非酒精性脂肪性肝病中脂肪组织胰岛素抵抗与肝巨噬细胞的相互作用

【据《J Hepatol》2019年11月报道】题:非酒精性脂肪性肝病中脂肪组织胰岛素抵抗与肝巨噬细胞的相互作用(作者Rosso C等)非酒精性脂肪性肝病(NAFLD)和脂肪性肝炎(NASH)的发病机制可能是由于紊乱的代谢环境与肝脏炎症和纤维化的局部介质之间的相互作用。该研究旨在阐明巨噬细胞活化、靶器官/组织胰岛素抵抗(IR)与肝损伤之间的相互作用。     

高血压合并脂肪肝与胰岛素抵抗的相关分析

目的：探讨高血压合并脂肪肝与胰岛素抵抗（IR）的相关性。方法：根据超声影像学的诊断结果将住院治疗的高血压患者分为高血压合并脂肪肝组（98例）和高血压未合并脂肪肝组（104例），研究两组的体重指数（BMD、血压（BP）、血糖、总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、肝酶和血浆胰岛索，胰岛素抵抗指数（IRI）水平。结果：高血压合并脂肪肝组较高血压未合并脂肪肝组的血糖、胰岛素水平、甘油三酯和胰岛素抵抗指数均明显增高（P〈0．05）。Logistic回归结果表明空腹血糖（FBG）、肥胖、丙氨酸氨基转氨酶（ALT）、葡萄糖负荷试验后3h胰岛素水平、甘油三醋（TG）是脂肪肝形成的独立危险因素（OR=1．980～3．245，P〈0．05）。结论：高血压和脂肪肝均是胰岛素抵抗的重要表现，高血压合并的脂肪肝其发病机制与胰岛素抵抗有关。     

Review: The role of insulin resistance in nonalcoholic fatty liver disease

CONTEXT: Insulin resistance is an almost universal finding in nonalcoholic fatty liver disease (NAFLD). This review outlines the evidence linking insulin resistance and NAFLD, explores whether liver fat is a cause or consequence of insulin resistance, and reviews the current evidence for treatment of NAFLD. EVIDENCE ACQUISITION: Evidence from epidemiological, experimental, and clinical research studies investigating NAFLD and insulin resistance was reviewed. EVIDENCE SYNTHESIS: Insulin resistance in NAFLD is characterized by reductions in whole-body, hepatic, and adipose tissue insulin sensitivity. The mechanisms underlying the accumulation of fat in the liver may include excess dietary fat, increased delivery of free fatty acids to the liver, inadequate fatty acid oxidation, and increased de novo lipogenesis. Insulin resistance may enhance hepatic fat accumulation by increasing free fatty acid delivery and by the effect of hyperinsulinemia to stimulate anabolic processes. The impact of weight loss, metformin, and thiazolidinediones, all treatments aimed at improving insulin sensitivity, as well as other agents such as vitamin E, have been evaluated in patients with NAFLD and have shown some benefit. However, most intervention studies have been small and uncontrolled. CONCLUSION: Insulin resistance is a major feature of NAFLD that, in some patients, can progress to steatohepatitis. Treatments aimed at reducing insulin resistance have had some success, but larger placebo-controlled studies are needed to fully establish the efficacy of these interventions and possibly others in reducing the deleterious effects of fat accumulation in the liver.     

非酒精性脂性肝脏疾病与胰岛素抵抗的关系

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。     

非酒精性脂肪肝与胰岛素抵抗

目的探讨非酒精性脂肪性肝病（NAFLD）与胰岛素抵抗（IR）的关系。方法NAFLD组52例,非NAFLD组50例,比较两组间BMI、WHR、TC、TG、CRP、HDL-C、LDL-C、ALT、Cr、FBG、FINS和HOMA-IR的差异,并进行Logistic回归分析。结果NAFLD组与非NAFLD组在BMI（26.7±2.3与22.4±2.5,P〈0.01）、WHR（0.94±0.06与0.83±0.05,P〈0.01）、TG（2.4±0.6与1.8±0.6,P〈0.01）、ALT（37.3±8.3与28.1±7.2,P〈0.05）、FBG（6.2±1.4与5.2±0.7,P〈0.01）、FINS（23.6±13.6与8.6±3.5,P〈0.01）、HOMA-IR（6.7±4.7与2.0±1.6,P〈0.01）的差异有统计学意义,Logistic回归分析显示BMI（P〈0.01）、WHR（P〈0.01）、TG（P〈0.01）、ALT（P〈0.05）、HOMA-IR（P〈0.01）是NAFLD的独立影响因素。结论BMI、WHR、TG、ALT、HOMA-IR是NAFLD的独立影响因素。     

非酒精性脂肪肝与胰岛素抵抗相关因素的分析

目的 探讨非酒精性脂肪肝病情与胰岛素抵抗之间的相关关系.方法 根据肝脏B超检查结果将所有纳入病例分为轻、中、重度三组,每组分别测身高、体重、血甘油三酯、胆固醇、肝功能等指标,计算出胰岛素抵抗指数和β细胞指数.比较各组间数据.结果 非酒精性脂肪肝的严重程度与胰岛素抵抗和血脂代谢紊乱是成正相关的.结论 证实了胰岛素抵抗及脂代谢紊乱在非酒精性脂肪肝发病及病情进展方面具有十分重要的地位.     

miRNA-103: Molecular link between insulin resistance and nonalcoholic fatty liver disease

AIM: To investigate the associations between miRNA-103(mi R-103) and insulin resistance and nonalcoholic fatty liver disease(NAFLD).METHODS: Serum samples were collected from 50 NAFLD patients who were overweight or obese(NAFLD group) and from 30 healthy subjects who served as controls(normal control group). Quantitative polymerasechain reaction was used to detect expression of mi R-103. Fasting plasma glucose, fasting insulin, and triglyceride(TG) levels were measured. Homeostasis model assessment was used to evaluate basal insulin resistance(HOMA-IR). Patient height and weight were measured to calculate body mass index(BMI).RESULTS: Compared with the normal control group, higher serum levels of mi R-103 were expressed in the NAFLD group(8.18 ± 0.73 vs 4.23 ± 0.81, P = 0.000). When P = 0.01(bilateral), mi R-103 was positively correlated with HOMA-IR(r = 0.881), TG(r = 0.774) and BMI(r = 0.878), respectively. mi R-103, TG and BMI were all independent factors for HOMAIR(β = 0.438/0.657/0.251, P = 0.000/0.007/0.001). mi R-103, TG, BMI and HOMA-IR were all risk factors for NAFLD(odds ratio = 2.411/16.196/1.574/19.11, P = 0.009/0.022/0.01/0.014).CONCLUSION: mi R-103 is involved in insulin resistance and NAFLD, and may be a molecular link between insulin resistance and NAFLD and a therapeutic target for these disorders.     

细胞因子、胰岛素抵抗与非酒精性脂肪性肝病

非酒精性脂肪性肝病(NAFLD)的发病机制目前尚不清楚,但大量研究表明胰岛素抵抗与之密切相关.随着胰岛素抵抗程度的加重,调控肝脏糖脂代谢的开关--Foxo1、Foxa2的基因活性发生不同程度的改变,导致肝脏糖脂代谢紊乱,引起NAFLD的续贯性发生.此外,与胰岛素抵抗密切相关的瘦素、肿瘤坏死因子-α作为损害性因子,脂联素作为保护性因子亦在NAFLD的发生、发展中起重要作用.     

Non-alcoholic fatty liver disease and insulin resistance

Non-alcoholic fatty liver disease (NAFLD) is an entity now recognized as one of the leading causes of asymptomatic chronic elevation of aminotransferase levels, which can, however, progress to more advanced forms of hepatic lesion and ultimately to liver failure. Insulin resistance is considered as having a central role in NAFLD pathogenesis, which is related with oxidative stress, abnormal production of cytokines and deregulation of fatty acid metabolism. In this article the authors make a brief review of the epidemiological data about NAFLD and insulin resistance, and their aetiological link, and treatment implications.     

Distinct roles of adipose triglyceride lipase and hormone-sensitive lipase in the catabolism of triacylglycerol estolides

Branched esters of palmitic acid and hydroxy stearic acid are antiinflammatory and antidiabetic lipokines that belong to a family of fatty acid (FA) esters of hydroxy fatty acids (HFAs) called FAHFAs. FAHFAs themselves belong to oligomeric FA esters, known as estolides. Glycerol-bound FAHFAs in triacylglycerols (TAGs), named TAG estolides, serve as metabolite reservoir of FAHFAs mobilized by lipases upon demand. Here, we characterized the involvement of two major metabolic lipases, adipose triglyceride lipase (ATGL) and hormone-sensitive lipase (HSL), in TAG estolide and FAHFA degradation. We synthesized a library of 20 TAG estolide isomers with FAHFAs varying in branching position, chain length, saturation grade, and position on the glycerol backbone and developed an in silico mass spectra library of all predicted catabolic intermediates. We found that ATGL alone or coactivated by comparative gene identification-58 efficiently liberated FAHFAs from TAG estolides with a preference for more compact substrates where the estolide branching point is located near the glycerol ester bond. ATGL was further involved in transesterification and remodeling reactions leading to the formation of TAG estolides with alternative acyl compositions. HSL represented a much more potent estolide bond hydrolase for both TAG estolides and free FAHFAs. FAHFA and TAG estolide accumulation in white adipose tissue of mice lacking HSL argued for a functional role of HSL in estolide catabolism in vivo. Our data show that ATGL and HSL participate in the metabolism of estolides and TAG estolides in distinct manners and are likely to affect the lipokine function of FAHFAs.

Branched esters of palmitic acid and hydroxy stearic acid (PAHSAs) are antiinflammatory and antidiabetic lipokines (1–3). PAHSA serum and adipose tissue levels correlate with insulin sensitivity and are decreased in insulin-resistant humans (2, 4). PAHSAs increase glucose-stimulated insulin secretion by enhancing the production of the gut-derived incretin glucagon-like peptide-1 (5, 6). The antiinflammatory effects of PAHSA isomers (2, 7, 8) are mediated via free fatty acid receptor 4 (FFAR4, GPR120) and modulate both innate and adaptive immune responses in a mouse colitis model (1) and type-1 diabetes (6). Therefore, PAHSAs have beneficial effects on both metabolism and the immune system (9).PAHSAs belong to the family of fatty acid (FA) esters of hydroxy FAs (HFAs) called FAHFAs, which are part of a much larger family of mono- or oligomeric FAHFA esters named estolides. Since FAHFAs contain only a single ester bond of one FA with one HFA (the estolide bond), they represent monoestolides (10). The position of the branching carbon atom defines the regioisomer (e.g., 5-PAHSA or 9-PAHSA). PAHSAs and other less-well-studied FAHFAs such as the oleic acid esters of hydroxy palmitic acid (OAHPAs) or the docosahexaenoic acid ester of 13-hydroxy linoleic acid (13-DHAHLA) derive from either dietary sources or de novo synthesis in adipose tissue and other organs (2, 11, 12). Nonesterified, free FAHFAs (free mono-estolides) can be esterified to glycerol to form FAHFA acylglycerols, which in combination with other FAs result in the formation of triacylglycerol (TAG) estolides, diacylglycerol (DAG) estolides, or monoacylglycerol (MAG) estolides. TAG estolides represent a major storage form of bioactive free FAHFAs and are present in plant oils (e.g., castor oil) (13, 14) and adipose tissue of mice (3, 15) and humans (16).Both the synthetic and catabolic pathways of FAHFAs and TAG estolides are insufficiently understood. The hydrolytic catabolism of FAHFAs and TAG estolides results in the generation of highly bioactive and physiologically relevant FAHFAs, HFAs, FAs, and DAGs. Given the structural and metabolic similarity between TAGs and TAG estolides, it seemed reasonable to suspect that canonical TAG lipases will be involved in FAHFA and TAG estolide degradation. Generally, the catabolism of TAGs in cells occurs in the cytosol (neutral lipolysis) or in lysosomes (acidic lipolysis). Neutral lipolysis represents the predominant pathway for the hydrolysis of lipid droplet-associated TAGs in adipocytes involving three major enzymes, adipose triglyceride lipase (ATGL), hormone-sensitive lipase (HSL), and monoglyceride lipase (MGL). ATGL catalyzes the initial step of TAG hydrolysis, generating DAG and one FA (3, 17, 18). The enzyme belongs to the patatin-like phospholipase domain-containing (PNPLA) family of proteins comprising a number of lipid hydrolases (3, 15). ATGL is the most potent TAG hydrolase within this family but also exhibits some phospholipase, retinylesterase, and transacylase activities of undefined physiological relevance (17, 19, 20). For full TAG hydrolase activity, ATGL requires a coactivator named comparative gene identification-58 (CGI-58; also called α/β-hydrolase domain containing 5, ABHD5) (21–23). CGI-58 features α/β-hydrolase folds and also exerts some acyltransferase and protease activities (23–25). Yet, the physiological role of these activities remains elusive. ATGL exhibits unique regioselectivity for TAG substrates and preferentially hydrolyzes the sn-2 position of the glycerol chain of TAGs (26). Upon stimulation of ATGL by CGI-58 this regioselectivity broadens to the sn-1 but not the sn-3 position (26).HSL is rate-limiting for the second step of TAG lipolysis converting DAG to one FA and MAG (27). The enzyme preferentially catalyzes DAGs at the sn-3 position and cholesteryl esters (28, 29) but also cleaves TAGs (sn-1 and sn-3 position), retinylesters (30), or medium- and short-chain carboxylic acid glycerol esters (29). The enzyme is structurally unrelated to ATGL and does not require enzyme coactivators. Hormonal stimulation of neutral lipolysis by β-adrenoreceptor agonists such as catecholamines activates both ATGL and HSL by promoting the molecular interaction of ATGL with CGI-58 on the surface of TAG-containing lipid droplets (21, 31) and the translocation of HSL from the cytoplasm to lipid droplets. These processes involve the protein kinase A-dependent phosphorylation of perilipin-1, CGI-58, and HSL (31–33).Previous studies by Tan et al. (15) and our laboratory (3) demonstrated that ATGL and HSL are both able to hydrolyze FAHFA–glycerol ester bonds of TAG estolides. However, enzyme preferences for this reaction, the substrate requirements, or the contribution of these enzymes to hydrolyze the FA–HFA ester bond (estolide bond) in TAG estolides as well as in free FAHFAs remained unaddressed. Using a newly generated library of TAG estolides, we now show that ATGL and HSL play distinct roles in the formation of TAG estolides by transesterification reactions and the degradation of (TAG) estolides by hydrolysis reactions.     

肝脂酶、脂蛋白脂肪酶在脂肪肝发病中的作用

目的　探讨肝脂酶（ＨＬ）和脂蛋白脂肪酶（ＬＰＬ） 在脂肪肝发病中的作用。方法　３１ 例脂肪肝患者、１０ 例急性肝炎患者、１２ 例慢性肝炎患者、８ 例肝硬化患者及８ 例对照组均测定肝素后血浆中的ＨＬ、ＬＰＬ活性和ＬＰＬ含量,同时测定血脂、肝肾功能、血糖及肝炎病毒标记,其中１３ 例脂肪肝患者和７ 例对照行肝组织ＨＬ、ＬＰＬ活性和ＬＰＬ含量测定。结果　脂肪肝组与正常对照组及其他各组肝病相比,血脂明显升高,主要表现为血甘油三酯升高,肝素后血浆中ＨＬ、ＬＰＬ 活性显著降低,而ＬＰＬ 含量保持不变。脂肪肝组患者肝组织中ＬＰＬ活性亦明显降低。结论　脂肪肝与高脂血症之间关系密切,肝素后血浆中脂蛋白脂肪酶、肝脂酶活性的降低可能在脂肪肝发病中起一定作用。     

非酒精性脂肪肝与胰岛素抵抗的关系

探讨非酒精性脂肪肝(NAFL)发病与胰岛素抵抗的关系。对63例受检者用放免法测定血清胰岛素,稳态模型法计算胰岛素抵抗指数。同时选择20例无脂肪肝肥胖者作为对照组。脂肪肝组与对照组比较,血清胰岛素、胰岛素抵抗指数显著性增高(P<0.001),重度脂肪肝与中度脂肪肝、轻度脂肪肝比较,血清胰岛素、胰岛素抵抗指数也存在明显增高(P<0.05)。胰岛素抵抗可能系脂肪肝发病的原发因素,而非继发性改变。     

高血压病患者非酒精性脂肪肝病与胰岛素抵抗关系探讨

探讨高血压病患者的非酒精性脂肪肝病（NAFLD）与胰岛素抵抗（IR）的关系。190例不伴有糖尿病的患者分为正常血压和高血压组;再根据B超诊断有无脂肪肝将高血压组分为伴NAFLD 48例（观察组）,高血压不伴NAFLD 50例（对照组）。对两组间及高血压组内的体重指数（BM I）、血压、血糖、血脂、血胰岛素、胰岛素抵抗指数（HOMA-IR）及转氨酶等指标进行比较分析,并对NAFLD与上述指标的关系进行多因素logistic回归分析。经相关分析显示：HMOA-IR与血压升高呈显著负相关;高血压伴NAFLD组的BM I、甘油三酯、空腹胰岛素、口服75g葡萄糖后2h胰岛素、ALT,AST及HOMA-IR较不伴NAFLD组显著增高（P〈0.05-0.01）,而且NAFLD与HOMA-IR及ALT呈独立相关（P〈0.05,0.01）。高血压病伴NAFLD患者有更显著的IR,而且在非糖尿病患者中,IR是高血压和NAFLD的独立危险因素。     

非酒精性脂肪肝与肥胖及胰岛素抵抗的关系

探讨非酒精性脂肪肝 (NASH)的体脂含量和分布特征 ,血脂情况及与胰岛素抵抗的关系。对 87例观察对象分为NASH组 (30例 )和对照组 (5 7例 ) ,检测身高、体重、血脂、血糖、血胰岛素 ,计算胰鸟素敏感指数和体重指数 ;做腹部CT扫描以其配备软件计算腹内脂肪面积 (VA)和腹皮下脂肪面积 (SA)。 6 8例肥胖者发生NASH2 8人(41 18% ) ,19例体重正常者发生HASH2人 (10 5 3% )。 (x2 =6 175 ,P <0 0 2 5 )差异有显著性。不伴NASH的肥胖者VA(x±s,cm2 ) (男 :10 5 8± 2 9 6　女 :117 3± 33 1)与伴有NASH的肥胖者VA(男 :138 2± 5 3 7　女 :14 2 6± 31 2 )比较差异有显著性 (t =2 72 ,2 31　P <0 0 1,0 0 5 )。无NASH肥胖者与伴有NASH肥胖者比较IAI差异有显著性 (t =1 98　P <0 0 5 )。肥胖尤其是腹内型肥胖与NASH有密切的关系 ;肥胖者发生NASH ,胰岛素抵抗在其中起重要作用。     

Increased prevalence of fatty liver in arterial hypertensive patients with normal liver enzymes: role of insulin resistance

BACKGROUND: The conditions associated with fatty liver disease presenting with normal liver enzymes and the mechanism involved in its development remain to be fully elucidated. AIMS: The aim of the present study was to test the hypothesis that fatty liver with normal liver enzymes occurs more frequently in arterial hypertensive patients and to establish whether this condition is associated with insulin resistance. PATIENTS: A total of 55 non-obese, non-diabetic, non-heavy alcohol drinking patients with arterial hypertensive and normal liver enzymes and 55 sex and age matched healthy subjects were enrolled into the study. METHODS: Plasma metabolic parameters, body mass index, and the presence of fatty liver were investigated. Insulin resistance was estimated from plasma insulin and glucose as the homeostasis model assessment index. Stepwise logistic regression and multivariate regression analysis were used on the combined sample to identify variables independently associated with fatty liver and insulin resistance. RESULTS: Hypertensive patients had a significantly higher prevalence of fatty liver (30.9% v 12.7%; p<0.041), higher insulin resistance (mean 2.27 (SD 1.81) v 1.56 (0.70); p = 0.022), and slightly higher body mass index (24.9 (3.0) v 24.0 (2.2); p = 0.043) than controls. Multivariate logistic regression identified insulin resistance (odds ratio 1.66 (95% confidence interval (CI) 1.03-2.52)) and body mass index (OR 1.22 (95% CI 1.00-1.49)) as factors independently associated with fatty liver. Multivariate regression analysis showed insulin resistance to be predicted by alanine transaminase (p = 0.002), presence of arterial hypertension (p = 0.029), and body mass index (p = 0.048). CONCLUSION: The higher prevalence of non-alcoholic fatty liver in non-obese hypertensive patients with normal liver enzymes appears to be related to increases in insulin resistance and body weight.     

Effect of adipose tissue insulin resistance on metabolic parameters and liver histology in obese patients with nonalcoholic fatty liver disease

The role of adipose tissue insulin resistance in the pathogenesis of nonalcoholic fatty liver disease (NAFLD) remains unclear. To evaluate this, we measured in 207 patients with NAFLD (age = 51 ± 1, body mass index = 34.1 ± 0.3 kg/m(2) ) and 22 controls without NAFLD (no NAFLD) adipose tissue insulin resistance by means of a validated index (Adipo-IR(i) = plasma free fatty acids [FFA] x insulin [FPI] concentration) and as the suppression of plasma FFA during an oral glucose tolerance test and by a low-dose insulin infusion. We also explored the relationship between adipose tissue insulin resistance with metabolic and histological parameters by dividing them based on quartiles of adipose tissue insulin resistance (Adipo-IR(i) quartiles: Q1 = more sensitive; Q4 = more insulin resistant). Hepatic insulin resistance, measured as an index derived from endogenous glucose production x FPI (HIRi), and muscle insulin sensitivity, were assessed during a euglycemic insulin clamp with 3-[(3) H] glucose. Liver fat was measured by magnetic resonance imaging and spectroscopy, and a liver biopsy was performed to assess liver histology. Compared to patients without steatosis, patients with NAFLD were insulin resistant at the level of adipose tissue, liver, and skeletal muscle and had higher plasma aspartate aminotransferase and alanine aminotransferase, triglycerides, and lower high-density lipoprotein cholesterol and adiponectin levels (all P < 0.01). Metabolic parameters, hepatic insulin resistance, and liver fibrosis (but not necroinflammation) deteriorated as quartiles of adipose tissue insulin resistance worsened (all P < 0.01). CONCLUSION: Adipose tissue insulin resistance plays a key role in the development of metabolic and histological abnormalities of obese patients with NAFLD. Treatment strategies targeting adipose tissue insulin resistance (e.g., weight loss and thiazolidinediones) may be of value in this population.     

非酒精性脂肪与胰岛素抵抗及糖代谢异常的关系

目的 探讨非酒精性脂肪肝（脂肪肝）与胰素抵抗及糖代谢异常之间的关系。方法 对４８例脂肪肝患者做胰岛素释放试验和葡萄糖耐量试验,计算胰岛素曲线下面积,血糖曲线下面积和胰岛素敏感性指标（血糖曲线下面积／胰岛素曲线下面积）,并以不嗜酒的正常人作为对照组。结果 脂肪肝组口服葡萄糖６０ｍｉｎ,１２０ｍｉｎ,１８０ｍｉｎ后胰岛素水平高于对照组且高峰后移;除１８０ｍｉｎ外脂肪肝组的各时点的血糖水平显著高于对照级