非酒精性脂肪肝与胰岛素抵抗及血清瘦素、脂联素水平的关系

目的 探讨胰岛素（Insulin）、瘦素（Leptin）及脂联素（Adiponectin）等细胞因子胰岛素抵抗（IR）在非酒精性脂肪肝（NAFLD）发病机理中的作用.方法 选择经诊断为非酒精性脂肪肝141例（其中轻度脂肪肝42例;中度脂肪肝51例;重度脂肪肝48例）,同时选择40例健康正常人做对照组.应用酶联免疫分析法对瘦素和脂联素进行检测.用放射免疫法（RIA）对胰岛素进行检测.结果 非酒精性脂肪肝患者的胰岛素及瘦素表达显著升高（p〈0.01）,较正常对照组有显著性差异（p〈0.01）,且与脂肪肝病情的进程呈正相关,胰岛素抵抗与病程成正相关;而脂联素明显降低（p〈0.01）,较正常对照组有显著性差异（p〈0.01）,且与病情的进程呈负相关.结论 胰岛素抵抗（IR）和脂质代谢紊乱导致的肝细胞脂质沉积,加重脂肪肝的进程,瘦素不依赖于IR,并且其血清水平与脂肪浸润严重程度相关,高瘦素浓度可致血胰岛素水平上升及肝细胞胰岛素抵抗,改变信号转导,加重脂酸堆积从而促进脂肪肝发生.非酒精性脂肪肝的发生可能与胰岛素、瘦素及脂联素的异常有一定的关系.

The relationship between non-Alcoholic Fatty Liver and Insulin Resistance and serum leptin and adiponectin

Objective To study the insulin resistance （IR） of cell factors including insulin, leptin and adipanectin in pathogenesis of non - alcoholic fatty liver disease. Methods 141 nonalcoholic fatty liver patients, consisting of 42 low grade fatty liver patients, 51 middle grade fatty liver patients and 48 high grade fatty liver patients, were chosen as the research subject, meanwhile, 40 healthy people as control group. ELISA was utilized to detect leptin and adipanectin. Radioimmunoassay （RIA） was employed to assay insulin. Results Insulin and iepfin contents of non- alcoholic fatty liver patients group are obviously higher than that the healthy control group （p 〈 0.01 ）. There is significant difference between the two groups （p 〈 0.01）. Correlative analysis shows that there is a positive correlation between contents of insulin and teptin and the grade of fatty liver disease. And there is also a positive correlation between insulin resistance and the disease severity. Compared with the normal control group, the adiponeetin content of fatty, liver patients is evidently lower （p 〈 0.01 ）. And there is significant difference between the two groups （p 〈 0.01）. Negative correlation is observed between the content of adipenectin and the grade of disease. Conciusions The accumulation of lipid in liver cells induced by IR and lipid metabolism disorder could aggravate the course of fatty liver disease. The teptin is independent of IR. The serum leptin content is correlated with the severiw of fatty infiltration. High level of lepfin could reduce the increase of blood insulin concentration and liver cells IR, effect the signal transduction, accelerate the accumulation of lipid and then resua in patuogenesis of fatty liver. It hypothesizes that the abnormity of insulin, leptin and adiponectin may be related to the non- alcoholic iatry liver.