胰岛素抵抗与HBV携带者合并非酒精性脂肪肝的关系

Relationship of insulin resistance with hepatitis B virus asymptomatic carriers complicated with nonalcoholic fatty liver disease

目的探讨胰岛素抵抗(IR)与HBV携带者发生非酒精性脂肪肝(NAFLD)的相关性。方法将携带HBV且合并NAFLD的68例患者设为NAFLD组,另将具可比性的携带HBV而未合并NAFLD(NNAFLD)的76例设为NNAFLD组。比较2组血压、BMI、腰臀比、空腹血糖、空腹胰岛素、总胆固醇、甘油三酯、ALT、谷氨酰转移酶(γ-GGT)、CRP、血尿酸、HBV DNA定量以及反映胰岛素抵抗情况的稳态模型评估的胰岛素抵抗指数(HOMA-IR)。采用Logistic回归对NAFLD与年龄、性别、BMI、腰臀比、空腹血糖、空腹胰岛素、甘油三酯、总胆固醇、ALT、γ-GGT、CRP、血尿酸、HBV-DNA定量及HOMA-IR等因素的相关性进行分析。结果 NAFLD组的血压、BMI、腰臀比、空腹血糖、空腹胰岛素、甘油三酯、总胆固醇、LDL-C、ALT、γ-GGT、CRP、血尿酸和HOMA-IR均高于NNAFLD组,2组比较差异均有统计学意义(P均<0.05),而2组HBV DNA定量比较差异无统计学意义(P>0.05)。HOMA-IR、腰臀比、甘油三酯、总胆固醇进入Logistic回归方程,与NAFLD的发生相关。结论 HOMA-IR可能与HBV携带者发生NAFLD有关,HBV DNA定量可能与此类患者发生NAFLD无明显相关性。

Objective To discuss the correlation between insulin resistance（ IR） and the incidence of non-alcoholic fatty liver disease（ NAFLD） in hepatitis B virus asymptomatic carriers. Methods Sixty-eight patients carrying HBV complicated with NAFLD were allocated into the NAFLD group. Seventy-six HBV carriers without NAFLD were enrolled in the NNAFLD group. The blood pressure,BMI,waist to hip ratio,fasting blood-glucose,fasting insulin,total cholesterol,triglyceride,ALT,glutamyltransferase（ γ-GGT）,CRP,blood uric acid,quantitative PCR detection of HBV DNA and homeostasis model assessment-estimated insulin resistance index（ HOMA-IR） were measured and statistically compared between two groups. Logistic regression was adopted to analyze the correlation between NAFLD and age,gender,BMI,waist to hip ratio,fasting blood-glucose,fasting insulin,triglyceride,total cholesterol,ALT,γ-GGT,CRP,blood uric acid,quantitative PCR detection of HBV DNA and HOMA-IR. Results The blood pressure,BMI,waist to hip ratio,fasting blood-glucose,fasting insulin,triglyceride,total cholesterol,LDL-C,ALT,γ-GGT,CRP and HOMA-IR in the NAFLD group were significantly higher compared with those in the NNAFLD group（ all P 0. 05）.Quantitative PCR detection of HBV-DNA did not significantly differ between two groups（ P 0. 05）. Logistic regression revealed that HOMA-IR,waist to hip ratio,triglyceride and total cholesterol were correlated with the incidence of NAFLD. Conclusions HOMA-IR is probably correlated with the incidence of NAFLD in HBV carriers. Quantitative determination of HBV DNA possibly has no significant correlation with the incidence of NAFLD in these patients.