非肥胖型与肥胖型非酒精性脂肪性肝病患者代谢特征和肝脂肪变程度比较

Comparison of metabolic characteristics and liver steatosis in non-obese and obese patients with nonalcoholic fatty liver diseases

目的比较非肥胖型与肥胖型非酒精性脂肪性肝病(NAFLD)患者代谢特征和肝脂肪变程度差异。方法2015年1月~2021年6月我院诊治NAFLD患者274例,根据体质指数(BMI)=25 kg/m^(2),将其分为非肥胖型66例和肥胖型208例。计算胰岛素抵抗指数(HOMA-IR),行磁共振仪检查,应用仪器自带软件计算肝脏脂肪含量(LFC)和腹部皮下脂肪厚度(ASFT),使用FibroTouch测量肝脏受控衰减参数(CAP),使用多普勒超声诊断仪检测颈动脉内膜中层厚度(CIMT),将肝脂肪变分为Ⅰ级、Ⅱ级和Ⅲ级。结果非肥胖型NAFLD患者BMI为(23.4±1.4)kg/m^(2)、血清丙氨酸氨基转移酶水平为24.2(19.6,35.8)U/L,天冬氨酸氨基转移水平为25.0(18.7,32.3)U/L,甘油三酯为(1.9±0.4)mmol/L,高密度脂蛋白为(1.3±0.4)mmol/L,空腹血糖为(5.0±0.7)mmol/L,空腹胰岛素为7.0(4.8,9.4)μU/mL,HOMA-IR为1.6(1.1,2.3),尿酸为376.5(294.3,430.5)μmol/L,与肥胖型组【分别为(28.6±3.0)kg/m^(2)、88.4(55.4,160.5)U/L、71.5(64.4,141.6)U/L、(2.8±0.6)mmol/L、(1.1±0.3)mmol/L、(5.8±0.8)mmol/L、10.4(7.7,14.2)μU/mL、2.5(1.8,3.4)和442.3(346.4,484.5)μmol/L】比,差异显著(P<0.05);LFC为8.2(6.2,13.4)%,ASFT为(19.2±5.7)mm,CAP为(233.2±40.5)dB/m和CIMT为0.6(0.6,0.7)mm,与肥胖型组【分别为14.6(10.0,18.6)%、(24.6±8.2)mm、(284.6±46.0)dB/m和0.8(0.6,0.9)mm】比,差异显著(P<0.05);Ⅰ级肝脂肪变发生率为43.9%,显著高于肥胖型组的26.0%,而Ⅲ级肝脂肪变发生率为22.7%,显著低于肥胖型组的40.4%(P<0.05)。结论与肥胖型NAFLD患者比,非肥胖型患者代谢紊乱程度和肝脂肪变程度显著较轻。因此,在临床实践中如何加强对这部分患者的监管仍需要进一步研究。

Objective The purpose of this study was to compare the metabolic characteristics and liver steatosis in non-obese and obese patients with nonalcoholic fatty liver diseases(NAFLD).Methods 274 patients with NAFLD were recruited in our hospital between January 2015 and June 2021,and were divided into non-obese(n=66)and obese(n=208)groups based on basic mass index equal to 25 kg/m^(2).The liver fat content(LFC)and abdominal subcutaneous fat thickness(ASFT)were obtained by MR scan.The controlled attenuation parameter(CAP)was detected by FibroTouch check-up and the carotid intima-media thickness(CIMT)was assessed by ultrasonography.Results In patients with non-obese NAFLD,the BMI was(23.4±1.4)kg/m^(2),serum alanine aminotransferase level was 24.2(19.6,35.8)U/L,aspartate aminotransferase level was 25.0(18.7,32.3)U/L,triglyceride level was(1.9±0.4)mmol/L,high-density lipoprotein cholesterol level was(1.3±0.4)mmol/L,fasting blood glucose level was(5.0±0.7)mmol/L,fasting insulin level was 7.0(4.8,9.4)μU/mL,the HOMA-IR was 1.6(1.1,2.3)and uric acid level was 376.5(294.3,430.5)μmol/L,significantly different as compared to[(28.6±3.0)kg/m^(2),88.4(55.4,160.5)U/L,71.5(64.4,141.6)U/L,(2.8±0.6)mmol/L,(1.1±0.3)mmol/L,(5.8±0.8)mmol/L,10.4(7.7,14.2)μU/mL,2.5(1.8,3.4)and 442.3(346.4,484.5)μmol/L,respectively,P<0.05]in obese patients;the LFC was 8.2(6.2,13.4)%,the ASFT was为(19.2±5.7)mm,the CAP was(233.2±40.5)dB/m and the CIMT was 0.6(0.6,0.7)mm,significantly different compared to[14.6(10.0,18.6)%,(24.6±8.2)mm,(284.6±46.0)dB/m and 0.8(0.6,0.9)mm,respectively,P<0.05]in obese patients;the incidence of liver steatosis gradeⅠwas 43.9%,significantly higher than 26.0%,while the incidence of liver steatosis gradeⅢwas 22.7%,significantly lower than 40.4%(P<0.05)in obese patients.Conclusion The metabolic disorders and liver steatosis in non-obese patients with NAFLD are mild,and how to monitor them is really a challenge in clinical practice.