非酒精性脂肪性肝病发病时瘦素的变化

CHANGE OF SERUM LEPTIN IN NAFLD PATIENTS

目的研究血清瘦素水平在非酒精性脂肪性肝病发病时的变化。方法样本取自2004年10月14日～11月4日在本院体体检中心体检人群，入选标准：BMI25-29．9，无酗酒史，肝炎病毒标志物阴性，无糖尿病者。符合标准的人群共有81例，其中非酒精性脂肪肝患者59例，男40例，女19例；正常对照组22例，男17例，女5例。结果非酒精性脂肪肝病组较对照组BMI更高（26．7vs26．15kg／m^2；P=0．02）、WHR（0．9vs0．86；P=0．002）及血脂更高（1．99vs1．42mmol／L；P=0．001）、胰岛素敏感指数更低（2．53×10^-2、，S3．96×10^2＊mmoL^1＊IU^-1；P=0．005），以单因素分析为基础的二值多元logistic回归分析显示：BMI和血脂的影响不存在统计学意义，对非酒精性脂肪肝的发病具有影响的依次是：WHR（P=0．001）和瘦素（P=0．027）。结论在BMI匹配及没有糖尿病的轻度肥胖人群中，瘦素水平在NAFLD组和正常对照之间没有差异，但是多元logistic回归分析显示WHR和瘦素是非酒精性脂肪性肝病发病的独立影响因素。

Objective To determine the level of serum leptin in NAFLD patients. Methods The samples were selected from individuals of physical examination from 14th of October to 4th of November in 2004. The cases were chosen according to the following criteria： BMI located between 25-29.9, ethanol consumption less than 40 g per week individually, the markers of hepatitis virus being negative, and with no diabetes mellitus. The diagnosis of fatty liver was based on sonographic evidence. According to the standards, 81 cases were chosen, including NAFLD 59 patients and 22 normal controls. Eight indexes were measured in fasting state： age, BMI, waist to hip ratio （WHR）, serum cholesterol, serum lipid, serum glucose,true insulin, and serum leptin. Results The fatty liver group,compared with the normol controls, had much higher BMI（26.70 vs 26.15 kg/m^2 P = 0.02）, higher WHR（0.90 vs 0.86 P = 0. 002）, higher serum lipid（1.99 vs 1.42, P = 0. 001） and lower insulin sensitive index（0. 025 vs 0. 039 P=0. 005）. By binary logistic regression analysis, WHIR and serum leptin is significantly associated with the development of NAFLD, and the P value is 0.01 and 0. 027 respectively. Conclusion WHR and serum leptin are independent factors of NAFLD development, in patients with BMI matched and no DM history in mild obese individuals.