非酒精性脂肪性肝病与胰岛素抵抗及糖脂代谢关系的研究

Correlation of non-alcoholic fatty liver disease with insulin resistance and glucose metabolism

目的:分析非酒精性脂肪性肝病(NAFLD)患者的肝脏脂肪含量与胰岛素抵抗(IR)、糖脂代谢间的关系。方法:收集19例NAFLD患者的临床资料,同时选择17例非NAFLD患者作为对照组,询问病史及体检,检测肝功能、血脂,行口服葡萄糖耐量试验(OGTT)并测各点血糖和胰岛素水平,采用磁共振及质子磁共振波谱(1HMRS)分析对肝脏的脂肪含量进行定量测检。结果:NAFLD组患者的肝丙氨酸氨基转移酶(ALT)、血三酰甘油(TG)、OGTT各点血糖、葡萄糖曲线下面积(AUCg)、OGTT0min胰岛素、OGTT120min胰岛素、早期胰岛素分泌(ΔI30/ΔG30)、稳态模型法评估胰岛素抵抗指数(HOMA-IR)均高于非NAFLD组(P<0.05),而其高密度脂蛋白-胆固醇(HDL-C)低于非NAFLD组(P<0.05)。NAFLD组中,11例糖代谢正常者与8例糖代谢异常者相比,两者间ALT差异无统计学意义,而糖代谢正常者的γ-谷氨酰转肽酶(GGT)较低,差异有统计学意义(P<0.05)。NAFLD糖代谢正常组GGT、TG、OGTT各点血糖及AUCg均低于糖代谢异常组(P<0.05),而其OGTT0min胰岛素、OGTT120min胰岛素有高于糖代谢异常组的趋势,但差异尚无统计学意义。结论:NAFLD患者存在明显的胰岛素抵抗(IR),其肝脏脂肪含量增加与IR明显相关,ALT为最早出现异常的指标。当NAFLD患者出现糖代谢异常后,则表现为胰岛β细胞分泌功能受损,胰岛素分泌量降低,GGT异常。因此,早期控制NAFLD,对保护患者的胰岛功能、改善其糖代谢异常有重要作用。

Objective To analyze the correlation of non-aleoholic fatty liver disease （NAFLD） with insulin resistance, glucose and lipid metabolism. Methods Clinical manifestations and laboratory results were collected in nineteen patients with NAFLD and 17 controls without NAFLD. Patients in the both groups underwent a 75 g OGTY （oral glucose tolerance test）, and glucose level and serum insulin were measured at different time points in OGTT. Quantification of liver fat was done by ^1H MRS. Results Serum ALT, TG, blood glucose and insulin levels in OGTT, AUC glucose, and HOMA-IR were significantly high （P〈0.05） and HDL-C was significantly lower （P〈0.05） in NAFLD group than those in control group. In NAFLD group, GGT was significantly higher in patients with abnormal glucose metabolism than that with normal glucose metabolism （P〈0.05）, whereas the difference in ALT was not statistically significant. GGT, TG, blood glucose levels in OGTT and AUC glucose were significantly higher in patients with abnormal glucose metabolism than those with normal glucose metabolism （P〈0.05）; insulin level in OGTT had a tendency to be lower in patients with abnormal glucose metabolism, but was not statistically significant. Conclusions Insulin resistance is obvious in patients with NAFLD, and is correlated with the accumulation of fat in liver. Increase of ALT is the earliest manifestation. NAFLD patients with abnormal glucose metabolism manifeste β cell function failure with decreased secretion of insulin and increase of GGT level. Early managing NAFLD is important for protecting pancreatic islet function and improving abnormal glucose metabolism.