Andreozzi Paola, Viscogliosi Giovanni, Colella Franco, Subic Miroslava, Cipriani Elisa, Marigliano Benedetta, Verrusio Walter, Servello Adriana, Ettorre Evaristo, Marigliano Vincenzo
Unita di Medicina Predittiva, Sapienza Universita di Roma, Roma, Italy.
Recenti Prog Med. 2012 Dec;103(12):570-4. doi: 10.1701/1206.13358.
NAFLD (non-alcoholic fatty liver disease) reaches an high prevalence in the general population, and it is closely related to metabolic syndrome (MetS). The entity of metabolic abnormalities and the chronic inflammation seem to play a main role in the development of liver fibrosis. The aim of our study is to determine whether subjects with NAFLD and MetS have higher liver fibrosis degree when compared with NAFLD subjects without MetS, and to investigate the relations between fibrosis, MetS and its single components and inflammation.
We considered 24 patients with NAFLD. Those who had viral- and alcohol- related liver disease were excluded. MetS was diagnosed according to NCEP ATP III criteria; inflammatory status was determined through C-reactive protein (PCR) assay. The peripheral insulin-resistance was assessed by calculating HOMA ir. Liver fibrosis was measured by transient elastography (Fibroscan®).
Subjects with MetS had higher HOMA ir, PCR and Fibroscan® score (log value: 0.92±0.24 KPa vs 0.73±0.2 KPa; p=0.047). The linear correlation analysis showed that Fibroscan® score was related to MetS, number of MetS components, waist circumference, HOMA ir and PCR. However the multivariate regression analysis showed that only HOMA ir (B=0.077; 95%CI: -0.002- 0.157; p=0.05) and PCR (B=0.152; 95% CI: 0.006 - 0.299; p=0.006) were independent predictors of higher Fibroscan® score.
MetS is associated to higher liver fibrosis degree in subjects with NAFLD. The insulin-resistance and inflammation seem to be the main determinants.
非酒精性脂肪性肝病（NAFLD）在普通人群中具有较高的患病率，并且与代谢综合征（MetS）密切相关。代谢异常和慢性炎症似乎在肝纤维化的发展中起主要作用。我们研究的目的是确定与无MetS的NAFLD受试者相比，患有NAFLD和MetS的受试者是否具有更高的肝纤维化程度，并研究纤维化、MetS及其单个组分与炎症之间的关系。
我们纳入了24例NAFLD患者。排除患有病毒性和酒精性肝病的患者。根据美国国家胆固醇教育计划成人治疗组第三次报告（NCEP ATP III）标准诊断MetS；通过C反应蛋白（PCR）测定确定炎症状态。通过计算稳态模型评估胰岛素抵抗指数（HOMA ir）来评估外周胰岛素抵抗。通过瞬时弹性成像（Fibroscan®）测量肝纤维化。
患有MetS的受试者具有更高的HOMA ir、PCR和Fibroscan®评分（对数 值：0.92±0.24千帕 vs 0.73±0.2千帕；p = 0.047）。线性相关分析表明，Fibroscan®评分与MetS、MetS组分数量、腰围、HOMA ir和PCR相关。然而，多变量回归分析表明，只有HOMA ir（B = 0.077；95%置信区间：-0.002 - 0.157；p = 0.05）和PCR（B = 0.152；95%置信区间：0.006 - 0.299；p = 0.006）是较高Fibroscan®评分的独立预测因素。
在患有NAFLD的受试者中，MetS与更高的肝纤维化程度相关。胰岛素抵抗和炎症似乎是主要决定因素。
