Chalasani Naga, Deeg Mark A, Persohn Scott, Crabb David W
Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
Am J Gastroenterol. 2003 Aug;98(8):1849-55. doi: 10.1111/j.1572-0241.2003.07619.x.
Insulin resistance is nearly universal in patients with nonalcoholic steatohepatitis (NASH) when tested by glucose tolerance tests or clamp methods. However, the pattern of insulin resistance in these patients after a physiological challenge is unknown. We conducted a study to characterize the metabolic response to a mixed meal in nondiabetic patients with NASH (NDN) and to identify anthropometric determinants of insulin resistance in these patients.
Serum insulin, C-peptide, glucose, and free fatty acid (FFA) levels were measured at 0, 30, 60, 90, and 120 min after a 500-kcal standard meal in 18 NDN and 18 age-, gender-, and body mass index (BMI)-matched controls. Correlations were made between insulin resistance and various anthropometric, calorimetric, and serological variables.
Compared with controls, NDN had significantly higher levels of insulin and C-peptide at baseline and after the mixed meal. However, glucose levels were not different either at baseline or after the meal. NDN had higher fasting levels of FFA than the controls (459 +/- 190 vs 339 +/- 144 micro mol/L, respectively, p = 0.03); however, meal-induced suppression in lipolysis was similar between the two groups (39 +/- 113% vs 46 +/- 60%, p = 0.8). Insulin resistance was significantly correlated with BMI (r = 0.39, p = 0.02) and visceral fat (r = 0.50, p = 0.004). Whereas BMI, percent total body fat, and subcutaneous abdominal fat were similar between the groups, the NASH group had significantly higher percent visceral fat compared with controls (28 +/- 10% vs 22 +/- 14%, p = 0.02).
NDN are significantly hyperinsulinemic, both at fasting and after the mixed meal; however, their glucose homeostasis and suppression in lipolysis after a meal challenge are maintained. Insulin resistance in these patients is likely related to their higher visceral fat mass.
通过葡萄糖耐量试验或钳夹法检测时，非酒精性脂肪性肝炎（NASH）患者几乎普遍存在胰岛素抵抗。然而，这些患者在生理应激后的胰岛素抵抗模式尚不清楚。我们开展了一项研究，以描述非糖尿病NASH患者（NDN）对混合餐的代谢反应，并确定这些患者胰岛素抵抗的人体测量学决定因素。
在18例NDN患者和18例年龄、性别及体重指数（BMI）匹配的对照者摄入500千卡标准餐后的0、30、60、90和120分钟，测量其血清胰岛素、C肽、葡萄糖和游离脂肪酸（FFA）水平。分析胰岛素抵抗与各种人体测量学、热量测定和血清学变量之间的相关性。
与对照组相比，NDN患者在基线和混合餐后的胰岛素和C肽水平显著更高。然而，基线时和餐后的葡萄糖水平并无差异。NDN患者的空腹FFA水平高于对照组（分别为459±190与339±144微摩尔/升，p = 0.03）；然而，两组间餐后脂解抑制情况相似（39±113%与46±60%，p = 0.8）。胰岛素抵抗与BMI显著相关（r = 0.39，p = 0.02），与内脏脂肪也显著相关（r = 0.50，p = 0.004）。虽然两组间BMI、全身脂肪百分比和腹部皮下脂肪相似，但NASH组的内脏脂肪百分比显著高于对照组（28±10%与22±14%，p = 0.02）。
NDN患者空腹及混合餐后均显著高胰岛素血症；然而，他们在餐后应激后的葡萄糖稳态和脂解抑制得以维持。这些患者的胰岛素抵抗可能与其较高内脏脂肪量有关。
