Giandalia Annalisa, Romeo Elisabetta Lucia, Ruffo Maria Concetta, Muscianisi Marco, Giorgianni Letterio, Forte Fiorella, Cucinotta Domenico, Russo Giuseppina Tiziana
Department of Clinical and Experimental Medicine, Messina University, Italy.
Department of Clinical and Experimental Medicine, Messina University, Italy.
Prim Care Diabetes. 2017 Jun;11(3):226-232. doi: 10.1016/j.pcd.2016.12.001. Epub 2016 Dec 22.
To evaluate the prevalence and the clinical implication of persistently elevated liver enzymes in diabetic subjects, with no evidence of viral hepatitis infection or alcohol abuse.
Clinical, lifestyle, anthropometric data and laboratory test values were collected in 916 type 2 diabetic subjects, examined for alanine aminotransferase (ALT), aspartate aminotransferase (AST) and γ-glutamyltranspeptidase (γ-GT) levels at two different time points.
Five hundred forty four patients (59.4%) showed normal (NLT group) and 182 (19.9%) persistently elevated (ELT group) liver tests in both determinations. ELT patients were prevalently men (P=0.016), younger (P<0.0001) and with a lower duration of diabetes (P=0.008). Adjusting for age and sex, ELT subjects had significantly higher BMI (P<0.001), waist circumference (P=0.010), systolic (P=0.017) and diastolic blood pressure (P<0.001), and higher levels of fasting blood glucose (P=0.023), and triglycerides (P<0.0001). Current hypoglycemic and/or hypolipidemic drugs were comparable between the two groups. At multivariate analysis, male gender (OR=3.017, P=0.012), worse metabolic control (HbA1c, OR=1.408, P=0.017), and a younger age (OR=1.054, P=0.007) predicted the presence of persistently elevated liver enzymes.
Persistently elevated liver enzymes are a common finding in outpatient type 2 diabetic subjects, particularly in young men with suboptimal metabolic control and with the features of metabolic syndrome. The persistence of abnormal liver tests may be of potential utilization in clinical practice for the screening of patients at high risk of NAFLD.
评估在无病毒性肝炎感染或酒精滥用证据的糖尿病患者中，肝酶持续升高的患病率及其临床意义。
收集了916例2型糖尿病患者的临床、生活方式、人体测量数据及实验室检查值，在两个不同时间点检测其丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）和γ-谷氨酰转肽酶（γ-GT）水平。
在两次检测中，544例患者（59.4%）肝酶检测正常（NLT组），182例（19.9%）肝酶持续升高（ELT组）。ELT组患者以男性居多（P=0.016），年龄较轻（P<0.0001），糖尿病病程较短（P=0.008）。校正年龄和性别后，ELT组患者的体重指数（BMI）显著更高（P<0.001），腰围（P=0.010）、收缩压（P=0.017）和舒张压（P<0.001）更高，空腹血糖（P=0.023）和甘油三酯水平（P<0.0001）更高。两组目前使用的降糖和/或降脂药物相当。多因素分析显示，男性（比值比[OR]=3.017，P=0.012）、代谢控制较差（糖化血红蛋白[HbA1c]，OR=1.408，P=0.017）和年龄较轻（OR=1.054，P=0.007）是肝酶持续升高的预测因素。
肝酶持续升高在门诊2型糖尿病患者中很常见，尤其是在代谢控制欠佳且具有代谢综合征特征的年轻男性中。肝酶检测异常的持续存在可能在临床实践中用于筛查非酒精性脂肪性肝病（NAFLD）高危患者。
