范围患者的各组结果显示，随着ALT的升高，尿酸(5.37±0.36、5.42±0.36、5.43±0.34、5.50±0.35，为自然对数值;P=0.000)和HOMA-IR的前3组(2.79±2.93、2.84±2.14、3.24±2.55、2.75±2.67;P=0.000)明显增加。4组(ALT 22~40U/ml)与1组(ALT 1~11U/ml)相比，收缩压(P=0.040)、空腹血糖(P=0.000)和餐后血糖(P=0.000)均明显增高。1组到4组的MS患病率分别为45.1%、47.6%、47.6%、58.0%;向心性肥胖的患病率为51.9%、51.2%、48.7%、60.2%;高甘油三酯患病率为33.5%、41.6%、47.6%、58.0%;第4组与前3组相比，差异均有统计学意义。结论ALT水平升高与心血管多种危险因素的簇集明显相关，正常高值的ALT患者有更高的MS患病率。

　　【关键词】谷丙转氨酶;代谢综合征;糖尿病，2型;心血管危险因素

　　doi:10.3969/j.issn.1006-6187.2012.01.017

　　Association of the higher alanine aminotransferase level in the normal range with cardiovascular risk clusters in the patients with T2DMQI Ting, LIU Yan-jun, XU Zhang-rong, et al. Department of Endocrinology, The PLA 306th Hospital, Beijing 100101, China

　　Corresponding author: XU Zhang-rong, E-mail:xzr1021@vip.sina.com

　　【Abstract】ObjectiveTo investigate the association between serum alanine aminotransferase (ALT) level in the normal range and the cardiovascular risk clusters in the Chinese patients with type 2 diabetes. Methods4744 patients with type 2 diabetes were selected for evaluating the relationship between cardiovascular risk clusters and the ALT level. The causes of the abnormal high ALT level such as hepatitis, alcohol and drugs were excluded based on the past history, hospital examinations. 4295 patients with normal ALT level were divided into 4 groups on the interquatile distances. The waist circumference, BMI, blood glucose, blood pressure, insulin and HOMA-IR, HbA1c, lipids, uric acid, urine albumin and the prevalence of the metabolic syndrome and its components were compared among these groups. ResultsThe uric acid level was significantly higher along with the increased ALT, from (5.37±0.36) in group 1 to (5.50±0.35) μmol/L in group 4. Patients with highest ALT level had significantly higher fasting glucose and postprandial glucose. Metabolic syndrome prevalence was 45.1%, 47.6%, 47.6 % and 58.0% when ALT level was from lowest to highest. ALT level was significantly different between group 4 and other 3 groups (P=0.000 to 0.015). Central obesity prevalence in the four groups was 51.9%, 51.2%, 48.7%, 60.2%, hypertriglyceridemia prevalence was 33.5%, 41.6%, 47.6%, 58.0%, and high serum uric acid prevalence was 4.1%, 6.0%, 5.5% and 9.9%, respectively, with significant difference between group 1 and group 4. ConclusionsThe increase in ALT level in the normal range is associated with the cardiovascular risk clusters in diabetic patients.

　　【Key words】Alanine aminotransferase; Metabolic syndrome; Diabetes mellitus,type 2; Macrovascular risk factors