Zhang Cong, Xu Qian, Xu Chengye, Yang Kun, Xia Tian, Hasi Wuying, Hao Ming, Kuang Hongyu
Department of Endocrinology, The First Clinical Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
Endocr Res. 2024 Jan 2;49(1):1-11. doi: 10.1080/07435800.2023.2262034. Epub 2024 Jan 4.
OBJECTIVES/INTRODUCTION: The purpose of the current study was to investigate the association between Aspartate Transaminase (AST)/Alanine transaminase(ALT) and type 2 diabetes (T2DM) in nonalcoholic fatty liver disease (NAFLD) patients and to determine whether there were sex differences.
In the retrospective study, we collected data on NAFLD patients (1, 896 men and 465 women) at Murakami Memorial Hospital from 2004 to 2015. Data were stratified by sex to investigate the association between AST/ALT and T2DM incidence by sex. Multiple regression analysis, smooth curve fitting model and subgroup analysis were used to determine the correlation, non-linear relationship and threshold effect between AST/ALT and T2DM.
In our study, 157 men and 40 women developed T2DM at follow-up. After adjusting for risk factors, AST/ALT was significantly associated with T2DM in men with NAFLD but not in women with NAFLD. The risk of T2DM increased as the AST/ALT ratio decreased. Besides, in male NAFLD patients, AST/ALT showed a non-linear relationship with T2DM, with an inflection point value of 0.964. When the AST to ALT ratio was below the threshold (AST/ALT <0.964), AST/ALT was significantly negatively associated with T2DM (HR = 0.177, 95% CI 0.055-0.568; = 0.0036). In contrast, when AST/ALT >0.964, no significant association was found (HR = 3.174, 95% CI 0.345-29.167; = 0.3074). Moreover, subgroup analysis showed that GGT could alter the relationship between AST/ALT and T2DM. In the group with GGT ≤ 40, AST/ALT was strongly associated with T2DM (HR = 0.24, 95% CI 0.09-0.66; = 0.0059).
These results suggested that there were sex differences in the association between AST/ALT and T2DM in NAFLD participants. A non-linear association between AST/ALT and T2DM was observed in males. AST/ALT in the normal GGT group (GGT ≤40) might better facilitate the early screening of T2DM.
目的/引言：本研究旨在探讨非酒精性脂肪性肝病（NAFLD）患者中天冬氨酸转氨酶（AST）/丙氨酸转氨酶（ALT）与2型糖尿病（T2DM）之间的关联，并确定是否存在性别差异。
在这项回顾性研究中，我们收集了2004年至2015年村上纪念医院NAFLD患者（1896名男性和465名女性）的数据。数据按性别分层，以研究AST/ALT与不同性别的T2DM发病率之间的关联。采用多元回归分析、平滑曲线拟合模型和亚组分析来确定AST/ALT与T2DM之间的相关性、非线性关系和阈值效应。
在我们的研究中，157名男性和40名女性在随访期间发生了T2DM。在调整风险因素后，AST/ALT与NAFLD男性患者的T2DM显著相关，但与NAFLD女性患者无关。T2DM的风险随着AST/ALT比值的降低而增加。此外，在男性NAFLD患者中，AST/ALT与T2DM呈非线性关系，拐点值为0.964。当AST与ALT比值低于阈值（AST/ALT <0.964）时，AST/ALT与T2DM显著负相关（HR = 0.177，95% CI 0.055 - 0.568；P = 0.0036）。相反，当AST/ALT>0.964时，未发现显著关联（HR = 3.174，95% CI 0.345 - 29.167；P = 0.3074）。此外，亚组分析表明γ-谷氨酰转移酶（GGT）可改变AST/ALT与T2DM之间的关系。在GGT≤40的组中，AST/ALT与T2DM密切相关（HR = 0.24，95% CI 0.09 - 0.66；P = 0.0059）。
这些结果表明，NAFLD参与者中AST/ALT与T2DM之间的关联存在性别差异。在男性中观察到AST/ALT与T2DM之间存在非线性关联。正常GGT组（GGT≤40）中的AST/ALT可能更有助于T2DM的早期筛查。
