Doi Yasufumi, Kubo Michiaki, Yonemoto Koji, Ninomiya Toshiharu, Iwase Masanori, Tanizaki Yumihiro, Shikata Kentaro, Iida Mitsuo, Kiyohara Yutaka
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka 812-8582, Japan.
Obesity (Silver Spring). 2007 Jul;15(7):1841-50. doi: 10.1038/oby.2007.218.
We studied the relationship between liver enzymes and the development of diabetes in a general Japanese population.
A total of 1804 non-diabetic subjects 40 to 79 years of age were followed-up prospectively for a mean of 9.0 years.
During the follow-up, 135 subjects developed diabetes. In both sexes, the age-adjusted cumulative incidence of diabetes increased significantly with elevating quartiles of serum gamma-glutamyltransferase (GGT) and alanine aminotransferase (ALT) levels. This pattern was also observed in aspartate aminotransferase (AST) quartiles for men but not for women. In multivariate analyses after adjusting for comprehensive risk factors and other liver enzymes, the risk of developing diabetes was significantly higher in the highest GGT quartile than in the lowest quartile [odds ratio (OR), 2.54; 95% confidence interval (CI), 1.03 to 6.26 for men; OR, 5.73; 95% CI, 1.62 to 20.19 for women]. Similar results were observed in ALT quartiles (OR, 2.32; 95% CI, 0.91 to 5.92 for men; OR, 4.40; 95% CI, 1.38 to 14.06 for women) but not in AST quartiles in either sex. Significant positive associations of GGT and ALT with diabetes were seen within each stratified category of risk factors, namely fasting insulin, BMI, waist-to-hip ratio, high-sensitivity C-reactive protein, and alcohol consumption. In receiver operating characteristic analyses, the areas under the receiver operating characteristic curve of GGT and ALT were significantly larger than that of AST, fasting insulin, waist-to-hip ratio, or C-reactive protein.
Our findings suggest that serum GGT and ALT concentrations are strong predictors of diabetes in the general population, independent of known risk factors.
我们研究了日本普通人群中肝酶与糖尿病发病之间的关系。
对1804名年龄在40至79岁的非糖尿病受试者进行了平均9.0年的前瞻性随访。
在随访期间，135名受试者患上了糖尿病。在男性和女性中，经年龄调整后的糖尿病累积发病率均随着血清γ-谷氨酰转移酶（GGT）和丙氨酸氨基转移酶（ALT）水平四分位数的升高而显著增加。在男性的天冬氨酸氨基转移酶（AST）四分位数中也观察到这种模式，但在女性中未观察到。在对综合风险因素和其他肝酶进行调整后的多变量分析中，GGT四分位数最高组患糖尿病的风险显著高于最低组[比值比（OR），2.54；95%置信区间（CI），男性为1.03至6.26；OR，5.73；95%CI，女性为1.62至20.19]。在ALT四分位数中也观察到类似结果（OR，2.32；95%CI，男性为0.91至5.92；OR，4.40；95%CI，女性为1.38至14.06），但在任何性别的AST四分位数中均未观察到。在每个分层的风险因素类别中，即空腹胰岛素、体重指数、腰臀比、高敏C反应蛋白和饮酒量，均观察到GGT和ALT与糖尿病之间存在显著正相关。在受试者工作特征分析中，GGT和ALT的受试者工作特征曲线下面积显著大于AST、空腹胰岛素、腰臀比或C反应蛋白的曲线下面积。
我们的研究结果表明，血清GGT和ALT浓度是普通人群中糖尿病的强预测指标，独立于已知风险因素。
