非酒精性脂肪肝与超敏C反应蛋白、胰岛素抵抗的关系

目的:探讨非酒精性脂肪肝(NAFLD)与超敏C反应蛋白(hsCRP)、胰岛素抵抗的关系.方法:从2006年10月至12月在湘雅二医院健康体检的长沙某企业职工中随机抽样,其中NAFLD组243例,无脂肪肝组361例,进行问卷调查、体格检查、空腹血糖、血脂、谷丙转氨酶(ALT)、血尿酸、空腹胰岛素和hsCRP检测以及腹部B超检查.结果:与轻度脂肪肝比较,中度脂肪肝血清hsCRP,胰岛素抵抗指数(HOMA-IR)增高显著(P<0.01).胰岛素抵抗NAFLD患者hsCRP,ALT水平明显高于无胰岛素抵抗患者(P<0.05).血清hsCRP高浓度组NAFLD患病风险是低浓度组的5.937倍.采用多因素logistic回归分析,调整了性别、年龄和多项代谢成分后,NAFLD与hsCRP,HOMA-IR独立相关(OR值分别为2.044,7.896,P<0.01).结论:血清hsCRP、胰岛素抵抗与NAFLD存在关联,是发生NAFLD的独立危险因素.全身系统性炎症和胰岛素抵抗在NAFLD发生发展中起重要作用.

Non-alcoholic fatty liver,high sensitivity C reactive protein and insulin resistance

Objective To explore the relationship among non-acoholic fatty liver disease (NAFLD), high sensitivity reactive C protein (hsCRP) and insulin resistance.Methods Workers of an enterprise in Changsha for health examination in Second Xiangya Hospital from October to December, 2006, NAFLD group (243 patients) and a control group without fatty liver disease (361 patients) were randomly drawn. Questionnaire, physical examination, fasting plasma glucose, serum lipid-profile, alanine aminotransferase (ALT),blood uric acid, and abdominal ultrasonographic examination were undertaken in the 2 groups.Results The moderate NAFLD group had significantly higher hsCRP concentration and homeostasis model assessment of insulin resistance (HOMA-IR) as compared with the mild NAFLD group (P<0.01). The patients with insulin resistance had significantly higher hsCRP concentration and ALT level compared with NAFLD patients without insulin resistance (P<0.05). The NAFLD patients were divided into 2 groups (low and high) according to the hsCRP concentration (<1 mg/L or >/= 1 mg/L). Compared with the low concentration group, the odds ratio of the high concentration group for prevalence of NAFLD was 5.937(P<0.001). Multi-factor logistic regression analysis demonstrated that NAFLD was independently correlated with hsCRP or HOMA-IR after adjustment for sex, age and metabolic components (OR=2.044, 7.896,P<0.01).Conclusion NAFLD is closely correlated with hsCRP and HOMA-IR. Insulin resistance and elevated hsCRP concentration are the independent risk factors for the presence of NAFLD.