非酒精性脂肪肝患者血管紧张素与胰岛素抵抗的相关性研究

The correlation between angiotensin and insulin resistance of nonalcoholic fatty liver disease

目的探讨非酒精性脂肪肝(non-alcohol fatty liver disease,NAFLD)患者血浆血管紧张素与胰岛素抵抗的关系。方法收集河北省蔚县人民医院400例住院和体检者,经腹部CT及临床诊断,分NAFLD组(210例)与对照组(190例),两组人群年龄、性别差异无显著性,采集病史及检测血管紧张素(angiotensin,Ang)Ⅰ、AngⅡ、肝功能、血脂、空腹血糖(fasting blood glucose,FBG)、空腹胰岛素(fasting insulin,FINS)等指标,采用稳态模型法计算胰岛素抵抗指数(homr-insulin resistance,HOMR-IR)。结果 NAFLD组较对照组AngⅠ、AngⅡ、肝脏转氨酶、甘油三酯(triglyceride,TG)、血清总胆固醇(total cholesterol,TC)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、FBG、FINS及HOMR-IR均显著升高(P均小于0.05),而高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)则显著降低(P=0.000)。AngⅠ和AngⅡ均分别与肝脏转氨酶、TG、FINS、HOMR-IR呈正相关,与肝/脾CT值比、HDL-C呈负相关。HOMR-IR是影响AngⅠ、AngⅡ升高的最关键因素。结论 NAFLD患者存在明显胰岛素抵抗并有Ang升高,NAFLD患者Ang的升高与胰岛素抵抗密切相关,进而影响NAFLD的发生。

Objective To investigate the correlation between angiotensin and insulin resistance in non-alcohol fatty liver disease（ NAFLD） patients. Method 400 hospitalized patients and outpatients,whose medical histories were collected and divided into two groups： the NAFLD group（ n = 210） and the control group（ n = 190）,who were diagnosed by the abdominal CT and clinical diagnosis. All patients＇ plasma angiotensin Ⅰ（ Ang Ⅰ）,angiotensin Ⅱ（Ang Ⅱ） were measured,as well as the indexes of transaminase,blood lipids,fasting blood glucose（FBG）,fasting insulin（ FINS）,et al. homr-insulin resistance（ HOMR-IR） was calculated by the steady-state model method.The indexes were analyzed by SPSS 13. 0. Result The concentration of plasma Ang Ⅰ,Ang Ⅱ,liver transaminase,triglyceride（ TG）,total cholesterol（ TC）,low density lipoprotein cholesterol（ LDL-C）,fasting blood glucose（FBG）,FINS and HOMR-IR of the NAFLD group were higher than those of the control group（P〈0. 05）; but the concentration of high density lipoprotein cholesterol（ HDL-C） of the NAFLD group was lower than that of the control group. Ang Ⅰ and Ang Ⅱ were positively correlated with liver transaminase,TG,FINS and HOMR-IR,but negatively correlated with liver / spleen CT value and HDL-C. HOMR-IR was a key risk factor for Ang Ⅰ and Ang Ⅱ.Conclusion The NAFLD patients with insulin resistance have increased concentration of plasma Angiotensin. The rise of Angiotensin closely relate with insulin resistance of NAFLD patients,which has an effect on the occurrence of NAFLD.