非肥胖型与肥胖型非酒精性脂肪肝临床特点比较分析

Clinical Characteristics Comparison between Non-obese and Obese Nonalcoholic Fatty Liver Disease

目的通过比较非肥胖型与肥胖型非酒精性脂肪性肝病(NAFLD)患者明确非肥胖型NAFLD的临床特点.方法随机选取2018年1~12月在笔者医院体检中心、门诊及住院确诊为NAFLD的患者.本研究将BMI<25kg/m^2定义为非肥胖组,25kg/m^2≤BMI<30kg/m^2定义为肥胖组,同时设置无肝脏疾病且BMI<25kg/m^2的健康人(或患者)作为对照组,收集研究对象具体信息,包括年龄、性别、吸烟、运动、学历、高血压、糖尿病、相关生化指标、腰围、血去甲肾上腺素、血肾上腺素、促甲状腺素等实验室检查以及Fibroscan、无创病理评分公式,比较3组之间的差异.结果两组NAFLD患者在文化程度、腰围、血肾上腺素、空腹胰岛素、甘油三酯、空腹血糖、胰岛素抵抗(IR)比较差异有统计学意义,而在ALT、AST、总胆固醇、LDL-C、HDL-C、白蛋白、PLT、TSH水平、去甲肾上腺素、年龄、性别、运动时间、吸烟情况、高血压、糖尿病方面比较差异无统计学意义.结论非肥胖型NAFLD患者虽无肥胖,但这部分患者仍有胰岛素抵抗,其程度低于肥胖组.此外,非肥胖型NAFLD患者肾上腺素水平高于肥胖患者,胰岛素则低于肥胖组,体内脂解激素及抗脂解激素水平变化,可能是非肥胖NAFLD患者除胰岛素抵抗之外的另一重要致病机制.

Objective To analyze the clinical features of non一obese NAFLD by comparing with the obese NAFLD patients.T Methods The research subjects were divided into 3 groups.The patients diagnosed with NAFLD in the First Hospital Affiliated of Wenzhou Medical University were divided in the non-obese group with BMI<25kg/m^2,and patients with 25kg/m^2≤BMI<30kg/m^2 for the obese group.Meanwhile healthy people(or patient)without liver disease were set as the control group.Then we collected patientsz information in detail,compared and found out the significant differences between two groups,including age,gender,smoke,exercise,hypertension,diabetes,lipid,WC,epinephrine,norepinephrine,fasting insulin,TSH,glucose,lipid,some other laboratory examinations and Fibroscan.Results There was significant difference in education,waistline,epinephrine,FINS,TG,FBG and IR.And there was no difference in ALT,AST,γ-GT,cholesterol,LDL-C,HDL-C,albumin,PLT,TSH,age,gender,exercise,smoking,hypertension,diabetes,and MS.Conclusion Although non-obese NAFLD patients have a normal BMI,they do have IR.The level of epinephrine and norepinephrine of non-obese patients are greater than obese patients.The alteration of lipolytic and anti-lipolytic hormones may be another important pathogenesis for the non-obese NAFLD apart from IR.