脂肪肝与胰岛素抵抗的关系

目的　探讨脂肪肝患者代谢紊乱、胰岛素抵抗的情况及脂肪肝与胰岛素抵抗的关系。方法　采用病例对照研究 ,2型糖尿病伴有脂肪肝 (DF)组 6 7例 ,2型糖尿病不伴脂肪肝 (NDF)组 33例 ,脂肪肝 (F)组 2 1例 ,正常对照 (C)组 18例。检测 4组患者的体脂参数、血脂、血糖 (空腹和餐后 2h)、胰岛素 (空腹和餐后 2h)及游离脂肪酸 (FFA) ,采用稳态模式胰岛素抵抗指数 (HOMA IR)评价胰岛素抵抗。结果　DF组与NDF组、F组与C组比较 ,体重指数 (BMI)、腰围 (W 1)、腰臀比 (WHR)、胆固醇 (TC)、三酰甘油 (TG)、丙氨酸氨基转移酶 (ALT)、天冬氨酸氨基转移酶 (AST)、HOMA IR水平明显升高 (P <0 .0 5 )。F组的空腹血糖 (FBG)、餐后 2h血糖 (2hBG)、空腹胰岛素 (FINS)和餐后 2h胰岛素 (2hINS)水平高于C组 (P <0 .0 5 )。DF组中游离脂肪酸 (FFA)水平高于C组 (P <0 .0 5 )。多元逐步回归分析显示 ,FBG、TG、BMI和脂肪肝是脂肪肝患者胰岛素抵抗独立的危险因素。结论　脂肪肝患者普遍存在胰岛素抵抗 ,FBG、TG、BMI和脂肪肝是影响脂肪肝患者胰岛素抵抗独立的危险因素

The relevance of fatty liver and insulin resistance

Objective To investigate the disordered lipid metabolism, the degree of insulin resistance in patients with fatty liver and the relevance of fatty liver to insulin resistance. Methods The investigation was conducted by means of case control study. Anthropometrical parameters, serum lipids, fasting and 2 hour postprandial serum glucose, fasting and 2 hour postprandial serum insulin, free fatty acid(FFA) were measured in 67 patients of type 2 diabetes with fatty liver(DF), 33 type 2 diabetes mellitus without fatty liver(NDF), 21 fatty liver(F) only and 18 control subjects(C). Homeostasis model assessment(HOMA) was applied to assess the status of insulin resistance. Results The results showed that body mass index(BMI), waist circumference(W1), waist hip ratio(WHR), serum cholesterol(TC), serum triglyceride(TG), alanine aminotransferase(ALT), aspartate aminotransferase(AST) and HOMA IR were significantly elevated in the subjects of DF, and F compared with those of NDF and C( P <0.05). The levels of fasting blood glucose(FBG), 2 hour postprandial blood glucose(2hBG), fasting serum insulin(FINS), 2 hour postprandial serum insulin(2hINS) in patients of F were significantly higher than those of C. FFA was obviously increased in DF patients compared with the control subjects( P <0.05). Multiple stepwise regression analysis showed that fasting glucose, TG, BMI, fatty liver were independent risk factors of insulin resistance in fatty liver patients. Conclusion The present study confirms that insulin resistance is generally present in subjects with fatty liver, even in absence of diabetes. Fasting glucose, TG, BMI, fatty liver are independent risk factors of insulin resistance in patients with fatty liver.