吡格列酮对合并代谢综合征的非酒精性脂肪性肝病患者血清TNF-α、IL-6的影响及意义

Effects of pioglitazone on tumor necrosis factor-alpha and serum interleukin-6 in patients with nonalcoholic fatty liver disease and metabolic syndrome

目的:研究吡格列酮对合并代谢综合征(MS)的非酒精性脂肪性肝病(NAFLD)患者血清肿瘤坏死因子α(TNF-α)和白细胞介素6(IL-6)水平的影响及其意义。方法:连续收集2012年1月—2013年6月在长江航运总医院治疗的合并MS的NAFLD患者。患者分别接受非药物治疗(中等程度热量限制和中等量有氧运动)或吡格列酮(30 mg·d^(-1))联合非药物治疗6个月。比较治疗后2组病例的TNF-α、IL-6、NAFLD/MS相关指标和疗效的差异,并分析TNF-α、IL-6与胰岛素抵抗指数(HOMA-IR)、疗效之间的关系。结果:共收集合并MS的HAFLD患者64例,每组各32例。非药物组治疗后6个月仅体重指数和空腹胰岛素显著性降低(P<0.05),吡格列酮联合非药物组治疗后TNF-α、IL-6水平及NAFLD/MS指标均显著改善(P<0.05)。联合治疗组的总有效率显著优于非药物组(81.3%vs 21.9%)。患者治疗前后血清TNF-α和IL-6水平差值与HOMA-IR差值显著性正相关(分别为r=0.676,P<0.001;r=0.498,P<0.001);HOMA-IR差值与疗效级别亦呈显著性正相关(r=0.608,P<0.001)。结论:吡格列酮可有效降低合并MS的NAFLD患者血清TNF-α、IL-6水平。TNF-α、IL-6可能通过影响胰岛素敏感性参与病变治疗过程。

OBJECTIVE To investigate levels of serum tumor necrosis factor-alpha （TNF-α） and interleukin-6（IL-6） in patients with nonalcoholic fatty liver disease （NAFLD） and metabolic syndrome （MS）,and evaluate their significance.METHODS A prospective study was conducted in consecutive patients with NAFLD and MS in General Hospital of Yangtze River Shipping from January 2012 to June 2013.Patients received either non-drug treatment （moderate caloric restriction and moderate aerobic exercise） or pioglitazone （30 mg·d-1） combined with non-drug therapy for 6 months.Serum TNF-α,IL-6 levels,insulin resistance index （HOMA-IR）,and therapeutic efficacy were analyzed.RESULTS Sixty-four patients were included in this study,32 received non-drug treatment and 32 received pioglitazone combined with non-drug treatment.Patients in non-drug group showed significant decreases only in body mass index and fasting insulin （P〈0.05）,whereas patients in pioglitazone group showed significant improvement in all NAFLD/MS parameters and TNF-α and IL-6 levels （P〈0.05）.Total effective rate in pioglitazone group was significantly higher than that in non-drug group （81.3% vs. 21.9%）.Both TNF-α and IL-6 changes were significantly correlated with HOMA-IR changes （r=0.676,P〈0.001; r=0.498,P〈0.001）.A significant correlation was also noted between HOMA-IR change and efficacy levels （r=0.608,P〈0.001）.CONCLUSION Pioglitazone can effectively decrease serum TNF-α and IL-6 levels in patients with FAFLD and MS.TNF-α and IL-6 may play important roles in pioglitazone treatment against NAFLD by regulating insulin sensitivity.