Bi Yaru, Yang Yang, Yuan Xiaojie, Wang Jiping, Liu Zhiyuan, Tian Suyan, Sun Chenglin
Department of Endocrinology and Metabolism, First Hospital of Jilin University, Changchun, 130000, People's Republic of China.
Department of Health Examination Center, First Hospital of Jilin University, Changchun, 130000, People's Republic of China.
Diabetes Metab Syndr Obes. 2024 Jan 20;17:261-269. doi: 10.2147/DMSO.S442165. eCollection 2024.
Multiple studies have investigated the association between alanine aminotransferase (ALT) and diabetes mellitus (DM); however, only a few studies have specifically examined the relationship between ALT and diabetic kidney disease (DKD). This study aimed to investigate the relationship between ALT and DKD using clinical data.
A cross-sectional study was conducted on 668 individuals that included non-DM (N=281), DM without DKD (N=160), and DKD (N=227) patients. A generalized additive model (GAM) was used to examine the dose-response relationship between ALT and DKD risk. We also analyzed the data from the US National Health and Nutrition Examination Survey (NHANES) 2015-2018 using the same statistical methods; 4481, 1110, and 671 individuals were included in the non-DM, DM without DKD, and DKD groups, respectively.
The changes in ALT activity among the non-DM, DM without DKD, and DKD groups showed a similar pattern in both our clinical data and the NHANES dataset. ALT activity increases with the onset of DM, whereas ALT activity decreases when DM progresses to DKD. The GAM revealed a nonlinear -shaped relationship between ALT and DKD risk in the two datasets, and the lowest range of ALT was 40-50 IU/L. Both lower (<40 IU/L) and higher (>50 IU/L) ALT activity were found to be positively associated with DKD risk.
A -shaped nonlinear association between ALT and DKD was found in our clinical data and NHANES data. DKD risk was increased by both lower or higher ALT activity. To confirm the causality of nonlinear relationship, larger prospective studies or Mendelian randomization analysis are required.
多项研究探讨了丙氨酸氨基转移酶（ALT）与糖尿病（DM）之间的关联；然而，仅有少数研究专门考察了ALT与糖尿病肾病（DKD）之间的关系。本研究旨在利用临床数据探究ALT与DKD之间的关系。
对668名个体进行了一项横断面研究，其中包括非糖尿病患者（N = 281）、无DKD的糖尿病患者（N = 160）和DKD患者（N = 227）。采用广义相加模型（GAM）来检验ALT与DKD风险之间的剂量反应关系。我们还使用相同的统计方法分析了美国2015 - 2018年国家健康与营养检查调查（NHANES）的数据；非糖尿病组、无DKD的糖尿病组和DKD组分别纳入了4481、1110和671名个体。
在我们的临床数据和NHANES数据集中，非糖尿病组、无DKD的糖尿病组和DKD组之间的ALT活性变化呈现出相似的模式。ALT活性随着DM的发生而升高，而当DM进展为DKD时ALT活性降低。GAM显示两个数据集中ALT与DKD风险之间呈非线性关系，ALT的最低范围为40 - 50 IU/L。发现较低（<40 IU/L）和较高（>50 IU/L）的ALT活性均与DKD风险呈正相关。
在我们的临床数据和NHANES数据中发现ALT与DKD之间呈非线性关联。较低或较高的ALT活性都会增加DKD风险。为了证实这种非线性关系的因果性，需要进行更大规模的前瞻性研究或孟德尔随机化分析。
