非酒精性脂肪性肝病（NAFLD）但无糖尿病患者的胰岛素抵抗和代谢综合征：6个月饮食方案干预的效果

Insulin resistance and metabolic syndrome in patients with NAFLD but without diabetes: effect of a 6 month regime intervention.

作者信息

Cankurtaran M, Tayfur O, Yavuz B B, Geyik S, Akhan O, Arslan S

机构信息

Hacettepe University, Medical Faculty, Department of Internal Medicine, Sihhiye, Ankara, 06100, Turkey.

出版信息

Acta Gastroenterol Belg. 2007 Jul-Sep;70(3):253-9.

PMID:18074733

Abstract

BACKGROUND AND STUDY AIMS

Non-alcoholic fatty liver disease (NAFLD) and the metabolic syndrome are two intertwined diseases sharing the same factor in their pathogenesis; insulin resistance. The aim of the study was to establish a link between glucose tolerance and NAFLD.

PATIENTS AND METHODS

Fifty-two non-diabetic NAFLD patients were included in the study. Inclusion criteria were elevated alanine aminotransferase (ALT), hyperechogenic liver detected at ultrasonography, and exclusion of other causes of liver disease. Hepatobiliary ultrasonography and laboratory tests including biochemical and metabolic profiles were performed; HOMA insulin resistance was calculated.

RESULTS

The mean age was 43 years, and 61% were male. More than a two fold increase in alanine aminotransferase levels was seen in 37% of the patients. Serum levels of aspartate aminotransferase, gamma-glutamyl transferase, alkaline phosphatase (ALP) were elevated in 36%, 46%, and 30% of patients respectively. Low HDL-C levels were found in 46% and high LDL-C levels in 25%. Other results of note were elevated lipoprotein-a levels in 40%, impaired fasting glucose in 23%, impaired glucose tolerance in 26%, elevated fasting c-peptide levels in 61%, and elevated fasting serum insulin levels in 11% of patients. In 30% of patients, body mass index was over 30 kg/m2 and 78% had a waist-hip ratio more than 0.9. HOMA insulin resistance was significantly related with elevated ALP levels and hepatomegaly. Following a 6 months treatment with a standard diet, liver enzymes and metabolic parameters both improved. Only 7 patients had persistently high liver enzymes.

CONCLUSIONS

Basal insulin levels and the oral glucose tolerance test should be an integral part of the evaluation of patients with NAFLD. The association between NAFLD and metabolic syndrome as well as the benefits of dieting on preventing progression of NAFLD should be stressed.

摘要

背景与研究目的

非酒精性脂肪性肝病（NAFLD）和代谢综合征是两种在发病机制上有共同因素相互交织的疾病，即胰岛素抵抗。本研究的目的是建立糖耐量与NAFLD之间的联系。

患者与方法

52例非糖尿病NAFLD患者纳入本研究。纳入标准为丙氨酸氨基转移酶（ALT）升高、超声检查发现肝脏回声增强，且排除其他肝病病因。进行了肝胆超声检查以及包括生化和代谢指标在内的实验室检查；计算稳态模型评估胰岛素抵抗（HOMA-IR）。

结果

平均年龄为43岁，61%为男性。37%的患者丙氨酸氨基转移酶水平升高超过两倍。分别有36%、46%和30%的患者天冬氨酸氨基转移酶、γ-谷氨酰转移酶、碱性磷酸酶（ALP）血清水平升高。46%的患者高密度脂蛋白胆固醇（HDL-C）水平低，25%的患者低密度脂蛋白胆固醇（LDL-C）水平高。其他值得注意的结果是，40%的患者脂蛋白-a水平升高，23%的患者空腹血糖受损，26%的患者糖耐量受损，61%的患者空腹C肽水平升高，11%的患者空腹血清胰岛素水平升高。30%的患者体重指数超过30kg/m²，78%的患者腰臀比大于0.9。HOMA-IR与ALP水平升高和肝肿大显著相关。经过6个月的标准饮食治疗后，肝酶和代谢参数均有所改善。只有7例患者肝酶持续升高。