超声测定肝脏衰减系数与糖脂代谢的关系

Relationship between liver attenuation coefficient measured with ultrasound and glucolipid metabolism

目的探讨超声测定肝脏衰减系数与糖脂代谢的关系。方法入选411例具备完整的体格检查、血压、糖脂代谢及肝脏超声检查结果的男性患者,年龄36～65岁。应用超声测定肝脏衰减系数作为肝脏脂肪含量的评价指标,以肝脏衰减系数三分位点(<0.48,≥0.48且<0.69,≥0.69)将研究对象分为3组,比较各组的临床及生化指标,并以年龄50岁为界进行亚组分析。结果 411例研究对象中,106例(25.8%)超声定性诊断为非酒精性脂肪性肝病(NAFLD)。上1/3位点组的年龄、收缩压(SBP)、餐后2h血糖(2hPG)、餐后2h胰岛素(2hIns)以及高血糖患病率、NAFLD患病率均显著高于下1/3位点组(P值分别<0.05、0.01),胰岛素敏感性(ISIc)指数显著低于下1/3位点组(P<0.05)。在≥50岁组中,上1/3位点亚组的稳态模型胰岛素抵抗指数(HOMA-IR)、2hIns、三酰甘油(TG)水平、高血糖患病率及超声定性诊断NAFLD患病率均显著高于下1/3位点亚组(P值分别<0.05、0.01),而ISIc显著低于下1/3位点亚组(P<0.05)。≥50岁组超声定性诊断为非NAFLD人群中,上1/3位点亚组的2hIns及TG水平均显著高于下1/3位点亚组(P值均<0.05),体质指数(BMI)显著低于下1/3位点亚组(P<0.05)。多元逐步回归分析显示,在总研究人群、≥50岁研究人群和≥50岁且超声定性诊断为非NAFLD人群中,肝脏衰减系数(标准化β值分别=0.154、0.151、0.170,P值分别=0.000、0.002、0.007)均是2hIns的独立危险因素。结论在年龄≥50岁超声定性诊断为非NAFLD的男性人群中,超声测定肝脏衰减系数对估测脂代谢异常及胰岛B细胞对糖负荷后的反应具有一定的临床意义。

Objective To explore the relationship between liver attenuation coefficient measured with ultrasound and glucolipid metabolism. Methods A total of 411 males aged from 36 to 65 years old with complete data of physical examination, blood pressure, glucolipid metabolism and liver ultrasound results were divided into 3 groups according to liver attenuation coefficient （〈0.48,≥0.48 and 〈0.69,≥0.69）. Clinical and biochemicalparameters of each group and subgroup of above 50 years old were compared. Results Ultrasonography revealed that 106 （25.8 % ） subjects had nonalcoholic fatty liver disease （NAFLD）. Compared with those of liver attenuation coefficient〈0.48, subjects of liver attenuation coefficient≥0.69 had significantly higher level of age, systolic blood pressure （SBP）, postprandial blood glucose （2hPG）, postprandial blood insulin （2hlns）, incidencerates of hyperglycemia and NAFLD （ P〈0.05 or 0.01）, and lower insulin sensitivity index （ISIc） （P〈0.05）. In the subjects above 50 years old, homeostasis model assessment for insulin resistance （HOMA-IR）, triglycerides （TG）, 2hlns and incidence rates of hyperglycemia and NAFLD were higher in the subjects of liver attenuationcoefficient≥0.69 than those of liver attenuation coefficient〈0.48 （P〈0.05 or 0.01 ）; however, the level of ISIc was opposite （P〈0.05）. In the non-NAFLD subjects above 50 years old, subjects of liver attenuation coefficient ≥0.69 had a lower level of BMI and a higher level of 2hlns and TG than those of liver attenuation coefficient〈0.48 （ P〈0. 05）. Multiple regression analysis showed that liver attenuation coefficient was the independent risk factor of 2hlns in total subjects, subjects above 50 years old and non-NAFLD subjects above 50 years old （Standardizedβ= 0. 154, 0. 151, 0. 170, P= 0. 000, 0. 002, 0. 007）. Conclusion Liver attenuation coefficient is related to lipid metabolism and pancreatic β-cell response after glucose load in men above 50 years old with non-NAFLD by ultrasonic qualitative diagnosis. （Shanghai Med J, 2012, 35 ： 15-19）