血糖正常者非乙醇性脂肪肝与高胰岛素血症的相关性

Relationship between nonalcoholic fatty liver and hyperinsulinemia in normoglycemic subjects

目的探讨血糖正常者非乙醇性脂肪肝(NFL)肝脏脂肪浸润程度与高胰岛素血症的关系.方法检测血糖正常NFL组30例和对照组22例的血脂、胰岛素、游离脂肪酸(FFA);根据肝脏脂肪含量(LFC)中位数(4.34%),将NFL组分为低含量组(LLFC)和高含量组(HLFC).结果LLFC,HLFC组空腹胰岛素、餐后2h胰岛素,TC,TG,LDL-C水平均高于对照组[FINS(mU/L)12.8±5.5vs14.1±6.0vs9.4±1.8;2h INS(mU/L)35.4±28.1vs31.7±26.3vs17.9±10.4;TC(mmol/L)5.0±1.2vs5.6±1.3vs4.0±0.8;TG(mmol/L)1.9±0.8vs3.8±2.1vs1.2±0.4;LDL-C(mmol/L)3.6±0.7vs3.9±1.0vs2.4±0.6,P<0.05].排除了年龄影响后,LFC仍与FINS呈正相关.多元逐步回归显示,腰臀比、BMI是影响NFL肝脏脂肪含量主要的危险因素.结论NFL患者肝脏脂肪浸润程度与高胰岛素血症密切相关,可能与后者影响脂质代谢有关,腰臀比、BMI是影响NFL主要的危险因素.

AIM： To investigate the relationship between degree of liver fat accumulation in normal glucose patients of nonalcoholic fatty liver （NFL） and hyperinsulinemia. METHODS ： Serum lipids, insulin and free fatty acid （FFA） were measured in 30 patients of NFL and 22 control subjects. The patients of NFL were divided into low liver fat content （LLFC） and high liver fat content （HLFC） groups according to median of liver fat content （LFC） （4.34%）. RESULTS： FINS, 2 h INS, TC, TG and LDL-C were significantly elevated in the subjects of LLFC and HLFC compared with control subjects [ FINS （mU/L） ： 12.8 ± 5.5 vs 14.1 ±6.0 vs 9.4 ±1.8; 2 h INS （mU/L） ： 35.4 ±28.1 vs 31.7 ±26.3 vs 17.9 ± 10.4; TC （mmol/L） ： 5.0 ± 1.2 vs 5.6 ±1.3 vs 4.0 ±0.8; TG （mmol/L） ： 1.9 ±0.8 vs 3.8 ±2.1 vs 1.2 ±0.4; LDL-C （mmol/L） ： 3.6 ±0.7 vs 3.9 ±1.0 vs 2.4 ±0.6, P 〈0.05]. Partial correlation analysis showed that LFC was positively correlated to FINS after adjusted age. Multiple stepwise regression analysis showed that waist-to-hip ratio （WHR） and BMI were the independent risk factors affecting LFC. CONCLUSION： Hyperinsulinemia is positively related to LFC in subjects of NFL, probably due to the effects of hyperinsulinemia on the metabolism of lipid. WHR and BMI are the main risk factors of LFC.