Colicchio P, Tarantino G, del Genio F, Sorrentino P, Saldalamacchia G, Finelli C, Conca P, Contaldo F, Pasanisi F
Interuniversity Center for Obesity and Eating Disorders, Department of Clinical and Experimental Medicine, Federico II University, Napoli, Italy.
Ann Nutr Metab. 2005 Sep-Oct;49(5):289-95. doi: 10.1159/000087295. Epub 2005 Aug 2.
BACKGROUND/AIMS: In the absence of other causes, obesity increases the risk of liver disease. We evaluated the prevalence and degree of metabolic and hepatic abnormalities associated with non-alcoholic fatty liver disease (NAFLD) in type II-III obesity in a metropolitan area of South Italy.
187 (81 M, 106 F) young adult non-diabetic obese patients, age range 18-50 years (mean 31.9 +/- 8.8), body mass index (BMI) > or =30 (mean 47.5 +/- 9.6), consecutively admitted from January 2000 to April 2003 to the Obesity Outpatients Clinic entered into the study. Patients were divided into two groups: (1) BMI 30.0-39.9, and (2) BMI> or =40. Ultrasound detected liver steatosis was classified as: (I) mild; (II) moderate, and (III) severe.
All patients, except 4, showed a variable degree of steatosis: mild was more frequent among females, severe steatosis present only in grade III obesity, with higher prevalence in males than in females (p < 0.001). Mean serum transaminases, in particular alanine aminotransferase (ALT), increased according to BMI and degree of steatosis. Homeostasis Model Assessment (HOMA) index, ferritin and fibrinogen levels increased with BMI, particularly in severe steatosis. In group 2, patients with BMI> or =40 showed a positive correlation between ferritin, aspartate aminotransferase (AST) (r = 0.46, p < 0.018), ALT (r = 0.41, p < 0.036) and gamma-glutamyltransferase (gammaGT) (r = 0.51, p < 0.007), between serum triglycerides (TG) and AST (r = 0.28, p < 0.036), ALT (r = 0.30, p < 0.02) and between HOMA and ALT (r = 0.30, p < 0.03) and gammaGT (r = 0.35, p < 0.012). In group 2 patients with severe steatosis the prevalence of metabolic syndrome according to Adult Treatment Panel III (ATP III) was 40%.
These data suggest that, in young adult non-diabetic grade III obese patients, fatty liver is always present and strictly related to insulin resistance which, in the presence of severe liver steatosis, is also related to serum ferritin.
背景/目的：在无其他病因的情况下，肥胖会增加患肝病的风险。我们评估了意大利南部大都市地区II - III级肥胖患者中与非酒精性脂肪性肝病（NAFLD）相关的代谢和肝脏异常的患病率及程度。
187例（81例男性，106例女性）年龄在18 - 50岁（平均31.9±8.8岁）、体重指数（BMI）≥30（平均47.5±9.6）的非糖尿病肥胖青年患者，于2000年1月至2003年4月连续入住肥胖门诊并纳入研究。患者分为两组：（1）BMI 30.0 - 39.9；（2）BMI≥40。超声检测到的肝脏脂肪变性分为：（I）轻度；（II）中度；（III）重度。
除4例患者外，所有患者均有不同程度的脂肪变性：轻度在女性中更为常见，重度脂肪变性仅出现在III级肥胖患者中，男性患病率高于女性（p < 0.001）。平均血清转氨酶，尤其是丙氨酸转氨酶（ALT），随BMI和脂肪变性程度升高。稳态模型评估（HOMA）指数、铁蛋白和纤维蛋白原水平随BMI升高，尤其是在重度脂肪变性患者中。在第2组中，BMI≥40的患者铁蛋白与天冬氨酸转氨酶（AST）（r = 0.46，p < 0.018）、ALT（r = 0.41，p < 0.036）和γ - 谷氨酰转移酶（γGT）（r = 0.51，p < 0.007）之间呈正相关，血清甘油三酯（TG）与AST（r = 0.28，p < 0.036）、ALT（r = 0.30，p < 0.02）之间呈正相关，HOMA与ALT（r = 0.30，p < 0.03）和γGT（r = 0.35，p < 0.012）之间呈正相关。在第2组重度脂肪变性患者中，根据成人治疗小组III（ATP III）标准，代谢综合征的患病率为40%。
这些数据表明，在非糖尿病的青年III级肥胖患者中，脂肪肝总是存在且与胰岛素抵抗密切相关，在存在严重肝脏脂肪变性的情况下，还与血清铁蛋白有关。
