Departments of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK.
Diabet Med. 2009 Dec;26(12):1235-41. doi: 10.1111/j.1464-5491.2009.02839.x.
To determine the prevalence of elevated alanine transaminase (ALT) in a large cohort of patients with Type 1 diabetes and to examine the clinical correlations and causes. Methods Patients with Type 1 diabetes mellitus were prospectively recruited and ALT, glycated haemoglobin and lipid profile were measured. Patients with Type 2 diabetes mellitus were recruited as a comparison group.
with abnormal ALT were investigated for underlying causes. Prevalence of abnormal ALT was analysed at three separate cut-offs and multivariable analysis used to identify independent risk factors.
Nine hundred and eleven with Type 1 diabetes and 963 with Type 2 diabetes were included. The prevalence of elevated ALT was dependent on the cut-off value: > 30 IU/l in males and > 19 IU/l in females, > 50 and > 63 IU/l was 34.5, 4.3 and 1.9%, respectively, in Type 1 diabetes and 51.4, 8.2 and 3.7%, respectively, in Type 2 diabetes. In Type 1 diabetes an elevated ALT was associated with worse glycaemic control, age > 55 years and elevated triglycerides. Investigation of these patients revealed a cause in 43.6% of patients, predominantly non-alcoholic fatty liver disease (NAFLD).
Elevated ALT is not uncommon in Type 1 diabetes and is associated with NAFLD-related risk factors. Patients with Type 1 diabetes and elevated ALT should be investigated as significant abnormalities may be found which are amenable to interventions.
在大型 1 型糖尿病患者队列中确定丙氨酸转氨酶（ALT）升高的患病率，并研究其临床相关性和病因。方法：前瞻性招募 1 型糖尿病患者，检测 ALT、糖化血红蛋白和血脂谱。招募 2 型糖尿病患者作为对照组。对 ALT 异常的患者进行潜在病因检查。分别在三个不同的切点分析异常 ALT 的患病率，并进行多变量分析以确定独立的危险因素。结果：共纳入 911 例 1 型糖尿病患者和 963 例 2 型糖尿病患者。ALT 升高的患病率取决于切点值：男性>30IU/L，女性>19IU/L，1 型糖尿病的患病率分别为 34.5%、4.3%和 1.9%，2 型糖尿病的患病率分别为 51.4%、8.2%和 3.7%。在 1 型糖尿病中，ALT 升高与血糖控制不佳、年龄>55 岁和甘油三酯升高有关。对这些患者进行检查后，发现 43.6%的患者存在病因，主要为非酒精性脂肪性肝病（NAFLD）。结论：1 型糖尿病中 ALT 升高并不少见，与 NAFLD 相关的危险因素有关。1 型糖尿病且 ALT 升高的患者应进行检查，因为可能会发现可干预的显著异常。
