非酒精性脂肪性肝病肝硬化患者胰岛素抵抗水平与颈动脉硬化程度和左心室功能研究*

目的 调查非酒精性脂肪性肝病（NAFLD）所致肝硬化患者与胰岛素抵抗（IR）有关的指标及颈动脉硬化程度和左心室功能变化。方法 2016年6月~2018年6月我院诊治的64例NAFLD所致肝硬化患者,其中Child-Pugh A级26例、B级21例和C级17例,另选择30例健康志愿者。检测空腹血糖（FPG）、空腹胰岛素（FINS）水平,并计算胰岛素敏感指数（ISI）,使用超声检查颈动脉内膜中层厚度（IMT）、颈动脉局部血管收缩末期脉搏波（PWV）传导速度（PWVES）和左心室Tei指数。结果 Child A级、B级和C级肝硬化患者FPG水平分别为（5.5±1.1） mmol/L、（5.6±1.2） mmol/L和（5.8±1.4） mmol/L,均显著高于健康人的（4.8±0.8） mmol/L,P<0.05];FINS水平分别为（8.7±1.7） mIU/L、（10.9±2.2） mIU/L和（15.1±3.1） mIU/L, 均显著高于健康人的 （6.5±1.3）mIU/L,P<0.05]; ISI水平分别为（-4.5±0.4）、（-4.8±0.5）和（-5.1±0.7）,均显著低于对照组的（-4.0±0.3）,P<0.05];Child A级、B级和C级肝硬化患者颈动脉IMT分别为（0.8±0.1） mm、（1.1±0.2） mm和（1.3±0.3） mm,均显著大于对照组（0.5±0.1） mm,P<0.05];颈动脉PWVES分别为（8.1±1.3） m/s、（8.5±1.6） m/s和（8.7±1.8） m/s,均显著大于健康人（7.4±1.1） m/s,P<0.05];左心室Tei指数分别为（0.38±0.08）、（0.44±0.09）和（0.52±0.12）, 均显著高于健康人（0.32±0.05）,P<0.05]。结论 NAFLD所致的肝硬化患者存在IR、颈动脉硬化和左心室功能损害,它们存在发病基础上的某种关联,需要进行综合预防和控制,才能改变疾病的发展轨迹。

Insulin resistance,carotid atherosclerosis and left ventricular function in patients with NAFLD-induced liver cirrhosis

Objective To investigate the changes of insulin resistance（IR）,carotid atherosclerosis and left ventricular function in patients with non-alcoholic fatty liver disease（NAFLD）-induced liver cirrhosis （LC）. Methods The clinical data of 64 patients with NAFLD-induced LC were retrospectively analyzed between June 2016 and June 2018. Out of them,26 were with Child-Pugh class A,21 with class B and 17 were with class C. 30 healthy volunteers were recruited serving as control. The IR-related indicators,such as fasting blood glucose （FPG）,fasting insulin （FINS） and insulin sensitivity index（ISI）],as well as carotid intima-media thickness （IMT） and left ventricular Tei index were obtained. Results In the patients with Child class A,B ad C,the FPG levels were （5.5±1.1） mmol/L,（5.6±1.2） mmol/L and （5.8±1.4） mmol/L,respectively,all significantly higher than （4.8±0.8） mmol/L,P<0.05] in the control;FINS levels were（8.7±1.7） mIU/L,（10.9±2.2） mIU/L and（15.1±3.1） mIU/L, respectively,all significantly higher than （6.5±1.3） mIU/L,P<0.05] in the control;ISI were （-4.5±0.4）,（-4.8±0.5） and（-5.1±0.7）,respectively,all significantly lower than（-4.0±0.3）,P<0.05] in the control;the carotid IMT in patients with Child A,B and C were （0.8±0.1） mm,（1.1±0.2） mm and （1.3±0.3） mm,respectively,all significantly greater than （0.5±0.1） mm,P<0.05] in the control;carotid PWVES were （8.1±1.3） m/s,（8.5±1.6） m/s and （8.7±1.8）m/s,all significantly higher than （7.4±1.1） m/s,P<0.05] in the control;left ventricular Tei index were （0.38±0.08）,（0.44±0.09） and（0.52±0.12）,respectively,all significantly higher than （0.32±0.05）,P<0.05] in the control. Conclusion Patients with NAFLD-induced LC have IR,as well as carotid atherosclerosis and left ventricular dysfunction,which might have a common pathogenesis and needs early intervention.