Strangeways Research Laboratory, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge,Worts Causeway, Cambridge CB1 8RN, UK.
Am J Epidemiol. 2013 Jul 15;178(2):159-71. doi: 10.1093/aje/kws469. Epub 2013 May 31.
We evaluated the associations of liver aminotransferases with risk of type 2 diabetes (T2D) in general populations by conducting a systematic review and meta-analysis of published prospective studies. Studies were identified in a literature search of PubMed, EMBASE, and Web of Science from 1950 through October 2012. Of the 2,729 studies reviewed, 17 studies involving 60,359 participants and 3,890 incident T2D events were included. All of the studies assessed associations between alanine aminotransferase (ALT) level and T2D, with heterogeneous findings (I(2) = 88%, 95% confidence interval (CI): 82, 92; P < 0.001). The pooled fully adjusted relative risk of T2D was 1.26 (95% CI: 1.14, 1.41) per 1-standard-deviation change in log baseline ALT level. This association became nonsignificant after trim-and-fill correction for publication bias. Nine studies evaluated associations between aspartate aminotransferase (AST) levels and T2D risk, with a corresponding relative risk of 1.02 (95% CI: 0.99, 1.04). The relative risk of T2D per 5-IU/L increase in ALT level was 1.16 (95% CI: 1.08, 1.25). Available data indicate moderate associations of ALT with risk of T2D events, which may be attributable to publication bias. There was no evidence for an increased risk of T2D with AST. Large prospective studies may still be needed to establish the magnitude and nature of these associations.
我们通过对已发表的前瞻性研究进行系统评价和荟萃分析，评估了肝氨基转移酶与 2 型糖尿病（T2D）风险的相关性。通过对 1950 年至 2012 年 10 月间PubMed、EMBASE 和 Web of Science 中的文献进行检索，确定了研究。在对 2729 项研究进行综述后，纳入了 17 项研究，涉及 60359 名参与者和 3890 例 T2D 事件。所有研究均评估了丙氨酸氨基转移酶（ALT）水平与 T2D 的相关性，结果存在异质性（I(2) = 88%，95%置信区间[CI]：82，92；P < 0.001）。按基线 ALT 水平的自然对数值每增加 1 个标准差，T2D 的汇总校正后相对风险为 1.26（95% CI：1.14，1.41）。经过发表偏倚的修剪和填充校正后，该相关性不再显著。有 9 项研究评估了天门冬氨酸氨基转移酶（AST）水平与 T2D 风险之间的相关性，相应的相对风险为 1.02（95% CI：0.99，1.04）。ALT 水平每增加 5IU/L，T2D 的相对风险为 1.16（95% CI：1.08，1.25）。现有数据表明，ALT 与 T2D 事件的风险之间存在中度相关性，这可能归因于发表偏倚。AST 与 T2D 风险增加无关。可能仍需要开展大型前瞻性研究以确定这些相关性的程度和性质。
