非酒精性脂肪肝病与胰岛素抵抗的相关性

Correlation of non-alcoholic fatty liver disease with insulin resistance

目的:探讨不同程度非酒精性脂肪肝病(NAFLD)与胰岛素抵抗(IR)的相关性。方法:测定非NAFLD组(A组60例)、轻度NAFLD组(B组60例)、中重度NAFLD组(C组52例)的体质量指数(BMI)、腰围(WC)、血压、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)、空腹血糖(FPG)、餐后2h血糖(2hPG)、空腹胰岛素(FIns)等指标,采用稳态模型评估法计算胰岛素抵抗指数(HOMA-IR)并作统计分析。结果:B、C组的BMI、WC、SBP、DBP、TG、LDL-C、FPG、2hPG、HOMA-IR均高于A组(P<0.05),B、C组HDL-C低于A组(P<0.01);C组BMI、WC、TG、2hPG、HOMA-IR较B组明显升高(P<0.01);相关分析显示,NAFLD的病变程度与BMI(r=0.212,P<0.05)、WC(r=0.209,P<0.05)、TG(r=0.547,P<0.01)、2hPG(r=0.323,P<0.01)、HOMA-IR(r=0.563,P<0.01)呈正相关。多元逐步回归分析显示,BMI、2hPG、TG和有脂肪肝是胰岛素抵抗的主要危险因素。结论:NAFLD与胰岛素抵抗的发生发展密切相关,是胰岛素抵抗发生的独立危险因素之一。

Objective To analyse the relevance of different degree non-alcoholic fatty liver disease （NAFLD） to insulin resistance （IR）. Methods Body mass index （BMI）, waist circumference （WC）, blood pressure, triglyceride （TG）, total cholesterol （TC）, low density lipoprotein （LDL-C）, high density lipoprotein （HDL-C）, fasting plasma glucose （FPG）, 2-hour postprandial plasma glucose （2hPG） and fasting serum insulin （Fins） were detected in 60 non-NAFLD controls （group A）, 60 mild NAFLD patients（group B） and 52 moderate- severe NAFLD patients （group C）. According to homeostasis model assessment, insulin resistance index （HOMA- IR） was calculated and analysed. Results Compared with group A, the levels of BMI, WC, SBP, DBP, TG, LDL-C, FPG, 2hPG and HOMA-IR in group B and C were elevated （P 〈 0.05）, while HDL-C levels was declined （P 〈 0.01 ）. BMI, WC, TG, 2hPG and HOMA-IR levels were obviously higher in group C than those in group B （P 〈 0.01 ）. Correlation analysis showed that the degree of NAFLD was significantly positively correlated with BMI （r = 0.212, P〈 0.05）, WC （r = 0.209, P〈 0.05）, TG （r = 0.547, P〈 0.01）, 2hPG （r = 0.323, P〈 0.01）, and HOMA-IR（r = 0.563, P 〈 0.01 ）. Multiple stepwise regression analysis showed that BMI, 2hPG, TG and with fatty liver were the main risk factors for insulin resistance. Conclusion NAFLD is closely correlated with the occurrence and development of IR and probably is one of the independent risk factors of insulin resistance.