脂肪肝患者血清瘦素与胰岛素抵抗的关系

Relation between serum leptin and insulin resistance in patients with fatty liver

目的:探讨脂肪肝患者血清瘦素水平变化及其与胰岛素抵抗之间的关系,以期为治疗和预防脂肪肝提供参考依据。方法:观察组57例脂肪肝患者均为广东医学院附属医院消化内科住院及门诊患者,男36例,女21例。纳入标准:无嗜酒史,近2～4周内未使用过肝损害药物。排除标准:排除糖尿病、原发性高血压。对照组33例,为本院健康体检者,男21例,女12例。纳入标准:糖耐量、肝功能、血脂、体质量指数均在正常范围,无饮酒史,无任何肝脏疾病,肝炎病毒标志物阴性。排除标准:B超检查排除脂肪肝。用放免法测定观察组患者及对照组血清瘦素水平,同时测定体质量指数(bodymassindex,BMI)、空腹血糖、空腹胰岛素、血脂,采用稳态模式评价胰岛素抵抗(homeostasismodelassessmentinsulinresistance,HOMA-IR)。结果:①脂肪肝患者瘦素水平、BMI、空腹血糖、空腹胰岛素、HOMA-IR、总胆固醇、三酰甘油、低密度脂蛋白胆固醇(low-densitylipoproteincholesterol,LDL-C)均高于对照组(t=3.920～10.060,P<0.05～0.01)。②脂肪肝组、对照组女性瘦素水平犤(11.84±2.07),(7.05±0.94)μg/L犦明显高于男性犤(5.50±1.32),(3.01±0.62)μg/L犦(t=6.356,7.890,P<0.01)。③同性别组内瘦素与BMI,HOMA-IR呈正相关(男性组r=0.7662,0.4883,P<0.01;女性组r=0.

AIM:To explore the relationship between the changes of serum leptin concentration and insulin resistance in patients with fatty lever,so as to provide references for the treatment and prevention of fatty liver. METHODS:Totally 57 inpatients or outpatients with fatty liver(36 males and 21 females) in the Department of Gastroenterology,Affiliated Hospital of Guangdong Medical College were involved in the observation group,all of them had no history of alcoholism and took no drug that were harm for liver during the recent 2 to 4 weeks,and those with diabetes and essential hypertension were excluded.Another 33 healthy controls(21 males and 12 females),who came to the hospital for health examination,were selected,all of them had normal glucose tolerance,liver function,blood lipid and body mass index(BMI),and had no history of drinking,no liver disease,negative hepatitis virus signs,and those with fatty liver examined by B ultrasonic wave were excluded.Serum leptin concentrations were measured by radioimmunoassay,and BMI,fasting plasma glucose(FPG),fasting serum insulin(FINS),total cholesterol(TC),triglycerides(TG),low density lipoprotein(LDL C) and high density lipoprotein(HDL C) were determined.Homeostasis model assessment(HOMA) was applied to assess the status of insulin resistance (HOMA IR). RESULTS:①The serum leptin concentrations,FPG,FINS,TC,TG,LDL C and HOMA IR in the observation group were all higher than those in the control group(t=3.920 to 10.060,P< 0.05 to 0.01).②Serum leptin concentrations of females[(11.84±2.07),(7.05±0.94) μg/L] were obviously higher than those of males[(5.50±1.32),(3.01±0.62) μg/L] in the observation group and control group(t=6.356,7.890,P< 0.01).③Serum leptin level was positively correlated with BMI and HOMA IR in the males(r=0.766 2,0.488 3,P< 0.01) and females(r=0.686 5,0.467 9,P< 0.01).The results of linear multiple regression analysis showed that BMI,HOMA IR and FINS were the main related factors of leptin variations in patients with fatty liver. CONCLUSION:There are close relations between high leptin level and leptin resistance,and also close relations of hyperindulinism and high leptin level with insulin resistance.