非酒精性脂肪肝病患者血清瘦素及可溶性瘦素受体的变化

Change of serum leptin and soluble leptin receptor in nonalcoholic fatty liver disease patients

目的通过检测非酒精性脂肪肝病(NAFLD)患者血清瘦素及可溶性瘦素受体(sOB-R)的水平,探讨血清瘦素及sOB-R与非酒精性脂肪肝的关系。方法应用放射免疫法(RIA)及酶联免疫吸附测定(ELISA)法对30例NAFLD患者及30例对照组瘦素、sOB-R,并检测空腹血糖、总胆固醇、甘油三酯、C肽、胰岛素、体质量指数(BMI)等临床指标,分析瘦素、sOB-R与血脂、胰岛素抵抗及NAFLD的关系。结果①NAFLD患者的瘦素、BMI、空腹胰岛素及胰岛素抵抗指数(HOMA IR)分别为(10.90±3.39)μg/L、26.47±3.11、(14.22±2.66)mU/L及3.46±0.64均显著高于对照组,sOB-R为(18.00±3.74)μg/L低于对照组(均P<0.05);②NAFLD男、女患者瘦素(9.07±2.22)μg/L、(12.73±3.43)μg/L均高于对照组男、女患者;sOB-R(19.58±4.04)μg/L、(16.41±2.70)μg/L均低于对照组男、女(P<0.05);③瘦素与sOB-R之间呈明显负相关性(r=-0.725,P<0.001);④以瘦素为因变量,BMI、HOMA IR、C肽、总胆固醇及甘油三酯作为自变量,进行多元逐步回归分析,BMI、HOMA IR对瘦素影响最大。结论瘦素及sOB-R与NAFLD有密切的关系,瘦素与sOB-R之间负相关,提示NAFLD存在瘦素抵抗。

Objective To determine the role of leptin system in nonalcoholic fatty liver disease（NAFLD） development by delineating the changes in serum levels of leptin and soluble leptin receptor（sOB-R）. Methods Blood samples were collected from 30 consecutive patients with liver biopsy-proven NAFLD and 30 persons with biopsyproven normal liver as controls. Serum leptin level was determined by RIA and concentration of sOB-R by ELISA. Body mass index（BMI） was calculated for all subjects,and serum insulin,C-peptide, and lipoprotein levels were also detected. Results ①The levels of Lp,BMI,Fins and HOMA IR in NAFLD were （10.90±3.39）μg/L,26.47±3.11 ,（14.22±2.66） mU/L,3. 46±0. 64 ,respectively. The levels of Lp,BMI,Fins and HOMA IR in NAFLD were significantly higher than those of control group （all P〈0.05）, but mean sOB-R level was lower in NAFLD group compared to that of control group. ②The levels of Lp and sOB-R in both men and women with NAFLD were （9.07±2.22） μg/L, （12.73±3.43） μg/L,（19.58±4.04） μg/L,（16.41±2.70） μg/L, respectively. Both men and women in NAFLD group had higher mean serum leptin levels and lower sOB-R levels than those of control group （all P〈0.05）. ③There was a significant negative correlation between serum leptin and sOB-R level（r=-0.725, P〈0.001）. ④Multivariate analysis showed BMI and HOMA IR were independently related to serum leptin level. Conclusion Enhanced release of leptin is accompanied by decrease in sOB-R concentration, suggesting a higher resistance of peripheral tissues（liver） towards the action of leptin.