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Abstract：
Insulin resistance is a common pathophysiology in patients with type 2 diabetes mellitus, cardiovascular disease, and non-alcoholic fatty liver disease. Thus, screening for the risk of insulin resistance is important to prevent disease progression. We evaluated the alanine aminotransferase/aspartate aminotransferase (ALT/AST) ratio to predict insulin resistance in the general population, regardless of comorbidities. Datasets from the 2015, 2019, and 2020 Korea National Health and Nutrition Examination Surveys were used, and the following four indices were implemented to indicate insulin resistance: fasting serum glucose, insulin, homeostatic model assessment for insulin resistance (HOMA-IR), and β-cell function. We analyzed the degree of association between the liver enzyme profile and insulin resistance indices using Pearson\'s correlation coefficient and determined the associations using linear or logistic regression analysis. Accordingly, ALT levels in both sexes were positively and consistently correlated with the four aforementioned insulin resistance indices in stratification analyses based on diabetes, dyslipidemia, alcohol consumption, and obesity status. In multivariate linear regression, when comparing with ALT levels, the ALT/AST ratio exhibited superior predictive performance for fasting serum glucose and HOMA-β in Korean men and improved outcomes for all insulin resistance indices in Korean women. In this analysis that included a large community-based population, the ALT/AST ratio was a more useful predictive marker than the HOMA-IR. Regarding the predicted presence or absence of insulin resistance, the ALT/AST ratio could better predict HOMA-IR than the ALT level alone in Koreans. A simple, precise marker that represents the ALT/AST ratio could be a practical method to screen for insulin resistance in the general population, regardless of diabetes mellitus, alcohol intake, and sex.
摘要：
胰岛素抵抗是2型糖尿病患者常见的病理生理,心血管疾病,和非酒精性脂肪性肝病。因此，筛查胰岛素抵抗风险对于预防疾病进展很重要.我们评估了丙氨酸氨基转移酶/天冬氨酸氨基转移酶（ALT/AST）比率以预测普通人群的胰岛素抵抗，不管合并症。使用了2015年、2019年和2020年韩国国家健康和营养检查调查的数据集，并实施以下四个指标来指示胰岛素抵抗：空腹血糖，胰岛素，胰岛素抵抗的稳态模型评估(HOMA-IR)，和β细胞功能。我们使用Pearson相关系数分析肝酶谱与胰岛素抵抗指数之间的关联程度，并使用线性或逻辑回归分析确定关联。因此，在基于糖尿病的分层分析中，两种性别的ALT水平与上述四种胰岛素抵抗指数呈正相关，血脂异常,酒精消费,和肥胖状况。在多元线性回归中，当与ALT水平比较时，ALT/AST比值在韩国男性中对空腹血糖和HOMA-β表现出优异的预测性能,在韩国女性中对所有胰岛素抵抗指数均有改善.在这项包括大量社区人口的分析中，ALT/AST比值是比HOMA-IR更有用的预测标志物。关于预测是否存在胰岛素抵抗，在韩国，ALT/AST比值比单独ALT水平能更好地预测HOMA-IR。一个简单的，代表ALT/AST比值的精确标记可能是在普通人群中筛查胰岛素抵抗的实用方法，不管糖尿病，酒精摄入量,和性爱。
