摘要
目的 探讨非酒精性脂性肝脏疾病 (NAFLD)脂代谢紊乱 ,胰岛素抵抗的情况及其与胰岛素抵抗、肿瘤坏死因子α(TNF α)水平的关系。 方法 采用病例对照研究 ,2型糖尿病 (T2DM )伴有脂肪肝组 (DF) 6 7例 ,T2DM不伴脂肪肝组 (NDF) 33例 ,脂肪肝组 (F) 2 1例 ,正常对照组 (NC) 18名。检测了 4组对象血脂、血糖和胰岛素 (空腹和 2h)、游离脂肪酸 (FFA)、TNF α,并通过CT定量评估了 2 6例DF组和 10名NC组对象肝脏脂肪含量。 结果 DF组与NDF组 ,F组与NC组比较 ,体重 (W )、体质指数 (BMI)、腰围 (W 1)、臀围 (H1)、腰臀比 (WHR)、胆固醇 (TC)、甘油三酯 (TG)、丙氨酸氨基转移酶 (ALT)、天门冬酸氨基转移酶 (AST)、TNF α、HOMA IR水平明显升高 (P <0 0 5 )。F组血糖和胰岛素 (空腹和 2h)水平高于NC组 (P <0 0 5 )。DF组FFA水平高于NC组 (P <0 0 5 )。多元逐步回归分析显示FBG、TG、BMI、脂肪肝是NAFLD胰岛素抵抗 (IR)的主要危险因素。不同程度的肝脏脂肪浸润程度 ,TC、TG、TNF α水平有显著性差异 (P <0 0 5 )。 结论 NAFLD存在IR。校正其他影响因素后 ,FBG、TG、BMI、脂肪肝是影响NAFLD病人IR的主要危险因素。
Objective To investigate the disorder of lipid metabolism, degree of insulin resistance in patients of nonalcoholic fatty liver disease(NAFLD) and relationship of NAFLD with insulin resistance and level of tumor necrosis factor alpha(TNF-α). Methods The investigation used a case control study. Serum lipids, free fatty acid(FFA), TNF-α, serum glucose and insulin(fasting and 2-hour postprandial) were measured in patients of 67 type 2 diabetes with fatty liver(DF), 33 type 2 diabetes without fatty liver(NDF), 21 fatty liver(FL) and 18 control subjects(NC). 26 DF patients and 10 control subjects were evaluated about hepatic fat content by using CT. Results The result showed that weight(W), body mass index(BMI), waist circumference(W1), hip circumference(H1), waist-hip ratio(WHR), serum cholesterol(TC), serum triglycerides(TG), alanine aminotransferase(ALT), aspartate aminotransferase(AST), HOMA-IR and TNF-α were significantly more elevated in the groups of DF, FL compared with those of group NDF and NC(P<0.05).The levels of fasting blood glucose(FBG), 2-hour postprandial blood glucose(2 h BG), fasting serum insulin(FIns), 2-hour postprandial serum insulin(2 h Ins) in patients of group F were significantly higher than those of group NC(P<0.05). FFA was obviously increased in DF patients compared with control subjects(P<0.05). Multiple stepwise regression analysis showed that FBG, TG, BMI, and fatty liver were the mainly risk factors for insulin resistance in patients of NAFLD. The significant difference of TC,TG and TNF-α was confirmed in patients of different degree of hepatic steatosis(P<0.05). Conclusion The study confirms that insulin resistance is uniformly present in subjects with fatty liver, even after correcting other influence factors. FBG, TG, BMI, and fatty liver were the mainly risk factors for insulin resistance in patients of NAFLD.
