Center of Investigation of Endocrinology and Nutrition, School of Medicine, and Unit of Investigation, Hospital Rio Hortega, Gastroenterology Department, Hospital Clinico Universitario, University of Valladolid, Valladolid, Spain.
J Investig Med. 2012 Oct;60(7):1005-8. doi: 10.2310/JIM.0b013e31826509f2.
Influence of adipokines and insulin resistance on liver histology is an unclear area in morbidly obese patients.
The aim of our study was to study the influence of insulin resistance and adipokines in the grade of liver steatosis and fibrosis in morbidly obese patients undergoing bariatric surgery.
Tertiary hospital.
A sample of 36 morbidly obese patients undergoing bariatric surgery was analyzed in a cross-sectional study. A liver biopsy was performed. Weights, basal glucose, insulin, insulin resistance (homeostasis model assessment for insulin resistance [HOMA-IR]), total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, and adipokine blood levels were measured.
Seventeen patients (47.2%) had low-grade steatosis, and 19 patients (52.8%) had high-grade steatosis. Sixteen patients (44.4%) did not have liver fibrosis, and 20 patients (56.6%) had liver fibrosis. Only insulin levels, HOMA-IR, and aspartate aminotransferase activity were higher in the patients with high-grade steatosis. Insulin levels and HOMA-IR were higher in patients with fibrosis. In the logistic regression analysis with a dependent dichotomous variable (grades of steatosis: low vs high), the HOMA-IR remained in the model, with an odds ratio to develop high-grade steatosis of 1.33 (95% confidence interval, 1.09-1.86). In the second logistic regression analysis with a dependent dichotomy variable (grades of fibrosis: present vs absent), the HOMA-IR remained in the model, with an odds ratio to develop fibrosis of 1.53 (95% confidence interval, 1.13-2.51).
Insulin resistance determined with HOMA-IR model is associated with high-grade steatosis and liver fibrosis in obese patients before bariatric surgery.
脂肪因子和胰岛素抵抗对病态肥胖患者肝脏组织学的影响尚不清楚。
本研究旨在研究胰岛素抵抗和脂肪因子对接受减重手术的病态肥胖患者肝脏脂肪变性和纤维化程度的影响。
三级医院。
对 36 例接受减重手术的病态肥胖患者进行横断面研究分析。进行肝活检。测量体重、基础血糖、胰岛素、胰岛素抵抗（稳态模型评估的胰岛素抵抗 [HOMA-IR]）、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、甘油三酯和脂肪因子的血液水平。
17 例（47.2%）患者为轻度脂肪变性，19 例（52.8%）患者为重度脂肪变性。16 例（44.4%）患者无肝纤维化，20 例（56.6%）患者有肝纤维化。只有重度脂肪变性患者的胰岛素水平、HOMA-IR 和天冬氨酸转氨酶活性较高。有纤维化的患者胰岛素水平和 HOMA-IR 较高。在依赖二分类变量（脂肪变性程度：低 vs 高）的逻辑回归分析中，HOMA-IR 仍保留在模型中，发生重度脂肪变性的优势比为 1.33（95%置信区间，1.09-1.86）。在依赖二分类变量（纤维化程度：存在 vs 不存在）的第二个逻辑回归分析中，HOMA-IR 仍保留在模型中，发生纤维化的优势比为 1.53（95%置信区间，1.13-2.51）。
HOMA-IR 模型确定的胰岛素抵抗与肥胖患者接受减重手术前的重度脂肪变性和肝纤维化有关。
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