老年男性非酒精性脂肪肝患者腹部脂肪面积及血清脂联素和瘦素水平的变化

Abdominal adipose area, serum adiponectin and leptin levels of nonalcoholic fatty liver disease in elderly males

目的研究老年男性非酒精性脂肪肝（NAFLD）患者腹部脂肪面积及血清脂联素和瘦素水平的变化。方法选择238名年龄≥60岁的老年男性，应用B超诊断脂肪肝，依据病史排除酒精性及病毒性脂肪肝。分为3组：脂肪肝组76例，年龄、体重指数与脂肪肝组匹配的非脂肪肝组77名（肥胖组），非肥胖非脂肪肝组85名（对照组）。采用放射免疫法测定血清脂联素、瘦素水平，采用CT扫描测定腹部内脏脂肪面积。组问比较采用方差分析。结果（1）脂肪肝组与肥胖组的体重指数、腹部皮下、内脏、总脂肪面积分别为（26．87±2．62）kg／m^2与（26．63±1．97）kg／m^2、（166．59±54．27）cm^2与（147．89±50．14）cm^2、（148．94±53．72）cm^2与（150．06±45．47）cm^2、（315．25±89．42）cm^2与（297．93±75．12）cm^2，均高于对照组（P〈0．01）。脂肪肝组的腹部皮下脂肪面积高于肥胖组（P〈0．05），而两者的腹部内脏及总脂肪面积差异无统计学意义。（2）脂肪肝组与肥胖组间的瘦素水平差异无统计学意义，但均高于对照组。NAFLD组的脂联素水平明显低于肥胖组[（6．31±3．31）μg／ml对比（9．87±7．07）lag／m1，P〈0．01]，也明显低于对照组[（6．31±3．31）μg／ml对比（11．05±7．19）μg／ml，P〈0．01]；肥胖组与对照组间脂联素水平差异无统计学意义。（3）非酒精性脂肪肝的高危因素包括天冬氨酸转氨酶、甘油三酯、腹部内脏及皮下脂肪面积。血脂联素水平是非酒精性脂肪肝的保护性因素。结论老年男性非酒精性脂肪肝患者的特征是腹型肥胖，瘦素水平高，脂联素水平低。其中脂联素水平的下降在其中起关键作用。

Objective To study the abdominal adipose area, serum adiponectin and leptin levels of nonalcoholic fatty liver disease in elderly males. Methods A total of 238 elderly males （≥ 60 years） were enrolled and divided into three groups： Nonalcoholic fatty liver disease （NAFLD） group （n = 76）, matching group （age and body mass index matching with NAFLD group, n = 77）, normal control group （n = 85）. Serum levels of adiponectin and leptin were measured by RIA （radiological immunological assay）. Abdominal adipose area was detected by computer tomography. Result （1） body mass index （BMI）, abdominal subcutaneous adipose area, visceral adipose area, total adipose area of NAFLD group and matching group were （26.87 ± 2.62） kg/m^2 and （26.63 ± 1.97） kg/m^2, （166.59 ± 54.27） cm^2 and （147.89 ± 50.14） cm^2, （148.94 ±53.72） cm^2 and （150.06 ± 45.47） cm^2, （315.25 ± 89.42） cm^2 and （297.93 ± 75.12） cm^2, respectively; and were higher than those in control group （P 〈 0.01）. The abdominal subcutaneous adipose area is higher in NAFLD group than in matching group, however, the abdominal visceral adipose area and total adipose area were not significantly different between those two groups. （2） The serum leptin level in NAFLD group and matching group was significantly higher than that in control group, and serum leptin level was not significantly different between NAFLD group and matching group. The serum adiponectin of NAFLD group [（6.31 ±3.31） μg/ml] was significantly lower than that of matching group [（9.87 ± 7.071）μg/ml, P 〈 0.01] and control group （P 〈 0.01）. There was no difference in adiponectin level between matching group and control group. 3） AST, TG, abdominal subcutaneous adipose area, abdominal visceral adipose area were risk factors of NAFLD, while serum adiponectin was protective factor of NAFLD. Conclusion These data indicate that elderly male NAFLD patients manifest abdominal obesity, high serum leptin, low serum adiponecin, and suggest that adiponectin may play a crucial role in the pathogenesis of NAFLD in elderly males.