Patel Dharmendrakumar A, Srinivasan Sathanur R, Xu Ji-Hua, Chen Wei, Berenson Gerald S
Tulane Center for Cardiovascular Health, Tulane University Health Sciences Center, New Orleans, LA 70112, USA.
Metabolism. 2007 Jun;56(6):792-8. doi: 10.1016/j.metabol.2007.01.010.
Elevations in alanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT), markers of liver dysfunction and nonalcoholic fatty liver, are considered as part of the metabolic syndrome and related diseases. However, information is limited regarding the persistence (tracking) in levels of these enzymes over time and their influence on cardiovascular (CV) risk in young adults. The study sample consisted of white and black subjects (N = 489, 40% male, 73% white; baseline age, 18-32 years) followed over a period of 12 years as part of the Bogalusa Heart Study, with repeat measurements of CV risk factor variables and liver enzymes. Both at baseline and follow-up, males vs females had higher ALT (P < .01 to .0001) and GGT (P < .0001); blacks vs whites had higher GGT (P < .0001). With respect to persistence in enzyme levels over time, of those individuals who had ALT and GGT at the top quintile specific for age, race, and sex at baseline, about 50% of them continued to remain so with high values after 12 years. Individuals with levels persistently in the highest quintile vs those in the lowest quintile showed higher (P < .0001) body mass index, waist circumference, triglycerides, low-density lipoprotein cholesterol, glucose, insulin, insulin resistance index, and systolic and diastolic blood pressures; lower (P < .0001) high-density lipoprotein cholesterol; and higher (P < .05 to .001) prevalence of obesity, hypertension, dyslipidemia, metabolic syndrome as defined by the National Cholesterol Education Program Adult Treatment Panel III, positive parental history of type 2 diabetes, and coronary heart disease. In addition, based on a multivariate analysis using 2 separate models for ALT and GGT, baseline levels of both enzymes were independent predictors of follow-up; insulin resistance index and baseline GGT were also predictive of follow-up systolic blood pressure. Elevations in liver enzymes ALT and GGT, within "reference" range, persist over time and relate to clinically relevant adverse CV risk profile in young adults.
谷丙转氨酶（ALT）和γ-谷氨酰转移酶（GGT）升高是肝功能障碍和非酒精性脂肪肝的标志物，被视为代谢综合征及相关疾病的一部分。然而，关于这些酶水平随时间的持续性（追踪情况）及其对年轻成人心血管（CV）风险的影响，相关信息有限。作为博加卢萨心脏研究的一部分，研究样本包括白人和黑人受试者（N = 489，40%为男性，73%为白人；基线年龄为18 - 32岁），随访时间长达12年，期间重复测量心血管风险因素变量和肝脏酶。在基线和随访时，男性的ALT（P <.01至.0001）和GGT（P <.0001）均高于女性；黑人的GGT（P <.0001）高于白人。关于酶水平随时间的持续性，在基线时ALT和GGT处于特定年龄、种族和性别最高五分位数的个体中，约50%在12年后仍保持高值。酶水平持续处于最高五分位数的个体与最低五分位数的个体相比，体重指数、腰围、甘油三酯、低密度脂蛋白胆固醇、血糖、胰岛素、胰岛素抵抗指数以及收缩压和舒张压更高（P <.0001）；高密度脂蛋白胆固醇更低（P <.0001）；肥胖、高血压、血脂异常、美国国家胆固醇教育计划成人治疗小组III定义的代谢综合征、2型糖尿病阳性家族史以及冠心病的患病率更高（P <.05至.001）。此外，基于使用针对ALT和GGT的2个独立模型进行的多变量分析，两种酶的基线水平均为随访的独立预测因素；胰岛素抵抗指数和基线GGT也可预测随访时的收缩压。在“参考”范围内，肝脏酶ALT和GGT升高会随时间持续存在，并与年轻成人临床相关的不良心血管风险状况相关。
