Division of Nephrology, West China Hospital of Sichuan University, Chengdu, Sichuan, China; Laboratory of Diabetic Kidney Disease, Centre of Diabetes and Metabolism Research, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
Division of Nephrology, West China Hospital of Sichuan University, Chengdu, Sichuan, China; Laboratory of Diabetic Kidney Disease, Centre of Diabetes and Metabolism Research, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
J Diabetes Complications. 2022 Aug;36(8):108235. doi: 10.1016/j.jdiacomp.2022.108235. Epub 2022 Jun 24.
To study the relationship between baseline serum aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AAR) in both clinicopathological features and renal outcome among type 2 diabetes mellitus (T2DM) patients with biopsy-confirmed diabetic nephropathy (DN).
As a retrospective cohort study, we included 253 patients with T2DM and biopsy-confirmed DN. For receiver operating characteristic (ROC) curve showed that the optimal cut-off for AAR to predict end stage renal disease (ESRD) was 1.22. So, patients were divided into two groups according to their AAR at the time of renal biopsy: high AAR Group (those with AAR > 1.22); low AAR Group (those with AAR ≤1.22). Association between AAR and clinicopathological features as well as renal outcome were analyzed.
Patients with higher AAR presented elder, more hypertensive, more insulin use, higher serum cholesterol, more proteinuria and lower estimated glomerular filtration rate (eGFR). Compared with low AAR group, patients with high AAR had more severe glomerular pathological lesions and interstitial fibrosis and tubular atrophy. For prognostic analysis, high AAR Group was associated with a higher risk of progression to ESRD in univariate analysis. No matter treated with continuous or categorical variate, higher AAR remained an independent predictor for ESRD after adjusted for various confounding factors: gender, age, the duration of diabetes, serum glucose level, hypertension, serum lipid level, smoking, insulin use, eGFR and proteinuria.
High AAR was associated with more severe renal pathologic lesions and worse renal function in patients with T2DM and DN, which might be a novel noninvasive predictor for ESRD.
To our knowledge, there was no biopsy-based cohort study. In our study, high AAR was associated with more severe renal pathologic lesions and worse renal function in patients with T2DM and DN, which might be a novel noninvasive predictor of ESRD for patients with DN.
研究 2 型糖尿病（T2DM）合并肾活检证实的糖尿病肾病（DN）患者基线血清天冬氨酸氨基转移酶（AST）与丙氨酸氨基转移酶（ALT）比值（AAR）与临床病理特征及肾脏结局的关系。
本研究为回顾性队列研究，纳入 253 例 T2DM 合并肾活检证实的 DN 患者。根据受试者工作特征（ROC）曲线，AAR 预测终末期肾病（ESRD）的最佳截断值为 1.22。因此，根据肾活检时的 AAR 将患者分为两组：高 AAR 组（AAR＞1.22）；低 AAR 组（AAR≤1.22）。分析 AAR 与临床病理特征及肾脏结局的关系。
高 AAR 组患者年龄较大、高血压比例较高、胰岛素使用率较高、血清胆固醇水平较高、蛋白尿较多、估算肾小球滤过率（eGFR）较低。与低 AAR 组相比，高 AAR 组患者肾小球病理损伤和间质纤维化及小管萎缩更严重。单因素分析显示，高 AAR 组患者进展为 ESRD 的风险较高。无论采用连续变量还是分类变量进行预后分析，在校正了性别、年龄、糖尿病病程、血糖水平、高血压、血脂水平、吸烟、胰岛素使用、eGFR 和蛋白尿等混杂因素后，高 AAR 仍然是 ESRD 的独立预测因素。
在 T2DM 合并 DN 患者中，高 AAR 与更严重的肾脏病理损伤和更差的肾功能相关，可能是 ESRD 的一种新的非侵入性预测指标。
据我们所知，目前尚无基于肾活检的队列研究。在本研究中，高 AAR 与 T2DM 合并 DN 患者更严重的肾脏病理损伤和更差的肾功能相关，可能是 DN 患者 ESRD 的新的非侵入性预测指标。
