非酒精性脂肪肝血清铁蛋白水平与胰岛素抵抗程度的相关性分析

The relaionship between serum ferritin and insulin resistance in patients with nonalcoholic fatty liver disease

目的:研究非酒精性脂肪肝、非酒精性脂肪肝合并2型糖尿病患者血清铁蛋白水平及其与胰岛素抵抗程度的相关性。方法:选取单纯非酒精性脂肪肝患者41例,非酒精性脂肪肝合并2型糖尿病患者76例,健康体检60例为研究对象。测定体质指数(BMI),检测空腹血糖(FBG)、丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)、胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)、糖化血红蛋白(HbA1C)、尿微量白蛋白/尿肌酐(UAlb/UCr)等生化指标并行肝脏B超检查。放射免疫法测定空腹胰岛素(FINS),计算胰岛素抵抗指数(HOMA IR)。同时测定血清铁(SI)、铁蛋白(SF)、转铁蛋白(TRF),并分析铁代谢指标与胰岛素抵抗指标的相关性。结果:非酒精性脂肪肝合并2型糖尿病组BMI、ALT、AST、TC、LDL、FBG、FINS、HOMA IR、HbA1C、UAlb/UCr、SF均高于对照组;与单纯非酒精性脂肪肝比较,非酒精性脂肪肝合并2型糖尿病组胰岛素抵抗及铁代谢异常程度更重;相关性研究表明FBG、HOMA IR、HbA1C与SF呈正相关,HbA1C与TRF呈负相关。结论:非酒精性脂肪肝患者存在明显的胰岛素抵抗及高血清铁蛋白血症,且两者具有一定的相关性。降低胰岛素抵抗联合纠正铁代谢紊乱对防止非酒精性脂肪肝的发生发展具有重要的临床意义。

Objective：To investigate the relationship of serum ferritin and insulin resistance in patients with non-alcoholic fatty liver disease（NAFLD） alone and NAFLD combined with type 2 diabetes. Methods：A total of 41 with NAFLD alone,76 NAFLD patients with type 2 diabetes and 60 healthy controls were studied. Abdominal ultrasound was taken for fatty liver examination. Serum ferritin and insulin levels were determined by radioimmunoassay （RIA）. Insulin resistance indexes were assessed by the homeostasis assessmentinsulin resistance（HOMA-IR）. Other biochemical variables were measured by routine methods. Results：Compared with healthy controls, the BMI,ALT,AST,TC,LDL,FBG,FINS,HOMA IR,HbA1C,UA1b/UCr and SF significantly increased in NAFLD patient with type 2 diabetes. Compared with NAFLD patients, insulin resistance was more serious in NAFLD with type 2 diabetes. Correlation analysis showed FBG,HOMA IR and HbA1C were closely related with SF. Conclusion：Serum iron metabolism is closely related with insulin resistance. Therefore,reduce of insulin resistance and correction of SF are important to prevent NAFLD.