丙氨酸转氨酶和天冬氨酸转氨酶是反映HBeAg阴性慢性乙型肝炎肝组织炎性分级的敏感指标

目的 分析HBeAg阴性慢性乙型肝炎(CHB)自然病程中血清ALT和AST水平,以及由相同肝实质细胞体积分摊的血清ALT和AST水平与肝组织炎症活动度分级的关系.方法 检测HBeAg阴性CHB患者肝组织病理学不同炎症活动度分级患者血清ALT和AST水平,以及相同肝实质细胞体积分摊的血清ALT和AST水平.数据经ANOVA检验.结果 145例CHB肝组织炎症活动度分级G1～G4级患者血清ALT水平分别为(35.3±29.1)、(91.6±120.4)、(111.6±116.1)和(118.0±122.1)U/L,用相同肝脏实质细胞体积分摊后的血清ALT水平分别为(54.0±45.1)、(144.2±184.9)、(191.3±204.8)和(215.1±226.5)U/L,G1级分别与G2～G4两两比较,差异有统计学意义(P＜0.05);G1～G4的AST水平分别为(35.5±29.0)、(64.9±71.7)、(96.0±81.9)和(102.8±77.0)U/L,相同肝脏实质细胞体积分摊后的血清AST水平分别为(54.3±44.6)、(102.3±107.9)、(165.2±148.7)和(189.4±145.4)U/L,G1与G3、G1与G4、G2与G3、G2与G4比较,差异有统计学意义(P＜0.05).结论 HBeAg阴性CHB自然病程中,ALT和AST均是反映肝组织炎症活动度分级严重性的较为敏感的指标.

Abstract：

Objective To investigate the relationship between serum levels of alanine aminotransferase (ALT)or aspartate aminotransferase (AST)apportioned by the same hepatic parenchyma cell volume and liver histological necroinflammation grades in HBeAg-negative chronic hepatitis B (CHB)patients.Methods A total of 145 CHB patients were divided into four groups:Gl,G2,G3 and G4 based on the liver histological necroinflammation grade.The serum ALT and AST levels were determined by automatic biochemical instrument in these four groups.Furthermore,serum ALT and AST levels were then apportioned by the same hepatic parenchyma cell volume.The data were analyzed by ANOVA.Results Mean serum ALT levels in G1,G2,G3 and G4 groups were (35.3±29.1),(91.6±120.4),(111.6± 116.1)and (118.0±122.1)U/L,respectively,and the serum ALT levels apportioned by same hepatic parenchyma cell volume were ( 54.0 ± 45.1 ),( 144.2 ± 184.9 ),(191.3± 204.8)and (215.1 ± 226.5)U/L,respectively.The pairwise comparison between G1 and other three groups all showed statistically significant difference (P＜0.05).Meanwhile,AST levels in G1 to G4 groups were (35.5± 29.0),(64.9±71.7),(96.0±81.9)and (102.8±77.0)U/L,respectively and the serum AST levels apportioned by the same hepatic parenchyma cell volume were (54.3±44.6),(102.3± 107.9),(165.2±148.7)and (189.4±145.4)U/L,respectively.The pairwise comparison between G1 and G3,G1 and G4,G2 and G3,G2 and G4 all showed statistically significant difference (P＜0.05).Conclusion Both AST and ALT levels are sensitive indicators for liver inflammation grading in HBeAg-negative CHB patients during the natural history of the disease.     

2型糖尿病患者丙氨酸氨基转移酶、天冬氨酸氨基转移酶水平与代谢紊乱、胰岛素抵抗之间的关系

目的探讨2型糖尿病患者丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)与胰岛素抵抗和代谢紊乱之间的关系。方法分析了806例2型糖尿病住院患者和103例健康体检者ALT、AST、体脂参数、血压、血脂、血糖、外周白细胞计数(WBC)水平,采用稳态模式(HOMA)评价胰岛素抵抗。根据ALT四分间距,分为ALT1组(<10 U/L)、ALT2组(10~14.9 U/L)、ALT3组(15~21.9 U/L)和ALT4组(≥22 U/L)。结果随着ALT水平升高,空腹胰岛素(FINS)和HOMA-IR呈升高趋势(P<0.05)。随着代谢紊乱数目增多,Log ALT和Log AST呈升高趋势(P<0.05)。校正性别和年龄后LogALT与LogFINS和LogHOMA-IR仍呈正相关(P<0.05),LogAST与LogHOMA-IR仍呈正相关(P<0.05)。多元逐步回归分析显示,Log ALT与代谢紊乱数目和LogHOMA-IR呈独立正相关(P<0.05)。结论2型糖尿病患者ALT、AST水平升高与胰岛素抵抗、代谢紊乱密切相关。     

Serum γ-glutamyltransferase, alanine aminotransferase, and aspartate aminotransferase activity in Iranian healthy blood donor men

AIM: To determine serum γ-glutamyltransferase (GGT), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) activity, and to assess their correlation with demographic and clinical findings in healthy blood donors.METHODS: This cross-sectional study was performed in 934 male blood donors, aged 18 to 68 years, who consecutively attended Tehran blood transfusion service in 2006. All participants were seronegative for HBV or HCV infections, non alcohol users, and all underwent a standard interview and anthropometric tests. Clinical and biochemical parameters including AST, ALT, and GGT activities were determined. Patients taking drugs known to cause hepatic fat deposition were excluded. For AST, ALT, and GGT variables, we used 33.33 and 66.66 percentiles, so that each of them was divided into three tertiles.RESULTS: Mean AST, ALT, and GGT activities were 25.26 ± 12.58 U/L (normal range 5-35 U/L), 33.13 ± 22.98 (normal range 5-35 U/L), and 25.11 ± 18.32 (normal range 6-37 U/L), respectively. By univariate analyses, there were significant associations between increasing AST, ALT, or GGT tertiles and age, body weight, body mass index, and waist and hip circumferences (P < 0.05). By multiple linear regression analyses, ALT was found to be positively correlated with dyslipidemia (B = 6.988, P = 0.038), whereas ALT and AST were negatively correlated with age. AST, ALT, and GGT levels had positive correlation with family history of liver disease (B = 15.763, P < 0.001), (B = 32.345, P < 0.001), (B =24.415, P < 0.001), respectively.CONCLUSION: Although we did not determine the cutoffs of the upper normal limits for AST, ALT, and GGT levels, we would suggest screening asymptomatic patients with dyslipidemia and also subjects with a family history of liver disease.     

Serum γ-glutamyltransferase, alanine aminotransferase, and aspartate aminotransferase activity in Iranian healthy blood donor men

AIM： To determine serum γ-glutamyltransferase （GGT）, alanine aminotransferase （ALT）, and aspartate aminotransferase （AST） activity, and to assess their correlation with demographic and clinical findings in healthy blood donors.
METHODS： This cross-sectional study was performed in 934 male blood donors, aged 18 to 68 years, who consecutively attended Tehran blood transfusion service in 2006. All participants were seronegative for HBV or HCV infections, non alcohol users, and all underwent a standard interview and anthropometric tests. Clinical and biochemical parameters including AST, ALT, and GGT activities were determined. Patients taking drugs known to cause hepatic fat deposition were excluded. For AST, ALT, and GGT variables, we used 33.33 and 66.66 percentiles, so that each of them was divided into three tertiles.
RESULTS： Mean AST, ALT, and GGT activities were 25.26 ± 12.58 U/L （normal range 5-35 U/L）, 33.13 ± 22.98 （normal range 5-35 U/L）, and 25.11±18.32 （normal range 6-37 U/L）, respectively. By univariate analyses, there were significant associations between increasing AST, ALT, or GGT tertiles and age, body weight, body mass index, and waist and hip circumferences （P 〈 0.05）. By multiple linear regression analyses, ALT was found to be positively correlated with dyslipidemia （B = 6.988, P = 0.038）, whereas ALT and AST were negatively correlated with age. AST, ALT, and GGT levels had positive correlation with family history of liver disease （B = 15.763, P 〈 0.001）, （B = 32.345, P 〈 0.001）, （B =24.415, P 〈 0.001）, respectively.
CONCLUSION： Although we did not determine the cutoffs of the upper normal limits for AST, ALT, and GGT levels, we would suggest screening asymptomatic patients with dyslipidemia and also subjects with a family history of liver disease.     

Determination of the upper cut-off values of serum alanine aminotransferase and aspartate aminotransferase in Chinese

AIM:To determine the upper cut-off values of serumalanine aminotransferase(ALT)and aspartate aminotransferase(AST)in a Northern Chinese population.METHODS:A total of 3769 subjects in Jilin Province Northeast China were stratified to determine the potential factors affecting serum ALT and AST levels.The upper cut-off values of serum ALT and AST in these subjects were determined using receiver operating characteristic analysis and their sensitivity and specificity were evaluated.RESULTS:Stratification analysis revealed that serum ALT and AST levels were associated with gender,alcohol consumption,serum cholesterol and triglyceride levels,and body mass index.The upper cut-off values of serum ALT and AST were 22.15 U/L and 25.35 U/L for healthy men and 22.40 U/L and 24.25 U/L for healthy women,respectively.The new cut-off values had a higher sensitivity,but a slightly lower specificity than the current standards.CONCLUSION:Our results indicate that the new upper cut-off values of serum ALT and AST are markedly lower than current standards and may be valuable for the evaluation of liver function.     

中老年人血清丙氨酸氨基转移酶水平与代谢综合征的相关性研究

目的 研究中老年人血清丙氨酸氨基转移酶(ALT)水平与代谢综合征的相关性.方法 对上海市宝山区友谊街道1 664名40岁以上居民进行问卷调查、体格检查以及空腹采血检测肝肾功能、血糖及血脂等生化指标.代谢综合征采用按照亚洲人特点改良的美国国家胆固醇教育计划成人治疗组第三次报告(NCEP-ATP Ⅲ)诊断标准.结果 研究对象各主要代谢指标均随着ALT水平的升高而逐渐趋向恶化.代谢综合征的患病率从第一个ALT四分位至第四个ALT四分位分别为29.2%、38.0%、44.9%和62.9%(组间趋势P<0.01).血清ALT水平与代谢综合征及其多个组分的患病风险之间存在显著的剂量一反应关系.相比ALT水平在第一个四分位的研究对象,ALT水平在第四个四分位的研究对象代谢综合征患病风险增加146%,中心性肥胖风险增加204%,高血压风险增加35%,高甘油三酯风险增加133%,高血糖风险增加72%.另外,随着代谢综合征组分个数的增加,ALT水平显著上升(组间趋势P<0.01).结论 中老年人血清ALT水平升高增加代谢综合征的患病风险.     

Individual and combined relationship of serum uric acid and alanine aminotransferase on metabolic syndrome in adults in Qingdao,China

Background and aimsAssociations of alanine aminotransferase (ALT) and serum uric acid (SUA) with metabolic syndrome (MetS) remain controversial. We aimed to explore individual and combined effects of ALT and SUA on MetS in community residents.Methods and resultsA population-based cross-sectional survey involving randomly selected Chinese adults aged 35–74 years was conducted in 2009 in Qingdao, China, and 4642 participants were included in the current study. Based on a combination of SUA and ALT levels in the tertile, subjects were grouped into Group 1-9. The individual and combined relations of SUA and ALT to MetS were analyzed by logistic regression models. The prevalence of MetS was 28.50% in males and 22.30% in females. ALT and SUA were independently associated with MetS and ORs (95% CIs) were 1.55 (1.42–1.70) and 1.92 (1.72–2.14), respectively, after adjusting for potential confounders. With the elevation of ALT and SUA levels, the risk of developing MetS increased. Compared to Group 1, ORs (95% CIs) of combined ALT and SUA for MetS were 2.21 (1.70–2.88), 4.02 (3.10–5.21), 2.19 (1.62–2.97), 2.53 (1.91–3.34), 4.69 (3.60–6.12), 1.76 (1.17–2.64), 3.65 (2.63–5.06) and 7.15 (5.41–9.46) in Group 2–9, respectively.ConclusionsALT and SUA were both related to MetS independently. Combined elevation of ALT and SUA levels could increase the risk of MetS and its components than an elevation in SUA and ALT alone. Therefore, measures should be taken to lower SUA and ALT levels to reduce the risk of having MetS.     

The presence of anti-mitochondrial antibodies in Chinese patients with liver involvement in systemic lupus erythematosus

Sixty-six hospitalized patients with systemic lupus erythematosus (SLE) were enrolled into this study. The test for anti-mitochondrial antibodies (AMAs) was performed and biochemical parameters were determined. AMAs were detected in 15 of the 66 patients with SLE. Meanwhile, we compared enzymatic levels in AMA-positive and -negative patients and found that serum aminotransferase levels were significantly higher in AMA-positive patients than in AMA-negative individuals. Furthermore, we found a positive correlation between serum AMA titration and serum aminotransferase levels. This study suggests that AMAs might contribute to the elevation of aminotransferases. Although much remains to be learned about the pathogenesis of autoimmune liver disease associated with AMAs, this report might provide greater insight into the metabolic mechanisms of AMAs in AMA-positive patients.     

Alanine aminotransferase and the 6-year risk of the metabolic syndrome in Caucasian men and women: the Hoorn Study.

AIMS: To study the association between alanine aminotransferase (ALT) and the 6-year risk of the metabolic syndrome in a population-based study in Caucasian men and women. METHODS: The association of ALT with the 6-year risk of the metabolic syndrome in 1097 subjects, aged 50-75 years, was assessed in the Hoorn Study with logistic regression analysis. Subjects with the metabolic syndrome at baseline, defined according to the Adult Treatment Panel III of the National Cholesterol Education Program, were excluded. RESULTS: After 6.4 (range 4.4-8.1) years follow-up, 226 subjects (20.6%) had developed the metabolic syndrome. The odds ratio (95% confidence interval) for developing the metabolic syndrome, adjusted for age, sex, alcohol intake and follow-up duration was 2.25 (1.50-3.37) for subjects in the upper tertile compared with those in the lower tertile of ALT. This association persisted after additional adjustment for all the baseline metabolic syndrome features [1.62 (1.02-2.58)]. Among the individual components of the metabolic syndrome, ALT was significantly associated only with fasting plasma glucose at follow-up. CONCLUSIONS: These data suggest that ALT is associated with risk of the metabolic syndrome in a general population of middle-aged Caucasian men and women, further strengthening the role of ALT as an indicator for future metabolic derangement. These findings warrant further studies to elucidate the role of non-adipose tissue fat accumulation in the pathogenesis of complications related to the metabolic syndrome.     

Protein kinase C alpha, epsilon and AP-1 mediate prolactin regulation of mitochondrial aspartate aminotransferase expression in the rat lateral prostate

Citrate accumulation and secretion are physiological functions of the prostate gland that are regulated by testosterone and prolactin. The metabolic pathway for citrate production in the prostate involves the activity of mitochondrial aspartate aminotransferase (mAAT). The expression of mAAT in the prostate is regulated by prolactin through a signal transduction pathway mediated by protein kinase C (PKC). In this report we determined which PKC isoforms are expressed in rat lateral prostate epithelial cells and their activation by prolactin. Eight PKC isoforms are expressed in the ventral and lateral prostate lobes. Although all eight isoforms are expressed, only PKC and PKC were stimulated by prolactin and only in the lateral prostate lobe. Activator protein-1 (AP-1) appears to be the target of prolactin-PKC signaling because prolactin stimulated nuclear protein binding to an AP-1 consensus oligodeoxynucleotide. Moreover, the nuclear binding protein stimulated by prolactin also bound an mAAT oligodeoxynucleotide that contained an AP-1 consensus sequence and which competed for binding with the consensus AP-1 oligodeoxynucleotide. A PKC antisense oligodeoxynucleotide blocked expression of mAAT mRNA. Thus, we conclude that PKC is a specific PKC isoform that mediates via AP-1 the signal for prolactin regulation of mAAT gene expression in rat lateral prostate epithelial cells.     

天冬氨酸氨基转移酶/血小板指数预测慢性乙型肝炎患者肝组织病理状态的价值

目的探讨天冬氨酸氨基转移酶/血小板指数（APRI）预测慢性乙型肝炎患者肝组织病理状态的价值。方法对慢性乙型肝炎171例患者进行肝穿刺行病理学分级和分期检查。检测患者血清天冬氨酸氨基转移酶（AST）和血小板（BPC）计数。采用单因素方差分析评价受试者工作特征（ROC）曲线下面积。结果AST和APRI在G1与G2之间有显著性差异（P=0.001和0.002）,在G2与G3、G3与G4之间均无显著性差异（P=0.926和0.551、0.926和0.805）;BPC在G1与G2、G2与G3、G3与G4之间均无显著性差异（P=0.464、0.388、0.218）。AST和APRI在S0与S1、S1与S2、S2与S3、S3与S4之间均无显著性差异（P=0.203和0.747、0.378和0.265、0.714和0.256、0.916和1.000）;BPC在S2与S3之间有显著性差异（P=0.008）,在S0与S1、S1与S2、S3与S4之间均无显著性差异（P=0.670、0.815、0.180）。AST和APRI预测G2～4的ROC曲线下面积分别为0.76和0.71（95%CI分别为0.67～0.86和0.61～0.80）,最佳截断值分别为74.0U/L和0.84;当AST≥74.0U/L和APRI≥0.84时,其预测G2～4的灵敏度、特异度、阳性预测值、阴性预测值、准确度、Youden指数分别为61%和54%、83%和83%、95%和94%、37%和27%、65%和59%、44%和36%。BPC预测S3～4的ROC曲线下面积为0.31（95%CI为0.23～0.39）,最佳截断值为141.50×109/L;当BPC≤141.50×109/L时,其预测S3～4的灵敏度、特异度、阳性预测值、阴性预测值、准确度、Youden指数分别为82%、55%、66%、74%、69%、37%。结论APRI对乙型肝炎相关性显著的炎症活动（G2～4）有一定的预测价值,但不优于AST;APRI对乙型肝炎相关性显著的肝纤维化（S2～4）或严重肝纤维化（S3～4）或肝硬化（S4）无预测价值,而BPC对乙型肝炎相关性严重的肝纤维化（S3～4）有预测价值。     

慢性乙型肝炎患者肝纤维化分级中AST/PLT比值指数的临床研究

目的评价天门冬氨酸氨基转移酶(AST)与血小板(PLT)比值在预测慢性乙型肝炎(CHB)肝纤维化分级中的作用。方法将178例CHB合并肝纤维化患者肝组织纤维化程度进行Ishak分期,同时检测患者AST和PLT,计算AST与PLT比值指数(APRI)。比较患者不同肝纤维化分期与APRI间的关系,通过APRI的受试者工作特征(ROC)曲线下面积,分析其预测显著肝纤维化及肝硬化的准确率,并对CHB肝纤维化患者抗病毒治疗前后肝组织纤维化分期和APRI的变化进行对比分析。结果 APRI与肝纤维化程度呈正比(P=0.001),APRI预测CHB进展为显著肝纤维化ROC曲线下面积为0.795,而预测肝硬化的ROC曲线下面积为0.714(P=0.003),APRI1.5和2分别为显著肝纤维化和肝硬化的截断点,其阳性预测值分别为96%和75%,阴性预测值分别为44%和74%。CHB患者经抗病毒药物治疗后,肝组织学检查结果显示其纤维化程度比治疗前明显减轻,而APRI也明显降低。结论 APRI可作为预测CHB患者发生显著肝纤维化及肝硬化的指标之一。     

Validation of aspartate aminotransferase to platelet ratio for diagnosis of liver fibrosis and prediction of postoperative prognosis in infants with biliary atresia

AIM: To validate the value of aspartate aminotransferase to platelet ratio index(APRI) in assessment of liver fibrosis and prediction of postoperative prognosis of biliary atresia(BA) infants from Mainland China.METHODS: Medical records of 153 BA infants who were hospitalized from January 2010 to June 2013 were reviewed. The efficacy of APRI for diagnosis of liver fibrosis was assessed using the receiver operator characteristic(ROC) curve compared to thepathological Metavir fibrosis score of the liver wedge specimens of 91 BA infants. The prognostic value of preoperative APRI for jaundice persistence, liver injury,and occurrence of cholangitis within 6 mo after KP was studied based on the follow-up data of 48 BA infants.RESULTS: APRI was significantly correlated with Metavir scores(rs = 0.433; P 0.05). The mean APRI value was 0.76 in no/mild fibrosis group(Metavir score F0-F1), 1.29 in significant fibrosis group(F2-F3), and2.51 in cirrhosis group(F4)(P 0.001). The area under the ROC curve(AUC) of APRI for diagnosing significant fibrosis and cirrhosis was 0.75(P 0.001)and 0.81(P = 0.001), respectively. The APRI cut-off of 0.95 was 60.6% sensitive and 76.0% specific for significant fibrosis diagnosis, and a threshold of 1.66 was 70.6% sensitive and 82.7% specific for cirrhosis.The preoperative APRI in infants who maintained jaundice around 6 mo after KP was higher than that in those who did not(1.86 ± 2.13 vs 0.87 ± 0.48, P 0.05). The AUC of APRI for prediction of postoperative jaundice occurrence was 0.67. A cut-off value of0.60 showed a sensitivity of 66.7% and a specificity of 83.3% for the prediction of jaundice persistence.Preoperative APRI had no significant association with later liver injury or occurrence of cholangitis.CONCLUSION: Our study demonstrated that APRI could diagnose significant liver fibrosis, especially cirrhosis in BA infants, and the elevated preoperative APRI predicts jaundice persistence after KP.     

Association between vitamin D status and metabolic syndrome risk among Korean population: based on the Korean National Health and Nutrition Examination Survey IV-2, 2008

Aims

Pyruvate dehydrogenase kinase 4 (PDK4) plays a crucial role in glucose utilization and lipid metabolism by regulating the pyruvate dehydrogenase complex (PDC) and is an emerging therapeutic target for type 2 diabetes. To date, no study has specifically examined the relationship between PDK4 gene polymorphisms and type 2 diabetes or metabolic syndrome.

Methods

The association of common single nucleotide polymorphisms (SNPs) was examined in PDK4 [−208A/G (rs10085637), IVS3 + 192C/T (rs3779478), IVS6 + 31A/G (rs2301630), IVS7 + 514A/G (rs12668651), IVS10 + 75C/T (rs10247649)] with type 2 diabetes and metabolic syndrome in 651 Korean subjects with type 2 diabetes and 350 nondiabetic Korean subjects. The association of these SNPs with clinical parameters related to metabolic syndromes including obesity, hyperglycemia, hypertension, and dyslipidemia was also examined.

Results

No significant association was found between the studied SNPs and type 2 diabetes, metabolic syndrome, or clinical parameters. The PDK4 gene haplotype ACAGC showed a modest association with type 2 diabetes. However, the significance of this association was lost after considering for multiple comparisons.

Conclusions

PDK4 polymorphisms may not be associated with type 2 diabetes or metabolic syndrome. Further studies utilizing a larger study population are required to confirm these results.     

声触诊组织量化联合天门冬氨酸氨基转移酶/血小板比值对慢性乙型肝炎患者肝纤维化分期的诊断价值研究*

目的 探讨声触诊组织量化（VTQ）联合天门冬氨酸氨基转移酶/血小板比值（APRI）对慢性乙型肝炎患者肝纤维化分期的诊断价值。 方法 2014年11月~2016年12月我院收治的慢性乙型肝炎患者103例,行肝穿刺活检病理学检查,另选同期在我院健康体检者36例作为对照组。两组均进行VTQ检查,同时计算APRI值,分析VTQ和APRI值与肝纤维化的相关性,观察联合检测对F2期以上肝纤维化的诊断价值。 结果 35例F4组患者年龄为（44.10±8.89）岁,明显大于健康人的（33.15±8.08）岁、20例F1组的（34.02±7.36） 岁和19例F3组的（38.55±9.39）岁（P<0.05）;F4组患者右肝斜径（ODRL）为（121.51±8.61） mm,明显短于健康人的（126.61±8.54） mm、F1组的（126.59±8.71） mm、29例F2组的（128.96±9.01） mm和F3组的（128.88±8.66） mm（P<0.05）;F4组VTQ值为（1.89±0.39） m/s,明显大于健康人的（1.11±0.14） m/s、F1组的（1.29±0.26） m/s、F2组的（1.35±0.25 m/s）和F3组的（1.55±0.24） m/s,VTQ值随患者肝纤维化程度的升高而增高（P<0.05）;健康人APRI值为（0.16±0.06）,明显小于F1组的（0.23±0.15）、F2组的（0.30±0.18）、F3组的（0.36±0.34）、F4组的（0.45±0.46）,APRI值随患者肝纤维化程度的升高而上升（P<0.05）;肝纤维化病理学分期与VTQ呈正相关（95%CI: 0.715~0.893,r=0.804,P<0.001）,与APRI呈负相关（95%CI: 0.583~0.781,r=0.681,P<0.001）;经分析VTQ与APRI诊断肝纤维化的ROC曲线,发现它们诊断F1期的AUC分别为0.873 对 0.811,诊断F2期的AUC分别为0.882 对0.861,诊断F3期的AUC分别为0.941 对0.861,诊断F4期的AUC分别为0.940 对0.817,显示VTQ诊断的AUC均大于APRI。以肝纤维化程度大于F2期为诊断显著肝纤维化的标准,发现VTQ诊断的特异度和阳性预测值均明显高于VTQ/APRI比值或APRI。 结论 VTQ和APRI与慢性乙型肝炎患者肝纤维化分期相关,VTQ联合APRI检测F2级以上肝纤维化诊断效能更佳。     

SGLT2 inhibitors and incretin agents: Associations with alanine aminotransferase activity in type 2 diabetes

Aim

The impact of new classes of glucose lowering medications on markers of non-alcoholic fatty liver disease (NAFLD) associated with type 2 diabetes (T2D) have been inconsistent in their magnitude and independence. This large retrospective study investigates changes in alanine aminotransferase (ALT) levels among subjects initiated on newer classes of T2D medications in comparison to a reference control group.

Endothelial dysfunction in metabolic syndrome: Prevalence,pathogenesis and management

The metabolic syndrome (MetS) is characterized by the presence of central obesity, impaired glucose metabolism, dyslipidemia and hypertension. Several studies showed that MetS is associated with increased risk for type 2 diabetes mellitus (T2DM) and vascular events. All components of MetS have adverse effects on the endothelium. Endothelial dysfunction plays a role in the pathogenesis of atherosclerosis and might also increase the risk for insulin resistance and T2DM. We review the prevalence and pathogenesis of endothelial dysfunction in MetS. We also discuss the potential effects of lifestyle measures and pharmacological interventions on endothelial function in these patients. It remains to be established whether improving endothelial function in MetS will reduce the risk for T2DM and vascular events.     

Circadian disruption in the pathogenesis of metabolic syndrome

Metabolic syndrome is a multifactorial process induced by a combination of genetic and environmental factors and recent evidence has highlighted that circadian disruption and sleep loss contribute to disease pathogenesis. Emerging work in experimental genetic models has provided insight into the mechanistic basis for clock disruption in disease. Indeed, disruption of the clock system perturbs both neuroendocrine pathways within the hypothalamus important in feeding and energetics, in addition to peripheral tissues involved in glucose and lipid metabolism. This review illustrates the impact of molecular clock disruptions at the level of both brain and behavior and peripheral tissues, with a focus on how such dysregulation in turn impacts lipid and glucose homeostasis, inflammation and cardiovascular function. New insight into circadian biology may ultimately lead to improved therapeutics for metabolic syndrome and cardiovascular disease in humans.