不孕症合并代谢综合征患者的非酒精性脂肪肝患病率及临床特点分析

The prevalence and clinical features of non-alcoholic fatty liver disease in infertile patients with metabolic syndrome

目的:探讨不孕症合并代谢综合征(MS)患者的非酒精性脂肪肝(NAFLD)的患病率及临床特点。方法:选取2003年5月至2010年3月在我院就诊且符合2004年CDS的MS诊断标准的不孕症女性。患者均行糖耐量及胰岛素释放试验、肝脏B超检查及肝脏功能测定。按肝脏B超结果将患者分为无NAFLD组、轻度NAFLD组、中重度NAFLD组,比较3组患者的一般情况、血糖、胰岛素水平、肝功能水平。结果:不孕症合并MS患者的NAFLD患病率为69%。与无NAFLD组比较,轻度NAFLD组和中重度NAFLD组的空腹胰岛素水平、服糖后2h胰岛素水平均显著升高(P<0.01,P<0.05),HOMA-IR显著增加(P<0.01);但中重度NAFLD组与轻度NAFLD组比较,差异均无统计学意义(P>0.05)。3组的空腹血糖、服糖后2h血糖及IGT的比例比较,差异均无统计学意义(P>0.05),但NAFLD组服糖后2h的血糖中位数达到或接近糖耐量异常标准。无NAFLD组、轻度NAFLD组、中重度NAFLD组的肝功能异常的程度和比例依次增加,差异有统计学意义(P<0.05)。结论:不孕症合并MS患者有较高的NAFLD患病率;该类患者合并脂肪肝时糖耐量受损、胰岛素抵抗程度加重。随着NAFLD程度的加重,空腹血糖及胰岛素水平并未发生明显变化,肝功能异常的程度和比例随着NAFLD程度的加重而增高。

Objective： To investigate the prevalence and clinical features of non-alcoholic fatty liver disease in infertile patients with metabolic syndrome. Methods： Infertile patients diagnosed according to the 2004 CDS criteria for metabolic syndrome were recruited from May.2003 to Mar. 2010. The oral glucose tolerance test（ OGTT）,insulin releasing test,liver ultrasound and liver function were measured. All participants were divided into three groups： nonNAFLD,mild NAFLD,and moderate / severe NAFLD with evidence of fatty liver in ultrasonography to compare the level of baseline,blood glucose,insulin and liver function,respectively. Results： The prevalence of NAFLD in infertile patients with metabolic syndrome was 69%. Compared with the non-NAFLD group,NAFLD groups had a significantly increased fasting insulin level（ P〈0. 01）,2h-insulin levels after glucose load（ P〈0. 05） and HOMA-IR（ P〈0. 01）.There was no statistical significance difference between the mild group and moderate / severe group. However,no significant differences was observed among the three groups with respect to fasting glucose level,2h-glucose level and the proportion of impared glucose tolerance（ IGT）,although the median 2h-glucose level of NAFLD group reached or came close to the standard for IGT. The percentage of liver dysfunction differed statistically in the three groups（ P〈0. 05）,and increased with the severity of the NAFLD. Conclusion： The infertile patients with metabolic syndrome had a higher prevalence of NAFLD,and displayed an increased insulin level and impared glucose tolerance. The percentage and degree of liver dysfunction increased as the aggravation of NAFLD,although the blood glucose level and insulin level remained almost constant.