孕早期丙氨酸转氨酶与妊娠期糖尿病的关联

The Association of Alanine Aminotransferase in Early Pregnancy with Gestational Diabetes.

作者信息

Yarrington Christina D, Cantonwine David E, Seely Ellen W, McElrath Thomas F, Zera Chloe A

机构信息

1 Maternal Fetal Medicine Division, Department of OB/GYN, Boston Medical Center, Boston, Massachusetts.

2 Department of Maternal and Fetal Medicine, Brigham and Women's Hospital , Boston, Massachusetts.

出版信息

Metab Syndr Relat Disord. 2016 Jun;14(5):254-8. doi: 10.1089/met.2015.0106. Epub 2016 Mar 9.

DOI:10.1089/met.2015.0106

PMID:26959309

Abstract

BACKGROUND

Elevated alanine amino transferase, attributed to nonalcoholic fatty liver, is associated with later development of type 2 diabetes mellitus. We sought to determine whether maternal ALT values are associated with subsequent development of gestational diabetes.

METHODS

We performed a nested case-control study utilizing prospectively banked serum samples collected in early gestation. We excluded women with known diabetes, liver disease, or alcohol use. We included 83 cases of gestational diabetes mellitus (GDM) and 247 controls matched for prepregnancy body-mass index (BMI) and compared ALT values. We then performed a conditional logistic regression to model the adjusted odds of GDM in women with ALT ≥19 U/L, stratified by prepregnancy BMI.

RESULTS

The median (interquartile range) ALT in cases was 15 (12, 19) IU/L compared to 13 (11, 18) IU/L in controls (P = 0.07). Among women with a prepregnancy BMI <30 kg/m(2), ALT ≥19 U/L was associated with a fourfold increased odds of GDM (adjusted odds ratio [aOR] 4.56 [1.45, 14.27]), while there was no such association among obese women (aOR 0.36 [0.11, 1.20]). Similarly, each unit increase in log-transformed ALT was associated with a threefold increased odds of GDM in nonobese (aOR 3.15 [1.04,9.54]), but not obese (aOR 3.15 [0.30,3.15]) women.

CONCLUSION

The association of high normal ALT and later GDM in nonobese women may reflect the role of hepatic insulin resistance and visceral obesity.

摘要

背景

丙氨酸氨基转移酶升高归因于非酒精性脂肪肝，与2型糖尿病的后期发生相关。我们试图确定母体丙氨酸氨基转移酶值是否与妊娠期糖尿病的后续发生相关。

方法

我们利用妊娠早期前瞻性保存的血清样本进行了一项巢式病例对照研究。我们排除了已知患有糖尿病、肝病或饮酒的女性。我们纳入了83例妊娠期糖尿病（GDM）病例和247例根据孕前体重指数（BMI）匹配的对照，并比较了丙氨酸氨基转移酶值。然后我们进行了条件逻辑回归，以模拟丙氨酸氨基转移酶≥19 U/L的女性发生GDM的调整后比值比，按孕前BMI分层。

结果

病例组丙氨酸氨基转移酶的中位数（四分位间距）为15（12，19）IU/L，而对照组为13（11，18）IU/L（P = 0.07）。在孕前BMI<30 kg/m²的女性中，丙氨酸氨基转移酶≥19 U/L与GDM发生几率增加四倍相关（调整后比值比[aOR] 4.56 [1.45，14.27]），而肥胖女性中无此关联（aOR 0.36 [0.11，1.20]）。同样，在非肥胖女性中，对数转换后的丙氨酸氨基转移酶每增加一个单位与GDM发生几率增加三倍相关（aOR 3.15 [1.04，9.54]），但肥胖女性中无此关联（aOR 3.15 [0.30，3.15]）。