非酒精性脂肪性肝病临床病理与血脂、胰岛素抵抗关系的初步研究

Relationships among clinical feature,blood lipids,insulin resistance and the pathology in the nonalcoholic fatty liver disease

目的研究非酒精性脂肪性肝病(nonalcoholic fatty liver disease,NAFLD)的病理变化、临床特征与血脂改变的关系。方法共有45例患者的肝脏病理学标本,对其进行脂肪变分级、炎症分级和纤维化分期,研究肝组织脂肪变程度与B超、血脂、稳态模型胰岛素抵抗指数之间的关系。结果45例病理标本,按脂肪变分级:12例为F0,设为对照组;19例为F1,即轻度脂肪肝组;13例为F2,即中度脂肪肝组;1例为F3,即重度脂肪肝。肝组织脂肪变程度与炎症分级、纤维化分期相关性无统计学意义。肝组织脂肪变程度与总胆固醇(TC)(r=0.484,P=0.004)、甘油三酯(TG)(r=0.388,P=0.028)、低密度脂蛋白胆固醇(LDL-C)(r=0.476,P=0.005)、载脂蛋白B(ApoB)(r=0.515,P=0.003)呈正相关。稳态模型胰岛素抵抗指数(HOMA-IR)在对照组与脂肪肝各组之间差异有统计学意义,而在轻度与中度脂肪肝组之间差异无统计学意义。结论肝脏B超未见异常的患者也可能有脂肪肝;血脂中ApoB与NAFLD相关性高,可作为常规检测指标;NAFLD患者的肝脏脂肪变程度与炎症及纤维化并非平行进展;病理学检查在NAFLD的诊断中的地位无可取代。

Objective To study the pathology,clinical features,blood lipids and insulin resistance of nonalcoholic fatty liver disease（NAFLD）. Methods 45 patients were analyzed. The relationships among pathohistological features of the livers and blood lipids.insulin resistance.ultrasonic examination of the patients were studied. Results Among the 45 patients with NAFLD（there were 12 with their liver fatty degeneration in grade 0,19 in grade 1,and 3 in grade 2,1 in grade 3）. Grading of the inflammation and fibrosis was not positively related with the degree of steatosis. The study found a correlation between the hepatocyte steatosis and total cholesterol, triglyceride,low density lipoprotein, apolipoprotein B. Homeostasis model assessment-insulin resistance were different between the group of contral and the group of NAFLD. There were no difference with homeostasis model assessment-insulin resistance in the diverse grade of the hepatic steatosis. Conclusion The NAFLD patient maybe have the normal result in the ultrasonic examination. Apolipoprotein B are well correlated with the hepatocyte steatosis. The grade of hepatocyte steatosis isn＇t parralel with the grade of hepatocyte inflammation and fibrosis. The pathohistological examination is essential in the NAFLD diagnosis.