γ-谷氨酰转移酶水平正常化与非酒精性脂肪性肝病患者更好的代谢控制相关。
Normalization of γ-glutamyl transferase levels is associated with better metabolic control in individuals with nonalcoholic fatty liver disease.
机构信息
Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan II Road, Yuexiu District, Guangzhou, 510080, China.
Department of Clinical Laboratories, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
出版信息
BMC Gastroenterol. 2021 May 10;21(1):215. doi: 10.1186/s12876-021-01790-w.
BACKGROUND
The normalization of liver biochemical parameters usually reflects the histological response to treatment for nonalcoholic fatty liver disease (NAFLD). Researchers have not clearly determined whether different liver enzymes exhibit various metabolic changes during the follow-up period in patients with NAFLD.
METHODS
We performed a retrospective analysis of patients with NAFLD who were receiving therapy from January 2011 to December 2019. Metabolism indexes, including glucose levels, lipid profiles, uric acid levels and liver biochemical parameters, were measured. Magnetic resonance imaging-based proton density fat fraction (MRI-PDFF) and liver ultrasound were used to evaluate steatosis. All patients received recommendations for lifestyle modifications and guideline-recommended pharmacological treatments with indications for drug therapy for metabolic abnormalities.
RESULTS
Overall, 1048 patients with NAFLD were included and received lifestyle modification recommendations and pharmaceutical interventions, including 637 (60.7%) patients with abnormal GGT levels and 767 (73.2%) patients with abnormal ALT levels. Patients with concurrent ALT and GGT abnormalities presented higher levels of metabolism indexes and higher liver fat content than those in patients with single or no abnormalities. After 12 months of follow-up, the cumulative normalization rate of GGT was considerably lower than that of ALT (38% vs. 62%, P < 0.001). Greater weight loss resulted in higher cumulative normalization rates of GGT and ALT. Weight loss (OR = 1.21, 95% CI 1.11-1.32, P < 0.001), ALT normalization (OR = 2.75, 95% CI 1.41-5.36, P = 0.01) and lower TG and HOMA-IR values (OR = 2.03, 95% CI 1.11-3.71, P = 0.02; OR = 2.04, 95% CI 1.07-3.89, P = 0.03) were independent protective factors for GGT normalization. Elevated baseline GGT (OR = 0.99, 95% CI 0.98-0.99, P = 0.01) was a risk factor.
CONCLUSIONS
For NAFLD patients with concurrently increased ALT and GGT levels, a lower normalization rate of GGT was observed, rather than ALT. Good control of weight and insulin resistance was a reliable predictor of GGT normalization.
背景
肝生化参数的正常化通常反映了非酒精性脂肪性肝病（NAFLD）治疗的组织学反应。研究人员尚未明确确定在 NAFLD 患者的随访期间，不同的肝酶是否表现出不同的代谢变化。
方法
我们对 2011 年 1 月至 2019 年 12 月接受治疗的 NAFLD 患者进行了回顾性分析。测量了葡萄糖水平、血脂谱、尿酸水平和肝生化参数等代谢指标。采用基于磁共振成像的质子密度脂肪分数（MRI-PDFF）和肝脏超声评估脂肪变性。所有患者均接受生活方式改变建议和指南推荐的药物治疗代谢异常的药物治疗建议。
结果
总体而言，纳入了 1048 例接受生活方式改变建议和药物干预的 NAFLD 患者，包括 637 例（60.7%）γ-谷氨酰转肽酶（GGT）水平异常和 767 例（73.2%）丙氨酸氨基转移酶（ALT）水平异常患者。同时存在 ALT 和 GGT 异常的患者的代谢指标水平和肝脂肪含量均高于单一异常或无异常的患者。随访 12 个月后，GGT 的累积正常化率明显低于 ALT（38%比 62%，P<0.001）。体重减轻越多，GGT 和 ALT 的累积正常化率越高。体重减轻（OR=1.21，95%CI 1.11-1.32，P<0.001）、ALT 正常化（OR=2.75，95%CI 1.41-5.36，P=0.01）和降低甘油三酯和 HOMA-IR 值（OR=2.03，95%CI 1.11-3.71，P=0.02；OR=2.04，95%CI 1.07-3.89，P=0.03）是 GGT 正常化的独立保护因素。基线 GGT 升高（OR=0.99，95%CI 0.98-0.99，P=0.01）是 GGT 正常化的危险因素。
结论
对于同时 ALT 和 GGT 水平升高的 NAFLD 患者，GGT 的正常化率较 ALT 低，而不是 ALT。良好的体重和胰岛素抵抗控制是 GGT 正常化的可靠预测指标。
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