The Association of Aspartate Aminotransferase/Alanine Aminotransferase Ratio with Diabetic Nephropathy in Patients with Type 2 Diabetes

Figures & data

Table 1 Characteristics of the Study Populations

Parameters	Total	Normoalbuminuria	Microalbuminuria	Macroalbuminuria
N	402	196	131	75
Men, n (%)	244 (60%)	121 (61.1%)	78 (58.6)	45 (59.2%)
Age, years	59.19±9.28	57.52±9.49	60.37±9.17*	61.49±8.13*
BMI, Kg/m2	24.42±3.39	24.17±3.20	24.46 ±3.09	25.01±4.24
Waist/Hip ratio	0.93±0.10	0.92± 0.10	0.94±0.12	0.94 ±0.08
SBP, mmHg	143±26	138±23	144±25*	156±30*^#
DBP, mmHg	83±8	83±8	83±8	85±8*^#
HbA1c	9.12±1.99	9.11±1.95	9.21±2.19	8.99±1.76
TC, mmol/L	4.53±1.37	4.46±1.46	4.51±1.16	4.76±1.48
TG, mmol/L	1.91±1.43	1.82±1.40	1.78±0.99	2.37±1.97*^#
HDL-C, mmol/L	1.05±0.29	1.05±0.29	1.07±0.30	1.03±0.25
LDL-C, mmol/L	2.75±1.06	2.76±1.08	2.80±1.02	2.66±1.09
Blood urea, mmol/L	6.44±2.16	5.94±1.68	6.38±1.79*	7.86±3.10*^#
Serum creatinine, mmol/L	70.00±36.92	59.53±16.80	67.54±26.21*	101.67±64.16*^#
eGFR, mL/min/1.73m^2	100.97±26.40	113.70±20.77	99.90±22.93*	69.58±26.76*^#
Serum uric, mmol/L	330.0±93.94	304.72±81.97	336.21±90.82*	386.21±103.73*^#
UACR(mg/g)	32 (0–140)	3 (0–17)	80 (47–122)*	1281 (696–3115)*
24-hour urinary protein, g	0.38±1.00	0.06±0.04	0.12±0.11*	1.70±1.81*#
Medicine used, %
RAAS inhibitor	27.6%	20.9%	26%*	48%*^#
Statin	26.1%	19.4%	25.2%*	45.3%*^#

Notes: Values are mean±SD or median with quartile range. *Refers to patients with normoalbuminuria, P<0.05; ^#refers to patients with microalbuminuria, P<0.05.

Abbreviations: BMI, body mass index; HbA1c, glycosylated hemoglobin; TC, total cholesterol; TG, triglyceride; HDL-c, high density lipoprotein cholesterol; LDL-c, low density lipoprotein cholesterol; eGFR, estimated glomerular filtration rate; UACR, urine albumin and creatinine ratio.

Table 2 AST/ALT Level and Serum Cytokine in Study Subjects

	Total	Normoalbuminuria	Microalbuminuria	macroalbuminuria
ALT, U/L	24.77±19.29	25.47±22.20	25.06±13.51	22.40±19.76
AST, U/L	22.19±14.35	21.25±16.09	23.09±11.64	23.07±13.85
AST/ALT	1.03±0.48	0.95±0.34	1.01±0.44*	1.25±0.71*^#
IL-2, pg/mL	3.19± 0.97	3.11±0.91	3.23±1.05	3.29±0.99*
IL-4, pg/mL	2.81±1.17	2.71±1.12	2.88±1.27	2.91±1.19*
IL-6, pg/mL	5.65±3.75	5.54±3.82	5.51±2.02	6.21±2.57
IL-10, pg/mL	4.33±1.05	4.23±0.99	4.40±1.09*	4.43±1.1*
TNF-α, pg/mL	2.93±0.70	2.86±0.70	2.99±0.61*	3.05±0.84*
INF-γ, pg/mL	2.84±1.82	2.82±1.87	2.85±1.37	2.88±1.87

Notes: Values are mean±SD or median with quartile range. *Refers to patients with normoalbuminuria, P<0.05; ^#refers to patients with microalbuminuria, P<0.05.

Abbreviations: IL, interleukin; TNF-α, tumor necrosis factor-α; INF- γ, interferon- γ.

Table 3 Spearman Correlation of AST/ALT Levels with Clinical and Biochemical Parameters

Variable	AST/ALT
	r	p
Age	0.208	<0.001
BMI	−0.144	0.004
HbA1c	−0.015	0.782
TC	0.094	0.106
TG	0.208	<0.001
HDL-C	−0.170	0.001
LDL-C	0.097	0.059
SBP	0.060	0.229
DBP	−0.075	0.136
UACR	0.188	<0.001
24-hour urinary protein	0.154	0.001
IL-2	0.027	0.596
IL-4	0.185	0.005
IL-6	0.274	<0.001
IL-10	0.041	0.425
TNF-α	0.101	0.048
INF-γ	0.057	0.263

Abbreviations: BMI, body mass index; HbA1c, glycosylated hemoglobin; TC, total cholesterol; TG, triglyceride; HDL-c, high density lipoprotein cholesterol; LDL-c, low density lipoprotein cholesterol; SBP, systolic blood pressure; DBP, diastolic blood pressure; UACR, urine albumin and creatinine ratio; IL, interleukin; TNF-α, tumor necrosis factor-α; INF- γ, interferon- γ.

Table 4 AST/ALT Associated with the Presence of Diabetic Nephropathy and Macroalbuminuria in Logistic Regression

	Diabetic Nephropathy		Macroalbuminuria
	OR (95% CI)	P	OR	P
Age	1.016 (0.986, 1.046)	0.199	0.988 (0.944, 1.034)	0.604
Gender	0.519 (0.297, 0.904)	0.021	0.440 (0.203, 0.953)	0.037
Use RAAS inhibitor	1.107 (0.634, 1.933)	0.720	1.743 (0.840, 3.617)	0.136
Use statin	1.172 (0.664, 2.068)	0.583	2.089 (0.984, 4.433)	0.055
Waist/Hip ratio	5.600 (0.449, 11.769)	0.139	4.935 (0.275, 10.080)	0.392
SBP	1.012 (1.001, 1.023)	0.036	1.016 (0.999, 1.034)	0.062
DBP	0.994 (0.959, 1.030)	0.723	1.010 (0.958, 1.065)	0.714
TG	1.024 (0.851, 1.232)	0.801	1.162 (0.933, 1.447)	0.180
Serum creatinine	1.027 (1.012, 1.042)	0.001	1.040 (1.023, 1.058)	<0.001
Urea nitrogen	1.004 (0.879, 1.194)	0.762	1.055 (0.865, 1.293)	0.542
Serum uric	1.004 (1.001, 1.007)	0.021	1.003 (0.999, 1.007)	0.116
IL-2	1.170 (0.861, 1.590)	0.293	0.964 (0.603, 1.541)	0.878
IL-4	1.056 (0.812, 1.374)	0.498	1.141 (0.975, 1.630)	0.390
IL-10	0.996 (0.761, 1.303)	0.974	1.071 (0.790, 1.524)	0.894
TNF-α	1.590 (1.081, 2.374)	0.047	2.347 (1.185, 4.651)	0.014
AST/ALT	1.770 (1.002, 3.127)	0.044	2.471 (1.113, 5.487)	0.026

Abbreviations: TG, triglyceride; SBP, systolic blood pressure; DBP, diastolic blood pressure; IL, interleukin; TNF-α, tumor necrosis factor-α.