Association Of GGT With Fatty Liver And Metabolic Syndrome

BackgroundGlutamyl transpeptidase(GGT) is a mitochondria enzyme containing hydrosulphonyl, and is one of the key enzyme responsible for extracellular GSH metabolism that catalytics glutamoyl transfering from glutathione or other substances containing glutamoyl to amino acids in glutamyl cycle, and then forms gamma-glutamine amino acid, and provides the raw material of amino acids for glutathione’s resynthesis in cells. GGT who has high excreting active and a variety of isozyme, is a sensitive,simple and economic testing index, can be widely seen in living organisms, and each organization cells of human body, such as cell membrane of liver, bravery, kidney, pancreas, intestine, heart, brain and prostate, most in the high absorption ability tissues rich in protein, such as bile duct, pancreas, kidney and epididymis. The serum GGT in human body is hepatic enzymes, mainly from hepatic organization, GGT in liver produced by mitochondria of epithelium in intrahepatic duct epithelium, located in liver cell plasma and intrahepatic ducts epithelium.,and excrete by biliary tract.Fatty liver is a reversible disease that related with unhealthy eating habits and diet structure,and is an acquired disease that caused by multiple causes and closely associated with way of life.It dues to the accumulation of excessive adipose in the liver. In recent years, the incidence of fatty liver is rising year by year, especially in young and middle-aged the incidence increased obviously, which may due to people’s generally improved living situation, and do not pay attention to adjustment of diet and dietary structure,taking food in high fat,high energy, excessive drinking and lacking relatively preventive care measures.The clinical characteristic of fatty liver related to it’s etiology and pathology levels.Metabolic syndrome is a group of gathered disease that associated with insulin resistance,has already become one of the major diseases that seriously influence the health of human. The four basic components of Metabolic syndrome are: central obesity,reduced glucose tolerance,hyperlipidemia,and high blood pressure. In recent years,around insulin resistance basis of pathology, generalized metabolic syndrome also related to high uric acid, fatty liver disease, high insulin hematic disease, oxidative stress, sleep apnea, trace proteinuria, polycystic ovarian syndrome, and other components. Because the serum GGT mainly exist in the liver cells, so for a long time,the rise of the enzyme clinical mainly related with and liver and gallbladder disease and drinking alcohol, also be mentioned with pancreatitis, kidney failure, heart damage, diabetes or take some drugs, but most of the causes of the rise are unclear and there are merely mildly elevated.Therefore, the clinical applications of GGT except in the liver and gallbladder disease are often neglected, and GGT is not seen as a predictor of disease index. Recent research has shown that the body GGT oxidatie may be a stress index, who reflecting the active oxygen produced by metabolism,and may damage the multiple tissue and organs, the activity has something to do with a variety of cardiovascular risk factors (such as abdominal obesity, high blood pressure, ifg, high-density lipoprotein (HDL) cholesterol, reduce LDL-C increase or triglycerides, etc), metabolic syndrome or insulin resistance has the very big relations, even in critical value during reference range. Existing research shows that:the rise in GGT group, the body mass index, systolic blood pressure, eat two hours after the blood sugar, cholesterol, low density lipoprotein cholesterol, high-density lipoprotein cholesterol of observation objects were significantly higher, while obesity, high blood pressure, diabetes and hyperlipidemia detection ratios were significantly higher than the normal group. The main consequences of the metabolic syndrome are raising dangers of cardiovascular disease and type2diabete. The new view insist that the metabolic syndrome is actually a chronic inflammation syndrome, as atherosclerosis process, with the releasing of fat-induced proinflammatory cytokines such as tumor necrosis factor, interleukin-V as tumor-initiating factors, leads to chronic vascular intima inflammation, and starts oxidatie stress reaction, and leads to increased GGT.A cross-sectional study in2000firstly analyses metabolic syndrome and GGT:the researchers observed that GGT closely related with body mass index, systolic blood pressure, fasting insulin levels and triglyceride, adjusted for age, sex, body mass index,drinking and other confounding factors, GGT is still an independent predictor of the metabolic syndrome.However, most of above researches of GGT and fatty liver,GGT and metabolic syndrome are cross-sectional designs,lacking long-term observations based on large samples of longitudinal monitoring healthy check-up cohort.In data analysis,lack of repeated measurement information,mostly use traditional Logistic regression or Cox regression model,ignoring the measurements measurement of at different time points measurement.Therefore, our study group depends on this large longitudinal monitoring healthy check-up queue,takes generalized estimating equations model system,to analysis the relationship of GGT and fatty liver, GGT and metabolic,and provides basis for the diagnosis, treatment, and prevention of fatty liver and metabolic syndrome.Subjects and MethodsBase on the database of check-up during January2005to October2010in health management center of Shandong province hospital and Shandong Qianfoshan hospital,we wanted to build th longitudinal monitoring healthy check-up queue,which contains166984persons, we chose a great number of people’s physical examination data to build a longitudinal monitoring cohort,the concluded are tested for3and more than3years, and were not have the research target disease (fatty liver and metabolic syndrome) at first tset,which enrolled of6513people (26256person-time).Fatty liver disease diagnosis based on diagnosis standard set in2006of Chinese society of hepatology of Chinese Medical Association,and metabolic syndrome diagnostic based on diagnosis standard set in2004of Chinese Medical Association diabetes branch.According to the missing value of medical database related research indexs, this study selected the indexs that missing value are less than10%from all the check-up indexs, assuming that the distribution of the data is multiply normal distribution, and arbitrary deletion patterns, so we use multiple imputation of Markov chain Monte Carlo (Markov chain Monte Carlo, MCMC), with SAS9.0software.Add the scores of body mass index, blood sugar, blood pressure, blood fat of all the subjects together,the total score which were above3were defined as metabolic syndrome,and were given1,the rest were given0. Evaluations and descriptions were finished by SPSS17.0statistics software.This study of data analysis uses the generalized estimating equations (generalized estimation equations, GEE) model, SAS9.0software.ResultsDuring the study subjects, the age focused on20-60years old, and mean age of male is40.5, women is37.6. Subjecte who tested for three, four, five years are of the similar number, the number of six years is least. During the three, four, five, six years of the physical examination, the number of women are all more than men.GGT value shous a positive partial peak. GGT quartiles are11.0,15.0,22.0,492.0, which devides GGT level into four grades, according to levels from low to high, the number gradually reduce.In this research material, fatty liver disease’s detection is2118people, the detection rate is8.1%; metabolic syndrome detection is307people, the detection rate is1.2%.In the analysis of generalized estimated equation of fatty liver’s multiple factors, adjusted for other potential confounding factors,the occurrence of fatty liver with GGT still has a statistically significant (P<0.0001). And compared with GGT’s0level, OR value of1,2,3level are as follows:1.3163,2.3634,3.7692, the risk of fatty liver is gradually increasing,which shows that GGT has clear dose response relation with fatty liver disease,and along with increased level of GGT, fatty liver disease risk is increasing.In the analysis of generalized estimated equation of metabolic syndrome’s multiple factors, adjusted for other potential confounding factors,the occurrence of metabolic syndrome with GGT still has a statistically significant (P<0.0001). And compared with GGT’s0level, OR value of1,2,3level are as follows:1.8036、2.9835、5.8480, the risk of metabolic syndrome is gradually increasing,which shows that GGT has clear dose response relation with metabolic syndrome disease,and along with increased level of GGT, metabolic syndrome risk is increasing.Similarly, in the generalized estimating equations analysis of the four components of the metabolic syndrome,overweight or obesity, high blood pressure, high blood sugar, blood lipid disorders, adjusted for other potential confounding factors,GGT has statistically significant with this four components(P<0.0001). And compared with GGT’s0level,the risk of metabolic syndrome is gradually increasing,which shows that GGT has clear dose response relation with them,and along with increased level of GGT, their risk is increasing.The effect of the increase of GGT on metabolic syndrome is more than the that on fatty liver;In metabolic syndrome’s four fractions, the influence of GGT’s increase on overweight or obesity is far greater than its on hypertension, hyperglycemia, dyslipidemia; and the effect of GGT’s increase on hypertension, hyperglycemia, lipid disorders are with similar degree.Conclusions(1)GGT is fatty liver’s influence factor,and they have a clear dose-response relationship.(2)GGT is metabolic syndrome’s influence factor,and they have a clear dose-response relationship.(3)GGT is influence factor of overweight or obesity, high blood pressure, high blood sugar, blood lipid disorders,and they all have a clear dose-response relationship.(4) The effect of the increase of GGT on metabolic syndrome is more than the that on fatty liver;In metabolic syndrome’s four fractions, the influence of GGT’s increase on overweight or obesity is far greater than its on hypertension, hyperglycemia, dyslipidemia; and the effect of GGT’s increase on hypertension, hyperglycemia, lipid disorders are with similar degree.