胰岛素抵抗与原发性脂肪肝家族集聚现象的初步研究

目的:对原发性脂肪肝(PFLD)患者及健康对照的一级亲属中PFLD发生情况、胰岛素抵抗(HOMA-IR)指数以及其他相关代谢指标的测定,了解PFLD是否有家族集聚现象及IR在其发病中的可能作用。方法:PFLD的诊断依据B超为脂肪肝并排除继发性原因。PFLD家系组(A组)共42例,11个家庭。选取与A组年龄、性别构成及生活方式和经济状况相近的健康志愿者家系为对照组(B组)共14例,4个家庭。所有受试者均进行身高、体重、腰围、血压等测定,行糖耐量试验、胰岛素及血脂质等检测,并对受试者的生活方式及文化程度和经济状况行量化打分。结果:A组PFLD33例(78.57%,A1组),无脂肪肝9例(A2组),说明有家族集聚现象。与B组相比,A1组的体重指数、腰围、舒张压、血总胆固醇和HOMA-IR指数显著高于B组(P<0.05);血高密度脂蛋白胆固醇(HDL-C)显著低于B(P<0.05);A2组的各项指标与B组相比差异无统计学意义,但变化趋势呈现出腹型肥胖、IR、代谢紊乱和血压偏高;而A1组及A2组与B组的生活方式及经济状况无明显差异。结论:PFLD具有较强的家族聚发现象,其IR程度显著高于对照组;家族中无脂肪肝者存在IR相关的代谢紊乱趋势。说明某种内在或遗传因素如IR可能与PFLD发病有关。

A Preliminary Study on Insulin Resistance and the Familial Clustering Phenomena of Primary Fatty Liver Disease

Objective:To investigate the relationship of insulin resistance(IR)with primary fatty liver disease(PFLD)in subjects with PFLD and their first-degree relatives.To study whether there is a familial clustering tendency of PFLD,and a possible role of IR in the pathogenesis of PFLD.Methods:Fourty-two subjects(group A)came from 11 families with PFLD.The families involved two generations:father or mother,their brothers or sisters,and their sons or daughters.There were 33 patients were diagnosed as PFLD by B-type ultrasound(other pathogenic factors were excluded at the same time)(group A1),9 patients were non-PFLD(group A2).There are 14 persons came from 4 families without abnormal metabolic indexes and matched lifestyle with group A as controls(group B).The levels of blood glucose,lipids,insulin etc.were detected in two groups,and blood pressure(BP),body mass index(BMI),waist circumference(WC)were measured too.On the other hand,life style score was evaluated in three groups separately.Results:Thirty-three patients(78.57%)were diagnosed as PFLD in group A.Group A1 had the higher levels of BP,BMI,WC,serum total cholesterol,and HOMA-IR index than group B,and lower levels of serum high density lipiprotein-cholesterol than group B.Because of the small sample of group B,the all metabolic indexes were not significantly different between the group A2 and group B.But statistical tendency showed group A2 had higher BMI,WC,and HOMA-IR index,more IR-related metabolic parameters,and higher BP in comparison with group B.Otherwise lifestyle score was not significantly different between group A1 and B,group A2 and B.Conclusion:There was highly familial clustering tendency in PFLD.IR might be a hereditary pathogenic factor in the development of PFLD,although it is sorry to say that this is only a small sample survey,so further study needs to be made.