South African Medical Research Council and University of Cape Town, South Africa.
J Hepatol. 2012 Nov;57(5):1083-9. doi: 10.1016/j.jhep.2012.06.034. Epub 2012 Jul 11.
BACKGROUND & AIMS: The relation between gamma-glutamyltransferase (GGT) and mortality risk has been little explored in people with diabetes. We examined (a) the association of GGT with cardiovascular disease (CVD) and all-cause mortality in people with and without diabetes; and (b) the predictive validity observed when adding GGT to a CVD risk algorithm.
Participants were 17,852 adults from three British cohorts representative of the general population in England (N=1) and Scotland (N=2). Follow-up was to December 2009 (Scottish cohorts) and February 2008 (English cohort). Cox models were used to compute the hazard ratio (HR) and 95% confidence interval (95% CI) for a standard deviation (SD) increase log(e)(GGT) in relation to mortality according to diabetes status. The value of adding GGT to a CVD risk engine was assessed through c-statistic and relative integrated discrimination improvement.
In an analytical sample of 17,852 participants, 583 (3.3%) had baseline diabetes. During 10.1 years of follow-up, there were 235 deaths from all causes (77 from CVD) in diabetics. Corresponding results for non-diabetics were 2859 and 719. The age- and sex-adjusted HR (95%CI) for a one SD increase in log(e)(GGT) in relation to CVD mortality risk in participants with diabetes was 1.43 (1.13-1.81) and in those without diabetes was 1.27 (1.18-1.37). Corresponding results for total mortality were 1.24 (1.08-1.44) and 1.30 (1.25-1.34). Thus, there was no evidence that diabetes status modified the strength of the GGT-mortality relationship (p value for interaction ≥0.16). Adding GGT to model with classical predictors only marginally enhanced the prediction of CVD in both people with and without diabetes.
Higher GGT levels are a risk factor for all-cause and cardiovascular disease death in people with and without diabetes. However, knowledge of GGT does not improve cardiovascular predictions beyond traditional risk factors.
γ-谷氨酰转移酶（GGT）与死亡风险之间的关系在糖尿病患者中尚未得到充分研究。我们检验了：（a）GGT 与糖尿病患者和非糖尿病患者的心血管疾病（CVD）和全因死亡率之间的关联；（b）当将 GGT 添加到 CVD 风险算法中时观察到的预测准确性。
参与者为来自英格兰（N=1）和苏格兰（N=2）的三个具有代表性的英国队列的 17852 名成年人。随访至 2009 年 12 月（苏格兰队列）和 2008 年 2 月（英格兰队列）。使用 Cox 模型计算与死亡率相关的每标准差（SD）log(e)(GGT)增加的危险比（HR）和 95%置信区间（95%CI），根据糖尿病状态进行分析。通过 C 统计量和相对综合判别改善来评估将 GGT 添加到 CVD 风险引擎中的价值。
在 17852 名参与者的分析样本中，有 583 名（3.3%）基线患有糖尿病。在 10.1 年的随访期间，糖尿病患者中有 235 例死于各种原因（77 例死于 CVD），非糖尿病患者中分别有 2859 例和 719 例。糖尿病患者中，log(e)(GGT)与 CVD 死亡率风险相关的一个 SD 增加的年龄和性别调整 HR（95%CI）为 1.43（1.13-1.81），而非糖尿病患者为 1.27（1.18-1.37）。总死亡率的相应结果为 1.24（1.08-1.44）和 1.30（1.25-1.34）。因此，没有证据表明糖尿病状态改变了 GGT-死亡率关系的强度（交互作用检验 P 值≥0.16）。在有和没有糖尿病的患者中，仅将 GGT 添加到仅包含经典预测因子的模型中，对 CVD 的预测略有改善。
较高的 GGT 水平是糖尿病患者和非糖尿病患者全因和心血管疾病死亡的危险因素。然而，与传统危险因素相比，了解 GGT 并不能改善心血管预测。
