Mức độ aminotransferase và gamma-glutamyl transpeptidase trong béo phì liên quan đến kháng insulin và hội chứng chuyển hóa

Journal of Endocrinological Investigation - Tập 28 - Trang 333-339 - 2014
G. Marchesini1, S. Avagnina2, E. G. Barantani3, A. M. Ciccarone4, F. Corica5, E. Dall’Aglio6, R. Dalle Grave7, P. S. Morpurgo8, F. Tomasi9, E. Vitacolonna10
1Metabolic Unit, Department of Internal Medicine and Gastroenterology, “Alma Mater Studiorum” University of Bologna, Bologna
2Unit of Dietetics and Clinical Nutrition, “San Giovanni Battista” Hospital, Turin
3Metabolic Rehabilitation, “San Giuseppe” Hospital, Piancavallo, Verbania
4Department of Endocrinology and Metabolism, University of Pisa, Pisa
5Department of Internal Medicine, University of Messina, Messina
6Center for Diabetes and Obesity, University of Parma, Parma
7Medical Department, “Villa Garda” Hospital, Garda, Verona
8Institute of Endocrine Sciences, “Maggiore” Hospital-IRCCS, University of Milan, Milan
9Unit of Dietetics and Clinical Nutrition, “S. Anna” Hospital, Ferrara
10Diabetes Unit, University of Chieti, Pescara, Italy

Tóm tắt

Giá trị mỡ trong gan qua siêu âm, với/không có sự tăng cao mức plasma của các enzym gan, là phổ biến trong tình trạng béo phì. Trong hầu hết các trường hợp, đây là dấu hiệu đặc trưng của bệnh gan nhiễm mỡ không do rượu (NAFLD), một bệnh có khả năng tiến triển liên quan đến kháng insulin và hội chứng chuyển hóa (MS). Chúng tôi kiểm tra giả thuyết rằng kháng insulin tự nó có thể liên quan đến hoại tử tế bào gan. Các aminotransferase alanine và aspartate (ALT và AST; n=799) và gamma-glutamyltranspeptidase (GGT; n=459) đã được phân tích trong một nhóm bệnh nhân béo phì tìm kiếm điều trị được tuyển chọn tại 12 trung tâm y tế ở Italy. Kháng insulin được tính toán theo phương pháp đánh giá mô hình về trạng thái cân bằng (HOMA-IR; n=522). Trung vị của ALT và AST tăng theo từng lớp béo phì (p=0.001 và p=0.005) và vượt qua giới hạn bình thường trong 21,0% các trường hợp. Ngoài ra, HOMA-IR cũng tăng theo lớp béo phì (p<0.0001) và cao hơn ở những người có ALT tăng (trung vị, 4.93 so với 2.89; p<0.0001). Một mối tương quan có ý nghĩa đã được quan sát giữa HOMA-IR và ALT (R2=0.208; p<0.0001), cũng như giữa HOMA-IR và AST hoặc GGT (R2=0.112 và R2=0.080; p<0.0001). Mối tương quan vẫn được duy trì khi các trường hợp có mức enzym cao bị loại trừ khỏi phân tích. Đái tháo đường và tăng triglycerid là những đặc điểm của MS thường xuyên liên quan đến mức enzym gan tăng. Trong hồi quy logistic, sau khi điều chỉnh cho tuổi, giới tính, chỉ số khối cơ thể (BMI) và các đặc điểm của MS, HOMA-IR giữ giá trị dự đoán cao cho mức ALT, AST và GGT tăng. Chúng tôi kết luận rằng trong béo phì, kháng insulin là yếu tố rủi ro cho mức enzym gan tăng, có thể liên quan đến NAFLD.

Từ khóa

#bệnh gan nhiễm mỡ không do rượu #kháng insulin #hội chứng chuyển hóa #aminotransferase #gamma-glutamyltranspeptidase #béo phì

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