摘要
目的 观察不同糖代谢人群中肝酶与肝脏脂肪含量（LFC）的关系.方法 109例受试者分为糖调节异常（IGR）31例,新诊断2型糖尿病（NT2DM）31例,正常糖耐量（NGT）47例,采用质子磁共振波谱分析（1H-MRS）定量测定LFC,分析LFC与丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、碱性磷酸酶（AKP）、γ-谷氨酰转肽酶（GGT）的关系.利用受试者工作曲线（ROC）获得ALT诊断非酒精性脂肪肝病（NAFLD）的最佳临界值.结果 （1）LFC在NGT、IGR、NT2DM组中分别为3.83（2.35～7.59）%、12.82（8.10～21.37）%、21.99（11.89～34.43）%,随着糖代谢异常程度增加依次增高（P＜0.01）;（2）根据LFC四分位数分组,分为Q1～4组.随着LFC增加,腰围、体质指数（BMI）、收缩压、甘油三酯、总胆固醇、空腹血糖、OGTT 2 h血糖、HOMA胰岛素抵抗指数（HOMA-IR）从Q2起呈现增高趋势,HDL-C从Q2起呈现降低趋势,组间比较差异有统计学意义;（3）随着LFC增加,ALT、AST、AKP、GGT均数虽尚在正常范围,但ALT、GGT在Q3时,AST、AKP在Q4时出现增高（P＜0.01）;（4）偏相关分析发现,校正了性别、年龄、BMI后,LFC与AST（r=0.329,P＜0.05）,ALT（r=0.454）、GGT（r=0.378）（均P＜0.01）呈正相关,与AST/ALT（r=-0.364,P＜0.01）呈负相关;（5）多元回归分析显示LFC是ALT、AST、GGT、AST/ALT独立影响因子;（6）ALT检测NAFLD,ROC曲线下面积为0.813（男）,0.769（女）（均P＜0.01）,ALT最佳临界值23.5 U/L（男）,17.5 U/L（女）.结论 肝酶在正常的范围内即与LFC相关,以目前ALT正常切点来诊断NAFLD,低估了NAFLD的实际患病率.
Objective To study the relationship between liver fat content （LFC） and liver enzymes in individuals with various statuses of glucose metabolism. Methods A total of 109 subjects including with impaired glucose regulation （IGR） （ n = 31 ） , newly diagnosed type 2 diabetes （ NT2DM ） （ n = 31 ） and normal glucose tolerance （NGT） （n =47 ） were recruited. The level of LFC was measured by 1H magnetic resonance spectroscopy （IH-MRS） to study the relationship between liver fat content （LFC） and alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, alkaline phosphatase （AKP） and T-glutamyhransferase（GGT）. The receiver operating characteristic curve（ROC） was employed to obtain the optimal cut-off point of ALT to predict the occurrence of nonalcoholic fatty liver disease （NAFLD）. Results （1）The levels of LFC were progressively raised in NGT, IGR and NT2DM groups respectively [ 3.83 （2.35-7.59）%, 12.82 （8.10-21.37）% and 21.99 （11.89-34.43）%, P〈0.01]; （2） the subjects were divided into four subgroups by the method of LFC quartile. And quartile subgroups Q1 -4 were associated with the increase of I,FC. Waist, BMI, systolic blood pressure, triglyeeride, total cholesterol, fasting plasma glucose, OGTY 2 h postprandial glucose and HOMA-IR had a rising trend from Q2. But HDL-C showed a declining trend from Q2; （ 3 ） ALT and GGT significantly increased from Q3 （ P 〈 0. 01 ） while AST and AKP significantly increased in Q4（ P 〈0. 01 ） ; （4） adjusted by gender, age and body mass index （ BMI）, LFC was positively correlated with AST （ r = 0. 329, P 〈 0. 05 ）, AI,T （ r = 0. 454 ） and GGT （ r = 0. 378 ） （ All P 〈 0. 0! ）. But it was negatively correlated with AST/ALT （ r = - 0. 364, P 〈 0. 01 ） ; （ 5 ） the analysis of stepwise regression demonstrated that LFC was a predictor of ALT, AST, GGT and AST/ ALT; （6） ALT had a ROC ate of 0. 813 （male） and 0. 769 （female） （ All P 〈 0. 01 ）. The optimal cut-off point of 23.5 U/l,（male） and 17.5 U/L（female） might predict the occurrence of NAFLD. Conclusions Liver enzymes are correlated with LFC even in normal range. The optimal cut-off point of 23.5 U/L（male） and 17. 5 U/L （female） might predict the occurrence of NAFLD. The current used ALT upper limit could underestimate the NAFLD.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2010年第48期3385-3390,共6页
National Medical Journal of China
基金
国家＂十一五＂科技支撑计划（2008BAI52B03）
上海市科委重点项目（07JC14011）
上海市科委基金（10411956400）
上海市市级医院新兴前沿技术联合攻关项目（SHDC12006101）
关键词
葡萄糖代谢障碍
脂肪肝
糖尿病
磁共振波谱学
肝功能试验
Glucose metabolism disorders
Fatty liver
Diabetes mellitus
Magnetic resonance spectroscopy
Liver function tests
