Relationship of Alanin Aminotransferase and Γ-glutamyltransferase

7/23/2019 Relationship of Alanin Aminotransferase and -glutamyltransferase

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REVISTAMEDICALROMN VOLUMULLXI, NR. 3, An 2014196

PROBLEME DE CERCETARE

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REZUMAT

Obiective. Scopul studiului a fost evaluarea asocierilor enzimelor hepatice, respectiv alaninaminotransferaza(ALT), aspartataminotransferaza (AST) i -glutamiltransferaza (GGT) cu sindromul metabolic (SM) i diferitelesale componente la pacieni cu DZ2 nou descoperit, precum i cu unii parametri ai insulinorezistenei i uneleadipocitokine.Material i metod. Am realizat un studiu cross-secional ce a inclus 227 de persoane (113 femei i 114brbai) cu diabet zaharat tip 2 (DZ2) nou descoperit. Am analizat parametrii antropometrici, clinici, biochimicii unele adipocitokine n funcie de prezena SM, de numrul de componente ale sindromului i dupstratificareape quartile de AST, respectiv GGT.Rezultate.86,6% din pacienii cu DZ2 nou descoperit au prezentat i SM. Valorile AST s-au corelat negativ cu

vrsta (p


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REVISTAMEDICALROMN VOLUMULLXI, NR. 3, An 2014 197

ol (p


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Datele despre stilul de via(fumatul, consumulde alcool), despre antecedentele heredo-colateralei personale patologice i despre tratamente medica-mentoase cronice au fost obinute prin anamnez.S-au determinat greutatea i nlimea, CA, indicelede mas corporal (IMC). Probele de snge s-au

recoltat dimineaa, dup8-10 ore de repaus alimen-tar. Glicemia jeun (mg/dl), hemoglobina glicat(HbA1c) (%), colesterolul total (mg/dl), colesterolulcu densitate mare (HDL-colesterolul; mg/dl), TG(mg/dl), creatinina (mg/dl), acidul uric (mg/dl), ALT(U/l), AST (U/l), GGT (U/l) au fost msurate utili-znd metode biochimice curente. Colesterolul cudensitate mic (LDL-colesterolul) a fost calculatfolosind formula Friedewald (16). Concentraiileserice ale insulinei, proinsulinei, peptidului C, lep-tinei, adiponectinei au fost determinate prin tehnica

ELISA, folosind kituri disponibile comercial (EIA-2935, EIA-1560, EIA-1293, EIA-2395 i EIA-4177;DRG Instruments, Germania), n conformitate curecomandrile productorului. Citirea absorbane-lor s-a realizat pe un cititor de plci Multiskan Ex-Thermo Electro Corporation (CV = 2,6%). Rezis-tena la insulin a fost apreciat prin calculareaHOMA-IR (Homeostasis Model Asessment for In-sulin Resistance): [glicemie (mmol/l) x insulinemie(U/ml)]: 22,5 (17).

Rezultatele pentru variabile continue sunt pre-zentate ca medie deviaie standard (DS) sau caprocente. Evaluarea diferenelor dintre subloturile

analizate a fost realizatfolosind Student t test pen-tru variabilele numerice i testul 2 pentru vari-abilele nominale sau ordinale. Pentru testarea dife-renei dintre mediile a mai multe grupe diferite s-afolosit analiza de varianunifactorial(One-wayANOVA). Metoda de corelaie bivariatPearson a

fost utilizatpentru a examina corelaiile dintre va-riabile. Semnificaia statistic a fost definit ca p


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n rndul brbailor), HDL-colesterol, leptin iadiponectin (p


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i n funcie de diferitele sale componente. Rezulta-tele obinute documenteazo prevalendestul demare a valorilor crescute ale AST i GGT la paci-enii cu DZ2 nou diagnosticat (18,06%, respectiv28,2%) precum i asocierea dintre acestea i com-ponentele SM. Dei valorile ALT nu au fost sem-

nificativ mai crescute la pacienii cu DZ2 i SM fa-de cei frSM, acestea s-au corelat cu numrulcriteriilor SM ndeplinite de ctre o persoan, ceeace subliniazasocierea cu tulburri metabolice maicomplexe. Nivelul ALT a fost mai mare la brbaifade femei i am descris o asociere negativ aALT cu vrsta, n concordancu alte date din lite-ratur(19,20). Valorile ALT s-au corelat pozitiv cuCA, element central al SM, excesul ponderal fiindraportat n alte studii ca factor de risc pentru cre-terea ALT (21). Persoanele din quartilele superioare

de ALT au avut valori semnificativ mai mari pentruTG i raport TG/HDL-colesterol i mai mici pentruHDL-colesterol, ceea ce aratlegtura dintre ALTi dislipidemia aterogen, precum i pentru insulin,proinsulini HOMA-IR. Rezultatele noastre suntn concordancu cele din literatur, care au artatc ALT a fost semnificativ asociat cu insulinore-zistena la persoanele cu SM (22) i la pacienii cuDZ2 nou descoperit (23).

Nivelul GGT a fost semnificativ mai mare la pa-cienii cu DZ2 nou diagnosticat i SM comparativcu cei frSM i s-a corelat cu numrul de criteriiale SM. Asocierea mai bun a GGT cu SM lapacienii studiai ar putea fiexplicatfie prin prismancrcrii grase a ficatului pe care GGT so reflecteprobabil cu o mai mare acuratee, fie prin prismaimplicrii GGT n catabolismul extracelular al glu-tationului (24). GGT este astfel legatde cretereastresului oxidativ, ca marker nespecific. Prin acestmecanism GGT ar putea fimai strns corelat cu in-sulinorezistena i SM, ntruct este cunoscutim-

plicarea stresului oxidativ ca mecanism patogenic

ce leaginsulinorezistena de disfuncia beta celu-lar(25). Relaia dintre valorile GGT, obezitate iapariia SM a fost puspe seama acestui mecanism(26). De altfel, am documentat corelaia dintre GGTi insulinorezisten (evaluat prin insulinemie iHOMA-IR). Pe lngparametrii dislipidemiei atero-

gene, GGT s-a corelat i cu LDL-colesterolul, ceeace ar putea sugera un factor suplimentar de riscpentru BCV. GGT s-a corelat negativ cu adiponec-tina, observaie concordantcu alte date din litera-tur(27).

CONCLUZII

Rezultatele noastre documenteazasocierea din-tre ALT i GGT componentele clasice ale SM (nspecial HDL-colesterol sczut i TG crescute), dari cu insulinorezistena la persoanele cu DZ2 noudescoperit. AST este corelat cu distribuia de tipcentral a excesului de esut adipos (evaluat prinCA). n plus GGT se coreleaznegativ cu adipo-nectina. Determinarea acestor enzime hepatice esterecomandatla pacienii cu DZ2, ncde la debut,ca marker pentru SM i pentru identificarea unuisubgrup de persoane cu tulburri metabolice maicomplexe ce ar putea semnifica un risc cardiovas-cular mai mare.

MULUMIRI

Aceast lucrare a fost susinutde un grant alAutoritii Naionale Romne pentru Cercetaretiinific, CNCS-UEFISCDI, PN-II-ID-PCE-2011-3-0429. Mulumim doamnelor Manuela Mitui Janeta Tudosoiu de la laboratorul de cercetare alInstitutului Naional de Diabet, Nutriie i BoliMetabolice N.C. Paulescu pentru excelenta asis-tenacordatpe parcursul studiului.

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Relationship of Alanin Aminotransferase and Γ-glutamyltransferase

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