Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
Eur J Gastroenterol Hepatol. 2022 Mar 1;34(3):316-323. doi: 10.1097/MEG.0000000000002215.
To determine whether a low aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AST/ALT ratio) is associated with insulin resistance among those without liver dysfunction.
In this cross-sectional study of the National Health and Nutrition Examination Survey (NHANES) 2011-2016, we included 2747 (1434 male and 1313 nonpregnant female) adults ≥20 years without evidence of liver dysfunction (ALT<30 in male and <19 in female, negative viral serologies, no excess alcohol consumption, no elevated transferrin saturation, AST/ALT <2). Serum AST/ALT ratio was categorized into sex-specific quartiles (female: <1.12, 1.12-1.29, 1.29-1.47, ≥1.47 and male: <0.93, 0.93-1.09, 1.09-1.26, ≥1.26). The primary outcome was insulin resistance, as determined by Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) index score ≥3. Covariate-adjusted odds ratios (ORs) were estimated. Study analysis completed from 13 March 2020 to 21 April 2021.
Among the 2747 individuals, 33% had insulin resistance. Those in the lowest quartile (Q1) of AST/ALT had 75% higher adjusted odds of insulin resistance compared to the highest quartile (Q4) [aOR (95% confidence interval (CI), 1.75 (1.20-2.57)]. This association was more pronounced in those with elevated BMI [Q1 vs. Q4; BMI ≥ 25: 2.29 (1.58-3.33), BMI < 25: 0.66 (0.26-1.69); NAFLD per Fatty Liver Index ≥ 60: 2.04 (1.21-3.44), No NAFLD: 1.68 (0.94-3.01)].
Lower AST/ALT ratio is associated with increased insulin resistance among those with healthy-range ALT, especially in those with BMI greater than or equal to 25 kg/m2.
在肝功能正常的人群中，确定较低的天门冬氨酸氨基转移酶（AST）/丙氨酸氨基转移酶（ALT）比值（AST/ALT 比值）是否与胰岛素抵抗有关。
在这项 2011-2016 年全国健康和营养调查（NHANES）的横断面研究中，我们纳入了 2747 名（男性 1434 名，非妊娠女性 1313 名）年龄≥20 岁且无肝功能障碍的成年人（男性 ALT<30，女性 ALT<19，病毒血清学阴性，无过量饮酒，转铁蛋白饱和度正常，AST/ALT<2）。血清 AST/ALT 比值按性别分为四分位数（女性：<1.12，1.12-1.29，1.29-1.47，≥1.47；男性：<0.93，0.93-1.09，1.09-1.26，≥1.26）。主要结局是通过稳态模型评估的胰岛素抵抗（HOMA-IR）指数评分≥3 来确定。采用协变量调整的比值比（OR）进行估计。研究分析于 2020 年 3 月 13 日至 2021 年 4 月 21 日完成。
在 2747 名参与者中，33%存在胰岛素抵抗。与 AST/ALT 比值最高四分位（Q4）相比，AST/ALT 比值最低四分位（Q1）的参与者调整后的胰岛素抵抗比值比（OR）高 75%[调整 OR（95%置信区间（CI）），1.75（1.20-2.57）]。这种关联在 BMI 升高的人群中更为明显[Q1 与 Q4；BMI≥25：2.29（1.58-3.33），BMI<25：0.66（0.26-1.69）；非酒精性脂肪性肝病（NAFLD）按 Fatty Liver Index（FLI）≥60 划分：2.04（1.21-3.44），无 NAFLD：1.68（0.94-3.01）]。
在 ALT 处于健康范围的人群中，AST/ALT 比值较低与胰岛素抵抗增加相关，尤其是 BMI 大于或等于 25kg/m2 的人群。
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