Sharma Rajeev, Sinha Sanjeev, Danishad K A, Vikram Naval K, Gupta Arun, Ahuja Vineet, Jagannathan N R, Pandey R M, Misra Anoop
Department of Internal Medicine, All India Institute of Medical Sciences, New Delhi, India.
Atherosclerosis. 2009 Mar;203(1):291-7. doi: 10.1016/j.atherosclerosis.2008.06.016. Epub 2008 Jun 26.
To study hepatic gluconeogenesis pathway in non-diabetic Asian Indian males having non-alcoholic fatty liver disease (NAFLD) using in vivo ((31)P) phosphorous magnetic resonance spectroscopy (MRS) and correlate these data with anthropometry and insulin resistance.
Forty non-diabetic patients with NAFLD and 20 healthy controls were divided into (i) obese with NAFLD (group I, n=20), (ii) non-obese with NAFLD (group II, n=20) and (iii) non-obese without NAFLD (group III, n=20). Anthropometric and biochemical profiles, short insulin tolerance test (SITT), liver ultrasound, and (31)P MRS (to determine hepatic gluconeogenesis metabolite; phosphomonoesters (PMEs), inorganic phosphate (Pi) and their ratios with respect to ATP) were done.
Insulin resistance (Kitt value) was highest in group I (p<0.05; compared to other two groups), but was also higher in group II as compared to group III (p=ns). The values of PME/Pi, PME/gammaATP, PME/betaATP, PME/tATP ratios were higher (p<0.05) in group I compared to other two groups. Interestingly, non-obese subjects with NAFLD also showed more derangements of hepatic gluconeogenesis metabolites than non-obese subjects without NAFLD. Positive correlation was observed between PME and other ratios in relation to body mass index, waist circumference, body fat percentage and fasting serum insulin levels in all the three groups.
Derangements in hepatic gluconeogenesis as assessed non-invasively using (31)P MRS, was observed in obese and non-obese, non-diabetic Asian Indians with NAFLD. Further research is warranted whether this investigation in NAFLD subjects could be developed as a non-invasive tool to assess those predisposed to develop hyperglycemia.
利用体内（31）P磷磁共振波谱（MRS）研究患有非酒精性脂肪性肝病（NAFLD）的非糖尿病亚洲印度男性的肝脏糖异生途径，并将这些数据与人体测量学和胰岛素抵抗相关联。
40例患有NAFLD的非糖尿病患者和20例健康对照者被分为：（i）肥胖且患有NAFLD组（I组，n = 20），（ii）非肥胖且患有NAFLD组（II组，n = 20），以及（iii）非肥胖且无NAFLD组（III组，n = 20）。进行了人体测量和生化指标检测、短胰岛素耐量试验（SITT）、肝脏超声检查以及（31）P MRS（以测定肝脏糖异生代谢物；磷酸单酯（PMEs）、无机磷酸盐（Pi）及其与ATP的比率）。
I组的胰岛素抵抗（Kitt值）最高（p < 0.05；与其他两组相比），但II组的胰岛素抵抗也高于III组（p =无显著差异）。与其他两组相比，I组的PME/Pi、PME/γATP、PME/βATP、PME/总ATP比率更高（p < 0.05）。有趣的是，患有NAFLD的非肥胖受试者的肝脏糖异生代谢物紊乱程度也高于无NAFLD的非肥胖受试者。在所有三组中，PME以及其他比率与体重指数、腰围、体脂百分比和空腹血清胰岛素水平之间均呈正相关。
在患有NAFLD的肥胖和非肥胖非糖尿病亚洲印度男性中，观察到使用（31）P MRS进行无创评估时肝脏糖异生存在紊乱。对于NAFLD受试者的这项研究是否能够发展成为一种评估易发生高血糖人群的无创工具，还需要进一步研究。
