肝脏脂肪含量与胰岛素抵抗及代谢综合征

目的 观察无糖尿病(DM)史的非酒精性脂肪肝(NAFLD)患者肝脂肪含量与胰岛素抵抗(IR)及代谢综合征(MS)的关系.方法 经B超诊断脂肪肝者106例,除外糖尿病、大量饮酒、病毒性肝炎史等,测量形体参数与实验室指标,CT测定肝脏脂肪含量.结果 研究对象肝脏脂肪含量在0～34%,根据中位数与四分位数,当肝脏脂肪含量分别为<3.11%,3.11%～6.34%,6.34%～10.82%,≥10.82%时,MS检出率分别为5例(19.2%),8例(29.6%),13例(48.1%),19例(73.1%)(P<0.05).强制肝脏脂肪含量进入模型逐步Logistic回归分析示性别、肝脏脂肪含量、空腹血糖、收缩压、体重指数、高血压史是MS独立危险因素,高密度脂蛋白胆固醇(HDL-C)与空腹胰岛素是MS独立保护因素.逐步多元线性回归分析表明,肝脏脂肪含量为胰岛素抵抗指数(HOMA-IR)独立危险因素.结论 肝脏脂肪含量是IR及MS独立危险因素,肝脏脂肪含量更能反映内脏性肥胖.

Relationship of liver fat content to insulin resistance and metabolic syndrome

OBJECTIVE: To observe the relationship of liver fat content to insulin resistance and metabolic syndrome (MS) in nonalcoholic fatty liver disease (NAFLD) patients without known diabetes mellitus (DM). METHODS: 106 patients diagnosed as with fatty liver by ultrasonography, 61 males and 45 females, aged 47 +/- 14, underwent anthropometric examination and laboratory tests including lipid profile, fasting and 2 hour serum glucose and insulin after 75 g glucose load. CT scanning was used to determine the fat content in liver. Homeostasis model assessment insulin resistance (HOMA-IR) was calculated. Metabolic syndrome was defined based on the ATP III criteria. RESULTS: The liver fat content in all subjects was distributed from 0 to 34.7% [median (quartile) 6.34% (3.11%-10.82%)]. Forty-five of the 106 patients (42.45%) were diagnosed as with MS. When the liver fat increased by quartile order [< 3.11% (n = 26), 3.11%-6.34% (n = 27), 6.34%-10.82% (n = 27), and > or = 10.82% (n = 26)], the percentages of MS were 19.2% (n = 5), 29.6% (n = 8), 48.1% (n = 13), and 73.1% (n = 19) respectively (P < 0.05). Stepwise Logistic regression analysis (forcing liver fat in the model) showed that being female, liver fat content, fasting glucose, systolic blood pressure, BMI, and history of hypertension were significant risk factors of MS, and HDL-C and fasting insulin were significant protection factors of MS. The standard partial regression coefficient of liver fat content was higher than those of fasting blood glucose, systolic blood pressure, and BMI. Stepwise multiple linear regression analysis demonstrated that liver fat content was a significant risk factor of HOMA-IR while BMI and waist circumference were not. CONCLUSION: Compared with BMI and waist circumference, liver fat content is a stronger risk factor of IR and MS.