Lonardo Amedeo, Lombardini Silvia, Scaglioni Federica, Carulli Lucia, Ricchi Matteo, Ganazzi Dorval, Adinolfi Luigi Elio, Ruggiero Giuseppe, Carulli Nicola, Loria Paola
Unità Operativa di Medicina Interna e Gastroenterologia, Nuovo Ospedale Civile-Estense, Via Giardini, Baggiovara, Modena 41100, Italy.
J Hepatol. 2006 Jan;44(1):190-6. doi: 10.1016/j.jhep.2005.06.018. Epub 2005 Jul 12.
BACKGROUND/AIMS: To ascertain whether the etiology of hepatic steatosis modulates insulin resistance (IR) and to determine the predictors of IR.
We studied IR through HOMA IR in 146 subjects, 99 of whom had ultrasonographic and/or histologic steatosis. Twenty-two had familial heterozygous hypobetalipoproteinemia (FHBL), 48 had non-alcoholic fatty liver disease (NAFLD), 34 HCV infection (17 with HCV1b, 17 with HCV3a) and 42 were healthy controls without steatosis.
Steatosis was present in 77.3% of FHBL and, by enrolment criteria, in all NAFLD and HCV cases. Overall HOMA-IR correlated with BMI and GGT (P<0.01). FHBL and healthy groups had similar HOMA-IR and GGT values, whereas higher levels were observed in HCV and NAFLD. HCV3a and FHBL patients were hypolipidemic. HOMA-IR was similar in FHBL patients and controls and lower than in HCV and NAFLD. FHBL patients had a high extent of steatosis, similar to that observed in HCV3a, but lower grading and staging than NAFLD and HCV. At multivariate analysis, steatosis and GGT predicted HOMA-IR.
Data suggest that not all hepatic fat associates with IR. FHBL patients, for some aspects, resemble HCV3a infection, possibly suggesting a shared steatogenic mechanism. Among steatotic patients serum GGT levels is the independent predictor of IR.
背景/目的：确定肝脂肪变性的病因是否会调节胰岛素抵抗（IR），并确定IR的预测因素。
我们通过稳态模型评估胰岛素抵抗（HOMA-IR）对146名受试者进行了研究，其中99人有超声和/或组织学证实的脂肪变性。22人患有家族性杂合子低β脂蛋白血症（FHBL），48人患有非酒精性脂肪性肝病（NAFLD），34人感染丙型肝炎病毒（HCV）（17人感染HCV1b，17人感染HCV3a），42人是无脂肪变性的健康对照。
77.3%的FHBL患者存在脂肪变性，根据入选标准，所有NAFLD和HCV病例均有脂肪变性。总体而言，HOMA-IR与体重指数（BMI）和γ-谷氨酰转移酶（GGT）相关（P<0.01）。FHBL组和健康组的HOMA-IR和GGT值相似，而HCV和NAFLD组的水平较高。HCV3a患者和FHBL患者血脂较低。FHBL患者的HOMA-IR与对照组相似，低于HCV和NAFLD患者。FHBL患者的脂肪变性程度较高，与HCV3a患者相似，但分级和分期低于NAFLD和HCV患者。多因素分析显示，脂肪变性和GGT可预测HOMA-IR。
数据表明并非所有肝脏脂肪都与IR相关。FHBL患者在某些方面类似于HCV3a感染，可能提示存在共同的脂肪生成机制。在脂肪变性患者中，血清GGT水平是IR的独立预测因素。
