Bookman Ian D, Pham J, Guindi M, Heathcote E J
Department of Medicine, University of Toronto, Toronto, Canada.
Liver Int. 2006 Jun;26(5):566-71. doi: 10.1111/j.1478-3231.2006.01256.x.
The prognosis of nonalcoholic fatty liver disease is determined by liver biopsy; steatohepatitis can be progressive whereas fatty liver is benign. Insulin resistance and increased hepatic-free fatty acids are central to the pathophysiology of this disorder. Our objective was to assess whether serum-free fatty acids, lipoproteins, and insulin resistance are increased in steatohepatitis compared with fatty liver and healthy controls, and thus may be potential noninvasive markers for liver disease severity.
Fifteen subjects with biopsy proven nonalcoholic steatohepatitis, 15 with histological fatty liver, and 15 healthy controls were enrolled. Fasting serum glucose and insulin levels, serum-free fatty acids, HDL, LDL, and cholesterol were collected from each subject. Insulin resistance was calculated using the homeostasis assessment model.
Insulin resistance, LDL, and cholesterol-to-HDL ratio values were significantly higher in steatohepatitis, whereas HDL was significantly lower compared with both fatty liver and controls. Free fatty acids were similar in all groups.
Along with insulin resistance, serum LDL, and cholesterol-to-HDL ratio values increase with worsening severity of liver histology, and serum HDL values decline. Free fatty acids, however, do not vary between groups.
非酒精性脂肪性肝病的预后通过肝活检确定；脂肪性肝炎可能会进展，而脂肪肝是良性的。胰岛素抵抗和肝脏游离脂肪酸增加是该疾病病理生理学的核心。我们的目的是评估与脂肪肝和健康对照相比，脂肪性肝炎患者的血清游离脂肪酸、脂蛋白和胰岛素抵抗是否增加，因此可能是肝病严重程度的潜在非侵入性标志物。
招募了15名经活检证实为非酒精性脂肪性肝炎的受试者、15名组织学诊断为脂肪肝的受试者和15名健康对照。收集每位受试者的空腹血清葡萄糖和胰岛素水平、血清游离脂肪酸、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）和胆固醇。使用稳态评估模型计算胰岛素抵抗。
与脂肪肝和对照组相比，脂肪性肝炎患者的胰岛素抵抗、LDL和胆固醇与HDL比值显著更高，而HDL显著更低。所有组的游离脂肪酸相似。
随着肝脏组织学严重程度的加重，胰岛素抵抗、血清LDL和胆固醇与HDL比值升高，血清HDL值下降。然而，游离脂肪酸在各组之间没有差异。
