肝臟轉胺酶Alanine Aminotransferase的上升與糖尿病之發生

Rising ALT Levels and the Development of Type 2 Diabetes

汪忠川(Chong-Shan Wang)

《台灣老年醫學暨老年學雜誌》 3卷1期 (2007/08) Pp. 54-63

https://doi.org/10.29461/TGG.200708.0005

摘要

糖尿病與肝功能ALT(GPT)上升有關，但是否ALT上升會增加糖尿病發生的危險性則未確定。我們回溯追蹤一位從1990年起長期在衛生所就診的83歲女性老人糖尿病發生的經過。這位老人沒有糖尿病家族史，沒有抽菸喝酒習慣，沒有使用類固醇或與糖尿病發生有關的藥物，也沒有Ｂ型肝炎或Ｃ型肝炎。檢驗數據顯示ALT值在糖尿病發生前三年比正常值高1.5到3倍。經藥物治療後ALT值雖降到正常範圍內，但糖尿病仍然發生。這反應出ALT上升是否會增加糖尿病發生及一般對ALT上升的藥物治療是否能夠預防糖尿病的發生？對於降低高ALT以致於預防糖尿病發生的方法，包括健康行爲介入及藥物治療，將被介紹與討論。這案例顯示ALT上升可能是糖尿病發生的合理預估指標。對於ALT上升的病人，我們建議先以運動及體重控制。

關鍵字

肝臟ALT ； 糖尿病 ； 非酒精的脂肪性肝疾病脂肪肝

並列摘要

Type 2 diabetes is associated with elevated ALT levels, but whether elevation in ALT levels increases the risk of developing type 2 diabetes remains uncertain. We retrospectively trace an 83-year-old female elderly, who has been regularly followed up in the A-Lein Community Health Center since 1990. Our study subject had reported no family history of diabetes, habit of smoking or alcohol drinking, and use steroid or special medications related to diabetes before developing type 2 diabetes in 1996. Laboratory data before and after the development of type 2 diabetes, including ALT levels (alanine aminotransferase), HBsAg (-) and anti-HCV (-), total cholesterol and triglyceride level, were compared. The ALT level was found to be 1.5 to 3 times higher than the normal range (ALT＜40) three years prior to the development of type 2 diabetes. Although the ALT level was recovered to the normal range after empirical therapy, type 2 diabetes still developed later. Does elevated ALT level predict the development of type 2 diabetes? Can empirical therapy for the elevated ALT level prevent the development of diabetes? The methods, including health behavior intervention and drug therapy, to lower the rising ALT level for preventing the progression into type 2 diabetes are discussed. This case demonstrates that increasing ALT levels might be a plausible predictor of the development of type 2 diabetes. Physical activity and body weight control are recommended for the individuals with elevated ALT levels.

並列關鍵字

community ； elderly ； intermediate care ； post-acute care