Endocrinology and Metabolism Research Center, Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Metab Syndr Relat Disord. 2011 Apr;9(2):111-7. doi: 10.1089/met.2010.0066. Epub 2010 Nov 20.
It has been shown that elevated levels of alanine and aspartate aminotransferases (ALT and AST) are associated with insulin resistance and type 2 diabetes mellitus; however, the pattern of this association in diabetic patients with negative or mild steatosis is not well understood. The aim of this study was to assess the association between elevated liver enzymes and insulin resistance in diabetic subjects without ultrasound signs of nonalcoholic fatty liver disease (NAFLD) (i.e., with less than 30% steatosis).
In a cross-sectional study, a total of 670 diabetic subjects without established causes of liver injury were included. Patients with evidence of NAFLD in ultrasonography were not included. Fasting blood samples were obtained and plasma glucose, insulin, glycosylated hemoglobin (HbA1c), C-peptide, alkaline phosphatase, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and lipid profile were measured. Three indices of insulin sensitivity/insensitivity: Homeostasis model assessment of insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), and McAuley were also calculated.
Elevated ALT was significantly (p < 0.001) correlated with fasting insulin, C-peptide, HOMA-IR, QUICKI, McAuley, and waist circumference. The same correlations were also observed for AST, which in all cases were weaker than ALT. Multivariate regression analysis showed that, among the above-mentioned variables, only HOMA-IR and fasting insulin were independently correlated with both ALT and AST. This correlation was independent of body mass index (BMI) or waist circumference.
In type 2 diabetes, in the absence of a detectable steatosis by ultrasonography, ALT and AST are associated with hyperinsulinemia and insulin resistance, independent of obesity. This finding possibly indicates that in diabetes a mild stage of steatosis is sufficient to mediate the association between insulin resistance and aminotransferases.
已有研究表明，丙氨酸和天冬氨酸氨基转移酶（ALT 和 AST）水平升高与胰岛素抵抗和 2 型糖尿病有关；然而，对于超声检查未见非酒精性脂肪性肝病（NAFLD）表现（即脂肪变＜30%）的糖尿病患者，这种关联的模式尚不清楚。本研究旨在评估无超声表现的非酒精性脂肪性肝病（即脂肪变＜30%）的糖尿病患者中，肝酶升高与胰岛素抵抗之间的关系。
在一项横断面研究中，共纳入了 670 例无明确肝损伤病因的糖尿病患者。超声检查有 NAFLD 证据的患者不纳入本研究。采集空腹血样，检测血浆葡萄糖、胰岛素、糖化血红蛋白（HbA1c）、C 肽、碱性磷酸酶、丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）和血脂谱。还计算了胰岛素敏感性/不敏感的 3 个指数：稳态模型评估的胰岛素抵抗（HOMA-IR）、定量胰岛素敏感性检查指数（QUICKI）和 McAuley。
ALT 升高与空腹胰岛素、C 肽、HOMA-IR、QUICKI、McAuley 和腰围显著相关（p＜0.001）。AST 也存在同样的相关性，且在所有情况下，AST 与 ALT 的相关性均弱于 ALT。多元回归分析显示，在上述变量中，只有 HOMA-IR 和空腹胰岛素与 ALT 和 AST 均独立相关。这种相关性独立于体重指数（BMI）或腰围。
在 2 型糖尿病患者中，在超声检查未发现明显脂肪变的情况下，ALT 和 AST 与高胰岛素血症和胰岛素抵抗相关，与肥胖无关。这一发现可能表明，在糖尿病中，轻度脂肪变就足以介导胰岛素抵抗与氨基转移酶之间的关联。
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