视黄醇结合蛋白4与非酒精性脂肪肝病的相关研究

Relationship between serum retinol-binding protein 4 and non-alcoholic fatty liver disease

从住院患者和体验人群中共选取261例研究对象，分为正常对照组（Nc）、单纯非酒精性脂肪性肝病组（NAFLD）、单纯2型糖尿病组（T2DM组）、2型糖尿病伴NAFLD组（DMN组）；2型糖尿病患者再按肝脏超声结果再分为无NAFLD组、轻度脂肪浸润组（NAFLD—L组）、中度脂肪浸润组（NAFLD—M组）、重度脂肪浸润组（NAFLD—S组）。测定空腹血糖、血脂、肝肾功能、视黄醇结合蛋白4（RBP4）等，通过方差分析、相关分析、logistic回归分析评价各指标对NAFLD的影响。结果显示，伴或不伴NAFLD的2型糖尿病患者空腹血糖水平显著高于NC组及单纯NAFLD组（P〈0．01）；DMN组甘油三酯（TG）水平显著高于其他3组（均P〈0．01），而高密度脂蛋白胆固醇（HDL-C）水平低于其他3组（均P〈0．01）；DMN组的收缩压及舒张压均高于NC组及T2DM组（P〈0．05或P〈0．01）；NAFLD患者血清RBP4水平较非NAFLD者高[45．00（38．75，51．00）mg／L对50．00（43．00，62．00）mg／L，P〈0．01]，并随着NAFLD的加重而升高[NAFLD-L组44．00（37．00，51．00）mg／L、NAFLD—M组52．00（46．00，63．00）mg／L、NAFLD—S组78．5（72．75，83．00）mg／L，均P〈0．01]。Logistic分析显示血清RBP4与NAFLD显著相关（P=0．029）。此外，血清RBP4水平与体重指数、腰臀比、1，一谷氨转肽酶、总胆固醇、TG、谷草转氨酶、谷丙转氨酶、前白蛋白、肌酐、尿素及尿酸相关（P〈0．05或P〈0．01）。这些结果提示血清RBP4可能是NAFLD的危险因素之一。

Two hundred and sixty-one subjects were recruited from in-patients and subjects for physical Check-up, and were divided into normal control group （ NC ）, nonalcoholic fatty liver disease group（ NAFLD ）, type 2 diabetes meUitus group （ T2DM ）, and T2DM accompanied by NAFLD group （ DMN ）. According to the result of ultrasonic examination, the patients with T2DM were further divided into non-NAFLD group, light fatty liver group （ NAFLD-L group） , moderate fatty liver group（ NAFLD-M group） , and severe fatty liver（ NAFLD-S group）. Fasting plasma glucose, blood lipid, liver function, kidney function, and serum retinol-binding protein 4 （ RBP4 ） levels were determined. The risk of various indicators for NAFLD was determined by correlation analysis and logistic regression analysis. The results showed that fasting glucose levels in diabetics with or without NAFLD were significantly higher than those in NC and NAFLD groups（ P〈0. O1 ）. Triglyceride （TG） level in DMN group was significantly higher than those in other three groups（ all P〈0.01 ） , while high density lipoprotein-cholesterol level was lower than those in other three groups（ all P〈0.01 ）. Systolic blood pressure and diastolic blood pressure in DMN group were higher than those in NC and T2DM groups （ P〈0.05 or P〈0.01 ）. Serum RBP4 level in patients with NAFLD was significantly higher compared with the subjects without NAFLD [ 45.00 （ 38.75,51.000 ） mg/L vs 51.00 （ 43.00,62. 00 ） mg/L, P〈 0.01 ] , and was rising with the progress of NAFLD [ NAFLD-L group 44.00 （ 37.00,51.00） mg/L, NAFLD-M group 52.00 （46.00,63.00） mg/L, and NAFLD-S group 78.5 （ 72.75,83.00 ） rag/L, all P〈 0.01 ]. Logistic regression analysis showed that the RBP4 level was an independent factor associated with NAFLD （ P = 0. 029 ）. In addition, serum RBP4 level was correlated with body mass index, waist-to-hip ratio, serum gamma-glutamyl transpeptidase, total cholesterol, TG, aspartate aminotransferase, alanine aminotransferase, prealbumin, ereatinine, blood urea nitrogen, and uric acid. These results suggest that serum RBP4 is an independent risk factor of NAFLD.