Guidorizzi de Siqueira Ana Cristina, Cotrim Helma P, Rocha Raquel, Carvalho Fernando M, de Freitas Luiz A R, Barreto Danyella, Gouveia Leandro, Landeiro Luciana
Curso de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Universidade Federal da Bahia, Brazil.
Eur J Gastroenterol Hepatol. 2005 Aug;17(8):837-41. doi: 10.1097/00042737-200508000-00010.
Non-alcoholic fatty liver disease (NAFLD) has been associated with several metabolic conditions (MC) and secondary causes, but the relationship between insulin resistance (IR) and the underlying aetiology of NAFLD has not been extensively explored.
To determine the frequency of IR among NAFLD patients and to describe IR according to risk factors and histological findings of the disease.
A case-series study of 64 patients with clinical and histological diagnosis of NAFLD. IR was calculated by homeostasis model assessment (HOMA) and IR was considered when HOMA > or = 3. Histological grades of NAFLD were: stage 1, steatosis isolated; stage 2, steatosis and inflammation; stage 3, steatosis and ballooning degeneration; stage 4, steatosis and fibrosis and/or Mallory bodies. Fibrosis was graded 0-4 (cirrhosis).
IR was found in 21 (33%) patients. Among those with IR, 16 patients (76%) had associated MC and five patients (24%) had exposure to petrochemicals. The mean value of HOMA varied from 3.5 in NAFLD associated with MC to 1.6 in patients with exposure to petrochemicals (P < 0.03). Waist circumference was the metabolic factor most strongly associated with IR (P < 0.005). Steatohepatitis (NASH) was observed in 54 (84.3%) cases. The HOMA mean value was significantly higher in patients with advanced fibrosis.
IR occurred in 33% of the NAFLD patients, being more frequent among those with MC than among those with exposure to petrochemicals. The presence of IR in cases with advanced fibrosis suggests that it may influence the prognosis of NAFLD.
非酒精性脂肪性肝病（NAFLD）与多种代谢状况（MC）及继发性病因相关，但胰岛素抵抗（IR）与NAFLD潜在病因之间的关系尚未得到广泛研究。
确定NAFLD患者中IR的发生率，并根据疾病的危险因素和组织学结果描述IR情况。
对64例经临床和组织学诊断为NAFLD的患者进行病例系列研究。通过稳态模型评估（HOMA）计算IR，当HOMA≥3时判定存在IR。NAFLD的组织学分级为：1期，单纯脂肪变性；2期，脂肪变性和炎症；3期，脂肪变性和气球样变；4期，脂肪变性和纤维化及/或马洛里小体。纤维化分级为0 - 4级（肝硬化）。
21例（33%）患者存在IR。在有IR的患者中，16例（76%）伴有MC，5例（24%）接触过石化产品。HOMA的平均值在与MC相关的NAFLD患者中为3.5，在接触石化产品的患者中为1.6（P < 0.03）。腰围是与IR关联最密切的代谢因素（P < 0.005）。54例（84.3%）病例观察到脂肪性肝炎（NASH）。晚期纤维化患者的HOMA平均值显著更高。
33%的NAFLD患者存在IR，在伴有MC的患者中比接触石化产品的患者更常见。晚期纤维化病例中IR的存在表明它可能影响NAFLD的预后。
