Aminotransferase and gamma-glutamyltranspeptidase levels in obesity are associated with insulin resistance and the metabolic syndrome
Aminotransferase and gamma-glutamyltranspeptidase levels in obesity are associated with insulin resistance and the metabolic syndrome
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DOI：
10.1007/bf03347199
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发表时间：
2005-04-01
影响因子：
5.4
通讯作者：
Vitacolonna, E
中科院分区：
文献类型：
--
作者：
Marchesini, G;Avagnina, S;Vitacolonna, E
脂肪肝在超声检查中，有/没有肝酶的血浆水平升高，在肥胖症中很常见。在大多数情况下，它是非酒精性脂肪性肝病（NAFLD）的标志，这是一种与胰岛素抵抗和代谢综合征（MS）相关的潜在进行性疾病。我们检验了胰岛素抵抗本身可能与肝细胞坏死相关的假设。丙氨酸和天冬氨酸氨基转移酶（ALT和AST，数量= 799)和γ-谷氨酰转肽酶（GGT;编号= 459)在12个意大利医学中心招募的寻求治疗的肥胖患者中进行分析。通过稳态模型评估方法计算胰岛素抵抗（HOMO-IR;编号= 0.00001）。522）。中位ALT和AST随肥胖级别的增加而增加（p=0.001和p=0.005），21.0%的病例超过正常范围。HOMO-IR也随着肥胖等级的增加而增加（p < 0.0001），并且在ALT升高的受试者中更高（中位数，4.93 vs 2.89; p < 0.0001）。HOMA-IR与ALT之间（R-2=0.208; p < 0.0001）以及HOMA-IR与AST或GGT之间（R-2=0.112和R-2=0.080; p < 0.0001）存在显著相关性。当从分析中省略酶水平升高的病例时，相关性得以维持。糖尿病和高甘油三酯血症是MS的特征，最常与肝酶升高相关。在logistic回归分析中，校正年龄、性别、BMI和MS特征后，HOMA-IR对ALT、AST和GGT升高具有高度预测价值。我们的结论是，在肥胖胰岛素抵抗是一个危险因素，肝酶水平升高，可能与非酒精性脂肪肝。(c)2005年，Editrice Kurtis。
Fatty liver at ultrasounds, with/without raised plasma levels of hepatic enzymes, is common in obesity. In most cases, it is the hallmark of non-alcoholic fatty liver disease (NAFLD), a potentially progressive disease associated with insulin resistance and the metabolic syndrome (MS). We tested the hypothesis that insulin resistance per se might be associated with hepatocellular necrosis. Alanine and aspartate aminotransferases (ALT and AST, no.=799) and gamma-glutamyltranspeptidase (GGT; no.=459) were analyzed in a group of treatment-seeking obese patients recruited in 12 Italian medical centers. Insulin resistance was calculated by the homeostasis model assessment method (HOMO-IR; no.=522). Median ALT and AST increased with increasing obesity class (p=0.001 and p=0.005) and exceeded normal limits in 21.0% of cases. Also HOMO-IR increased with the obesity class (p < 0.0001), and was higher in subjects with elevated ALT (median, 4.93 vs 2.89; p < 0.0001). A significant correlation was observed between HOMA-IR and ALT (R-2=0.208; p < 0.0001), as well as between HOMA-IR and AST or GGT (R-2=0.112 and R-2=0.080; p < 0.0001). The correlation was maintained when cases with elevated enzyme levels were omitted from analysis. Diabetes and hypertriglyceridemia were the features of the MS most commonly associated with raised liver enzymes. In logistic regression, after correction for age, gender, BMI and features of the MS, HOMA-IR maintained a highly predictive value for raised ALT, AST and GGT. We conclude that in obesity insulin resistance is a risk factor for raised liver enzyme levels, possibly related to NAFLD. (c) 2005, Editrice Kurtis.