非酒精性脂肪性肝病患者血清瘦素和脂联素与胰岛素抵抗的关系

The relationship of leptin and adiponectin with insulin resistance in nonalcoholic fatty liver disease

目的 探讨非酒精性脂肪性肝病（NAFLD）患者血清瘦素、脂联素的变化及其与胰岛素抵抗的关系. 方法 选取NAFLD患者60例,同期门诊体检健康者60名为对照组,ELJSA法测定血清瘦素、脂联素水平,并检测体质量指数、腰臀比、甘油三酯、总胆固醇、高密度脂蛋白胆固醇（HDL-C）、空腹血糖、ALT、AST、γ-谷氨酰转肽酶（GGT）,稳态模型评估的胰岛素抵抗指数（HOMA-IR）.采用SPSS10.0软件包进行统计学分析,计量资料差异性比较用方差分析和t检验,多因素相关性用Spearman分析和Logistic回归分析. 结果 血清瘦素、脂联素水平NAFLD组分别为（12.37±1.99）μg/L和（12.69±2.83）mg/L,对照组分别为（5.20±1.03）μg/L和（22.83±4.61）mg/L,t值分别为24.661和14.516,P值均〈0.01 HOMA-IR,NAFLD组为4.86±0.63,对照组为1.91±0.41,t值为30.451,P〈0.01.Logistic多因素回归分析显示瘦素与腰臀围之比、HOMA-IR、空腹血糖呈独立正相关,β值分别为8.175、0.974和0.564,P值均〈0.01 脂联素与HOMA-IR、体质量指数呈独立负相关,β值分别为-0.495和-0.314,P值均〈0.01.结论 NAFLD患者血清瘦素、脂联素的变化与胰岛素抵抗有关.

Objective To investigate the serum leptin and adiponectin levels in nonalcoholic fatty liver disease （NAFLD） patients, and their relationship with insulin resistance. Methods A total of 120 cases were enrolled and divided into two groups： NAFLD group （n = 60） and normal control group （n = 60）. The serum levels of leptin and adiponectin were measured by EL1SA. The body mass index （BMI）, waist-to-hip ratio （WHR）, triglyceride （TG）, total cholesterol （Tchol）, high-density lipoprotein cholesterol （HDL-C）, aspartate aminotransferase （AST）, alanine aminotransferase （ALT）, gamma-glutamyl transpeptidase （GGT）, fasting blood glucose （FBG） and HOMA-IR （homeostasis model assessment insulin resistance） were detected and analyzed. Results Compared with control group, the serum leptin level in NAFLD group was Significantly higher [（12.37 ± 1.99） μg/Lvs （5.20 ± 1.03）μg/L,P〈0.01], while the serum adiponectin level was significantly lower [（12.69 ± 2.83） mg/L vs （22.83 ± 4.61） mg/L, P 〈 0.01]. HOMA-IR was also much higher in NAFLD group than that in control group[（4.86 ± 0.63） vs （1.91 ± 0.41）, P 〈 0.01]. Logistic regression analysis showed that leptin was positively correlated with WHR （ P = 8.175, P 〈 0.01）, HOMA-IR （ P = 0.974, P 〈 0.01 ）, FBG （ β = 0.564, P 〈 0.01）. In contrast, adiponectin inversely associated with HOMA-IR （ β = -0.495, P 〈 0.01 ） and BMI （ β = -0.314, P 〈 0.01） respectively. Conclusions The increased serum leptin level and decreased serum adiponectin level in NAFLD patients independently associated with HOMA-IR.