血清脂联素水平与非酒精性脂肪性肝病相关性研究

The relationship between serum adiponectin and nonalcoholic fatty liver disease

目的研究北京市成人非酒精性脂肪肝(NAFLD)患者血清脂联素水平的变化特点并对其相关因素进行分析。方法通过随机多级分层整群抽样对2007～2008年北京市东城区和通州区各4个居委会20岁以上居民进行流行病学调查,按照随机配对的原则,排除其中有高血压、糖尿病、肝硬化的患者。入选NAFLD组435例,平均年龄(45.0±11.4)岁,对照组442例,平均年龄(44.7±11.6)岁,测量受试者的身高、体重、腰围及臀围;抽空腹血测定肝肾功能、肝炎病毒标志物、空腹血糖(FBG)、血脂、空腹胰岛素(FINS)和脂联素;计算体重指数(BMI)及稳态模型胰岛素抵抗指数(HOMA-IR)。采用SPSS19.0软件进行统计学分析。计量资料采用t检验,脂联素相关因素分析采用Spearman等级相关分析,以P<0.05为差异有统计学意义,NAFLD的危险因素用多因素非条件Logistic回归分析。结果 (1)NAFLD组体重指数、腰臀比、血压、血糖、血清总胆固醇、甘油三酯、胰岛素水平、低密度脂蛋白胆固醇、HOMA-IR、尿酸较非NAFLD组高(P均<0.05),而脂联素、高密度脂蛋白胆固醇(HDL-C)则较对照组低(P均<0.05)。(2)血清脂联素与BMI、HO-MA-IR、腰臀比、血糖、TG、TC、低密度脂蛋白胆固醇(LDL-C)、尿酸呈负相关(r值分别为-0.075,-0.13,-0.185,-0.49,-0.137,-0.008,-0.041,-0.133,P均<0.05)。(3)采用多因素非条件Logistic回归分析,入选变量包括:腰臀比、BMI、收缩压、舒张压、甘油三酯、LDL-C、HDL-C、尿酸、ALT、血糖、FINS、HOMA-IR、脂联素。结果显示BMI、HOMA-IR、脂联素是NAFLD形成的主要危险因素,回归方程P=1/[1+e-(-8.734+0.281BMI+0.409HOMA-IR-0.198脂联素)]。结论 NAFLD患者的特征是体重增加,存在明显胰岛素抵抗,脂联素含量减少。其中血清脂联素水平的下降与NAFLD的发生存在密切的关系。

Objective To investigate the relationship between serum adiponectin and nonalcoholic fatty liver disease in Beijing.Methods Across-sectional survey with multiple-stages stratified cluster and random sampling was performed.All residents aged 20 and above were invited to participate in the survey;they came from two communities of Dongcheng District and Tongzhou District.435 cases with NAFLD were collected,442 cases without fatty liver were selected randomly as control.The associated variables were analyzed by using logistic regression model.The clinical data and liver function were compared between two groups.Results （1） The BMI,WHR,BP,FPG,TC,TG,FINS,LDL-C,HOMAIR,UA in the NAFLD were higher than in the control（P ＜0.05）,the serum adiponectin and HDL-C in the NAFLD were lower than in the control（P ＜0.05）.（2）The serum level was negatively correlated with BMI,HOMAIR,WHR,FPG,TG,TC,LDL and UA（r：-0.075,-0.13,-0.185,-0.49,-0.137,-0.008,-0.041,-0.133,P ＜0.05）.（3）The linear multiple regression analysis showed that NAFLD were significantly positively correlated with BMI,HOMA-IR and adiponectin.P =1/[1 ＋ e-（-8.734＋0.281BMI＋0.409HOMA-IR-0.198 adiponectin）].Conclusions These date indicate that NAFLD patients manifest higher BMI,obviously insulin resistance,low serum adiponecin,and suggest that adiponectin may play a crucial role in the pathogenesis of NAFLD.