Montreal Clinical Research Institute (IRCM), Montréal, Québec, Canada.
Department of Nutrition, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada.
PLoS One. 2019 Jul 18;14(7):e0219855. doi: 10.1371/journal.pone.0219855. eCollection 2019.
Cystic fibrosis (CF) patients are at high risk of developing CF-related diabetes (CFRD). In non-CF patients, liver disease, specifically steatosis and non-alcoholic fatty liver disease (NAFLD), is strongly associated with type 2 diabetes. We compared glycemic status and metabolic profiles in CF patients according to a biomarker of hepatic injury, alanine aminotransferase (ALT).
We conducted a cross-sectional study among 273 adult CF patients recruited from the Montreal CF Cohort. A 2-hour oral glucose tolerance test (OGTT) was performed to collect glucose and insulin measures every 30 minutes. Fasting ALT levels and anthropometric measures were also obtained. Patients were categorized into 2 groups based on ALT cut-off of 25 U/L.
Patients in the high ALT group were mostly men (83%), had higher mean weight and BMI (p<0.001) and showed elevated glucose levels throughout OGTT (p≤0.01). When stratified by sex, only men with high ALT showed significantly higher weight (p<0.001), higher glycemic values at 60, 90 and 120 minutes of OGTT (p≤0.01), higher frequency of de novo CFRD (20.5% vs 8.2%, p = 0.04) as well as lower insulin sensitivity than men with normal ALT (p = 0.03). ALT levels were strongly associated with HOMA-IR in CFRD patients (p = 0.001, r2 = 0.28).
Adult CF men with higher ALT show an increased frequency of dysglycemia and de novo CFRD, lower insulin sensitivity and higher eight. Our data suggests that ALT levels could be an interesting tool to guide targeted diabetes screening, particularly among CF men. Prospective studies are needed to confirm these observations.
囊性纤维化（CF）患者发生 CF 相关糖尿病（CFRD）的风险较高。在非 CF 患者中，肝脏疾病，特别是脂肪变性和非酒精性脂肪性肝病（NAFLD），与 2 型糖尿病密切相关。我们根据肝损伤生物标志物丙氨酸氨基转移酶（ALT）比较 CF 患者的血糖状态和代谢特征。
我们对来自蒙特利尔 CF 队列的 273 名成年 CF 患者进行了横断面研究。进行 2 小时口服葡萄糖耐量试验（OGTT），每 30 分钟采集一次血糖和胰岛素水平。还测量了空腹 ALT 水平和人体测量学指标。根据 ALT 截断值 25 U/L 将患者分为 2 组。
ALT 水平较高组的患者主要为男性（83%），平均体重和 BMI 更高（p<0.001），OGTT 期间血糖水平升高（p≤0.01）。按性别分层时，仅男性高 ALT 组的体重显著更高（p<0.001），OGTT 60、90 和 120 分钟时血糖值更高（p≤0.01），新发 CFRD 的频率更高（20.5%比 8.2%，p = 0.04），且胰岛素敏感性低于 ALT 正常的男性（p = 0.03）。ALT 水平与 CFRD 患者的 HOMA-IR 密切相关（p = 0.001，r2 = 0.28）。
ALT 较高的成年 CF 男性患者表现出更高的血糖异常和新发 CFRD 发生率、更低的胰岛素敏感性和更高的胰岛素抵抗。我们的数据表明，ALT 水平可能是一种有用的工具，用于指导有针对性的糖尿病筛查，特别是在 CF 男性中。需要前瞻性研究来证实这些观察结果。
