青年人群中非酒精性脂肪肝患者糖代谢状况的评价

To Evaluate the Status of Glucose Metabolism in the Young People Crowed with Nonalcoholic Fatty Liver Diseases

目的:探讨青年人群中非酒精性脂肪肝患者的糖代谢情况及其高危因素分析。方法:对260例青年人非酒精性脂肪肝患者进行口服葡萄糖耐量试验(OGTT),根据OGTT结果分为糖耐量正常(NGT)、空腹血糖受损(IFG)、糖耐量减退(IGT)和糖尿病(DM)4组,分析各组的发病率,对各组的血脂(TG、TC、HDL、LDL)、体重指数、腰围、胰岛素抵抗(HOMA-IR)、β细胞功能(HOMA-β)、胰岛素敏感性指数(ISI)、空腹及餐后2h胰岛素等进行比较。结果:青年人非酒精性脂肪肝患者近2/3有糖代谢异常,发病率非常高,但知晓率很低;随糖代谢异常的加重,脂肪肝患者的体重指数、腰围呈上升趋势,IFG和NGT组间比较无差异(P>0.05),IGT或DM组与NGT组比较差异有显著性(P<0.05);血脂异常也越加明显,TG、TC、LDL呈上升趋势,HDL则下降;IGT组HOMA-IR明显升高(P<0.01),与DM组比较无差异;IGT组HOMA-β细胞功能升高,与其它3组间比较无差异,DM组和IGT组ISI下降。结论:青年人群中非酒精性脂肪肝患者存在明显的糖耐量异常,随着糖耐量异常的加重,其他代谢异常也恶化。有必要对青年人非酒精性脂肪肝患者进行OGTT,做到早期发现早期干预,预防糖尿病对心、脑、肾等脏器损害所致并发症。

Objective： To know the glucose metabolism in the young people crowed with nonalcoholic fat- ty liver diseases and analysis the risk factors of group. Methods： After OGTT, 260 young patients with nonalcoholic fatty liver diseases were divided into NGT, IFG, IGT and T2DM. The morbidity of each group had been made. Parameters such as TC, TG, HDL, LDL, BMI, waist, fasting insulin and postprandial 2 hour insulin were detected. Homeostasis model assessment （ HOMA-IR ） , HOMA-β and insulin sensitivity index （ ISI ） were applied to assess the status of insulin resistance and function of β-cell. Results： The abnormality of glucose metabolism was about two thirds in the young patients with nonalcoholic fatty liver diseases, the morbidity was very high. As the abnormality of glucose metaolism worsen, BMI, waist, TG, TC, LDL were much higher, HDL lower （P〈0. 05 ）. HOMA-IR and HOMA-β were higher in IGT group （ P〈0. 01 ）, ISI decreased in IGT and DM. Conclusion. There was the abnormality of glucose metabolism in the young patients with nonalcoholic fatty liver diseases. The worsen the glucose metabolism, the aggravated the other metabolism, such as lipid. In order to prevent complication caused by diabetes, the young patients with nonalcoholic fatty liver diseases should have OGTT earlier to find glucose metabolism abnormality.