超重和肥胖患者血清泌乳素水平与非酒精性脂肪性肝病的关系

Association between prolactin and non-alcoholic fatty liver disease in overweight and obesepatients

目的探讨在超重及肥胖患者中血清泌乳素（PRL）与非酒精性脂肪性肝病（NAFLD）的关系。 方法回顾性分析2015年9月至2017年1月在南京大学医学院附属鼓楼医院内分泌科就诊的成年超重及肥胖患者494例，根据腹部彩色超声结果分为NAFLD组（n=353）及非NAFLD组（n=141）。同时选取同期在我院行代谢手术的肥胖患者20例，进行肝脏病理活检。清晨空腹抽血检测PRL、肝酶、血糖、血脂，组间比较利用Mann-Whitney U或Kruskal-Wallis H秩和检验分析，用非条件Logistic回归分析血清PRL与NAFLD的关系。 结果纳入277例男性及217例女性超重及肥胖患者，NAFLD患者血清PRL水平明显低于无NAFLD人群[男性7.7（5.9，10.8）比8.7（6.9，11.8）μg/L，Z=-2.500，P=0.012；女性8.4（6.2，12.2）比10.7（7.7，13.4）μg/L，Z=-3.890，P〈0.001]；根据血清PRL水平由低到高的三分位数分成三组，随着PRL水平升高，男性及女性NAFLD患病率均显著降低（均P〈0.05）；在校正年龄、性别等混杂因素后，PRL仍是NAFLD的保护因素（OR=0.923，P=0.008）。同时，肝脏病理诊断为NAFLD者（n=16）其血清PRL水平也低于无NAFLD者（n=4）[9.2（5.0，13.5）比16.8（11.8，20.9）μg/L]。 结论超重及肥胖患者中，血清PRL水平降低是NAFLD发生的危险因素。

ObjectiveTo investigate the association between serum prolactin （PRL） and non-alcoholic fatty liver disease （NAFLD） in overweight and obese （body mass index ≥ 24 kg/m2） patients. MethodsA total of 494 patients from September 2015 to January 2017 in our hospital were retrospectively analyzed. Patients were classified to non NAFLD （n=353） and NAFLD group （n=141） according to abdominal ultrasound. Twenty female obese patients who received bariatric surgery were also underwent liver biopsy. All patients＇ fasting blood samples were collected for the PRL and other metabolic parameters measurements. Abdominal ultrasound was also performed. The Mann-whitney U or Kruskal-wallis H rank test were used to compare the data between two groups, and the relationship between serum PRL and NAFLD was analyzed by non-conditional Logistic regression. ResultsSerum PRL levels were significantly lower in patients with NAFLD in males （n=277） and females （n=217） [7.7 （5.9, 10.8） vs 8.7 （6.9, 11.8） μg/L, Z=-2.500, P=0.012 in men; 8.4 （6.2, 12.2） vs 10.7 （7.7, 13.4） μg/L, Z=-3.890, P〈0.001 in women] than those without NAFLD. Moreover, there was a stepwise decrease in prevalence of NAFLD in both gender from the lowest to the highest PRL tertiles （both P〈0.05）. After normalized for confounding factors, PRL level became a protective factor against NAFLD （OR=0.923, P=0.008）. In obese patients with pathology diagnosis, NAFLD patients （n=16） also exhibited lower PRL levels than those without NAFLD [n=4, 9.2 （5.0, 13.5） μg/L vs 16.8 （11.8, 20.9） μg/L]. ConclusionIn overweight and obese patients, decreased PRL is a risk factor for NAFLD.