Marchesini G, Brizi M, Morselli-Labate A M, Bianchi G, Bugianesi E, McCullough A J, Forlani G, Melchionda N
Department of Internal Medicine and Gastroenterology, Cattedra di Malattie del Metabolismo, Università di Bologna, Italy.
Am J Med. 1999 Nov;107(5):450-5. doi: 10.1016/s0002-9343(99)00271-5.
Nonalcoholic fatty liver disease is frequently associated with type 2 diabetes mellitus, obesity, and dyslipidemia, but some patients have normal glucose tolerance or normal weight. We tested the hypothesis that there is an association between nonalcoholic fatty liver disease and insulin resistance that is independent of diabetes and obesity.
We measured anthropometric and metabolic variables in 46 patients with chronically elevated serum aminotransferase levels, "bright liver" on ultrasound scan, and normal glucose tolerance. Indexes of insulin resistance and secretion were determined using the homeostasis model assessment method. They were compared with 92 normal subjects who were matched for age and sex.
Patients with nonalcoholic fatty liver disease were characterized by fasting and glucose-induced hyperinsulinemia, insulin resistance, postload hypoglycemia, and hypertriglyceridemia. Insulin resistance [odds ratio (OR) = 15 per percent increase, 95% confidence interval (CI): 3.0 to 70], fasting triglyceride level (OR = 3.1 per mmol/liter increase, 95% CI: 1.1 to 8.9), 180-minute blood glucose level (OR = 4.3 per mmol/ liter decrease, 95% CI: 1.6 to 12), and average insulin concentration in response to oral glucose (OR = 3.0 per 100 pmol/liter increase, 95% CI: 1.5 to 6.2) were independently associated with nonalcoholic fatty liver disease. The exclusion of overweight and obese subjects did not change the results.
Nonalcoholic fatty liver disease is associated with insulin resistance and hyperinsulinemia even in lean subjects with normal glucose tolerance. Genetic factors that reduce insulin sensitivity and increase serum triglyceride levels may be responsible for its development.
非酒精性脂肪性肝病常与2型糖尿病、肥胖和血脂异常相关，但部分患者葡萄糖耐量正常或体重正常。我们检验了以下假设：非酒精性脂肪性肝病与胰岛素抵抗之间存在独立于糖尿病和肥胖的关联。
我们测量了46例血清转氨酶水平长期升高、超声检查显示“明亮肝”且葡萄糖耐量正常的患者的人体测量和代谢变量。使用稳态模型评估法测定胰岛素抵抗和分泌指标。将其与92名年龄和性别匹配的正常受试者进行比较。
非酒精性脂肪性肝病患者的特征为空腹及葡萄糖诱导的高胰岛素血症、胰岛素抵抗、负荷后低血糖和高甘油三酯血症。胰岛素抵抗[比值比（OR）=每增加1%为15，95%置信区间（CI）：3.0至70]、空腹甘油三酯水平（OR =每增加1 mmol/升为3.1，95% CI：1.1至8.9）、180分钟血糖水平（OR =每降低1 mmol/升为4.3，95% CI：1.6至12）以及口服葡萄糖后平均胰岛素浓度（OR =每增加100 pmol/升为3.0，95% CI：1.5至6.2）均与非酒精性脂肪性肝病独立相关。排除超重和肥胖受试者后结果未改变。
即使在葡萄糖耐量正常的瘦人中，非酒精性脂肪性肝病也与胰岛素抵抗和高胰岛素血症相关。降低胰岛素敏感性并增加血清甘油三酯水平的遗传因素可能导致其发生。
