Yan Hong-mei, Gao Xin, Liu Meng, Gu Qian, Zhang Bin, Li Xiang
Department of Endocrinology and Metabolism, Zhongshan Hospital Affiliated to Fudan University, Shanghai 200032, China.
Zhonghua Yi Xue Za Zhi. 2008 May 13;88(18):1255-8.
To observe the relationship of liver fat content to insulin resistance and metabolic syndrome (MS) in nonalcoholic fatty liver disease (NAFLD) patients without known diabetes mellitus (DM).
106 patients diagnosed as with fatty liver by ultrasonography, 61 males and 45 females, aged 47 +/- 14, underwent anthropometric examination and laboratory tests including lipid profile, fasting and 2 hour serum glucose and insulin after 75 g glucose load. CT scanning was used to determine the fat content in liver. Homeostasis model assessment insulin resistance (HOMA-IR) was calculated. Metabolic syndrome was defined based on the ATP III criteria.
The liver fat content in all subjects was distributed from 0 to 34.7% [median (quartile) 6.34% (3.11%-10.82%)]. Forty-five of the 106 patients (42.45%) were diagnosed as with MS. When the liver fat increased by quartile order [< 3.11% (n = 26), 3.11%-6.34% (n = 27), 6.34%-10.82% (n = 27), and > or = 10.82% (n = 26)], the percentages of MS were 19.2% (n = 5), 29.6% (n = 8), 48.1% (n = 13), and 73.1% (n = 19) respectively (P < 0.05). Stepwise Logistic regression analysis (forcing liver fat in the model) showed that being female, liver fat content, fasting glucose, systolic blood pressure, BMI, and history of hypertension were significant risk factors of MS, and HDL-C and fasting insulin were significant protection factors of MS. The standard partial regression coefficient of liver fat content was higher than those of fasting blood glucose, systolic blood pressure, and BMI. Stepwise multiple linear regression analysis demonstrated that liver fat content was a significant risk factor of HOMA-IR while BMI and waist circumference were not.
Compared with BMI and waist circumference, liver fat content is a stronger risk factor of IR and MS.
观察非酒精性脂肪性肝病（NAFLD）且无已知糖尿病（DM）患者的肝脏脂肪含量与胰岛素抵抗及代谢综合征（MS）之间的关系。
106例经超声诊断为脂肪肝的患者，男性61例，女性45例，年龄47±14岁，接受了人体测量检查及实验室检测，包括血脂谱、空腹及75克葡萄糖负荷后2小时的血清葡萄糖和胰岛素水平。采用CT扫描测定肝脏脂肪含量。计算稳态模型评估胰岛素抵抗（HOMA-IR）。根据ATP III标准定义代谢综合征。
所有受试者的肝脏脂肪含量分布为0至34.7%[中位数（四分位数）6.34%（3.11%-10.82%）]。106例患者中有45例（42.45%）被诊断为患有MS。当肝脏脂肪按四分位数顺序增加时[<3.11%（n = 26），3.11%-6.34%（n = 27），6.34%-10.82%（n = 27），≥10.82%（n = 26）]，MS的比例分别为19.2%（n = 5）、29.6%（n = 8）、48.1%（n = 13）和73.1%（n = 19）（P<0.05）。逐步Logistic回归分析（将肝脏脂肪纳入模型）显示，女性、肝脏脂肪含量、空腹血糖、收缩压、BMI及高血压病史是MS的显著危险因素，而HDL-C和空腹胰岛素是MS的显著保护因素。肝脏脂肪含量的标准偏回归系数高于空腹血糖、收缩压和BMI。逐步多元线性回归分析表明，肝脏脂肪含量是HOMA-IR的显著危险因素，而BMI和腰围不是。
与BMI和腰围相比，肝脏脂肪含量是胰岛素抵抗和MS更强的危险因素。
