2型糖尿病合并非酒精性脂肪肝患者丙氨酸氨基转移酶水平与颈动脉粥样硬化的相关性

摘要

Objective To investigate the association of alanine aminotransferase (ALT) level with glucose and lipid metabolism, insulin resistance and carotid atherosclerosis in type 2 diabetic patients with non-alcoholic fatty liver disease (NAFLD). Methods A total of 394 patients with type 2 diabetes were recruited. Based on the results of abdominal ultrasonography and plasma ALT level, they were divided into group 1 (Gl, 154 subjects without NAFLD), group 2 (G2, 170 subjects with NAFLD whose ALT<40 U/L), and group 3 (G3, 70 subjects with NAFLD whose ALT>40 U/L). Height, weight, blood pressure, liver enzymes, blood glucose and blood lipids were detected; homeostasis assessment for insulin resistance (HOMA-IR) was calculated based on oral 75 g glucose tolerance and insulin release test; the plaques in carotid arteries were measured by ultrasonography. Results The three groups differed significantly in age, diabetes duration, body mass index (BMI), triglycerides, high-density lipoprotein-cholesterol, fasting serum insulin, postprandial insulin and HOMA-IR (P<0.05); but not in carotid atherosclerosis (P>0.05). Carotid atherosclerosis was more common in patients over 65 years; NAFLD with carotid atherosclerosis was more common in patients aged 45 - 65 years. Logistic regression analysis showed that BMI and ALT were independently associated with NAFLD; age was independently associated with carotid atherosclerosis. Conclusion The increased level of ALT is closely related to BMI, lipid metabolism disorder and insulin resistance, which results in earlier onset of type 2 diabetes and carotid atherosclerosis.%目的 探讨2型糖尿病合并非酒精性脂肪肝(NAFLD)患者丙氨酸氨基转移酶(ALT)水平与糖脂代谢、胰岛素抵抗以及颈动脉粥样硬化的关系.方法 选取住院的2型糖尿病患者394例,其中G1组(T2DM不伴有非酒精性脂肪肝)154例;G2组(T2DM伴非酒精性脂肪肝且ALT<40U/L)170例;G3组(T2DM伴非酒精性脂肪肝且ALT>40U/L)70例.测量身高、体重、血压;检测肝酶、糖脂代谢指标;颈动脉B超测定颈动脉粥样硬化斑块.结果 随着血清ALT水平的升高,2型糖尿病患者的年龄更轻,糖尿病病程更短,体重指数(BMI)更大,γ-谷氨酸氨基转移酶(GGT)、甘油三酯(TG)、空腹胰岛素(FINS)、餐后2h胰岛素(PINS)、HOMA-IR更高,高密度脂蛋白胆固醇(HDL-C)更低,差异有统计学意义(P<0.05);而颈动脉粥样硬化的患病率3组间无统计学差异(P>0.05).年龄分层后发现,颈动脉粥样硬化在65岁以上2型糖尿病患者中的患病率最高,可高达92.2%;而脂肪肝合并颈动脉粥样硬化的患者主要集中45～65岁人群中.Logistic分析发现,BMI、ALT是影响NAFLD的独立危险因素;而年龄是影响颈动脉粥样硬化的独立危险因素.结论 血清ALT水平升高与体重指数、脂代谢紊乱以及胰岛素抵抗密切相关,并且使2型糖尿病以及颈动脉粥样硬化的发病年龄提前.