非糖尿病的非酒精性脂肪性肝病（NAFLD）患者中代谢综合征与肝脏组织学之间的关联
Association between metabolic syndrome and liver histology among NAFLD patients without diabetes.
作者信息
Kanwar Pushpjeet, Nelson James E, Yates Katherine, Kleiner David E, Unalp-Arida Aynur, Kowdley Kris V
机构信息
New York Methodist Hospital, Brooklyn, New York, USA; Benaroya Research Institute, Seattle, Washington, USA.
Benaroya Research Institute , Seattle, Washington , USA.
出版信息
BMJ Open Gastroenterol. 2016 Nov 9;3(1):e000114. doi: 10.1136/bmjgast-2016-000114. eCollection 2016.
BACKGROUND
Metabolic syndrome (MetS) and obesity are associated with non-alcoholic fatty liver disease (NAFLD). The aim of this observational study was to examine the relationship of MetS and a diagnosis of non-alcoholic steatohepatitis (NASH) in patients without diabetes in the NASH Clinical Research Network (CRN).
METHODS
Clinical, demographic, histological, laboratory and anthropometric data were collected on 356 adult patients without diabetes with NAFLD. Obesity was defined as body mass index ≥30.0. MetS was determined using the National Cholesterol Education Program-Adult Treatment Panel III (NCEP ATPIII) 2001 criteria to include 3 or more of the following: increased waist circumference, elevated triglycerides, reduced high-density lipoprotein cholesterol, hypertension and elevated fasting blood glucose.
RESULTS
Most patients were obese (71%) and had MetS (67%). Obesity was more prevalent among patients with MetS (80% vs 52%; p≤0.001). Markers of insulin resistance such as homoeostasis model assessment of insulin resistance (6.5 vs 4.9, p≤0.001) were higher among those with MetS compared with those without MetS. Histologically, patients without MetS had higher hepatocellular (p=0.04) and reticuloendothelial system iron (p=0.04). Patients with MetS were more likely to have severe hepatic steatosis (p=0.04) and chronic portal inflammation (p=0.01). On multiple logistic regression analysis, patients with definite NASH were almost 2.5 times more likely to have MetS than those without definite NASH (OR=2.41, p=0.01).
CONCLUSIONS
MetS is common in patients without diabetes with NAFLD and is associated with greater insulin resistance, hepatic steatosis and portal inflammation. While patients without MetS have greater iron overload, patients with MetS may have an increased propensity to have NASH. Therefore, presence of MetS in patients without diabetes with NAFLD may serve as a potential criterion for liver biopsy.
TRIAL REGISTRATION NUMBER
NCT00063622; Pre-results.
背景
代谢综合征（MetS）和肥胖与非酒精性脂肪性肝病（NAFLD）相关。这项观察性研究的目的是在非酒精性脂肪性肝炎临床研究网络（CRN）中，检查无糖尿病患者中MetS与非酒精性脂肪性肝炎（NASH）诊断之间的关系。
方法
收集了356例无糖尿病的NAFLD成年患者的临床、人口统计学、组织学、实验室和人体测量数据。肥胖定义为体重指数≥30.0。采用2001年美国国家胆固醇教育计划成人治疗专家组第三次报告（NCEP ATPIII）标准确定MetS，包括以下3项或更多项：腰围增加、甘油三酯升高、高密度脂蛋白胆固醇降低、高血压和空腹血糖升高。
结果
大多数患者肥胖（71%）且患有MetS（67%）。肥胖在患有MetS的患者中更为普遍（80%对52%；p≤0.001）。与无MetS的患者相比，MetS患者的胰岛素抵抗标志物如胰岛素抵抗稳态模型评估（6.5对4.9，p≤0.001）更高。在组织学上，无MetS的患者肝细胞（p = 0.04）和网状内皮系统铁（p = 0.04）含量更高。患有MetS的患者更有可能出现严重肝脂肪变性（p = 0.04）和慢性门静脉炎症（p = 0.01）。在多元逻辑回归分析中，确诊为NASH的患者患MetS的可能性几乎是未确诊为NASH患者的2.5倍（比值比=2.41，p = 0.01）。
结论
MetS在无糖尿病的NAFLD患者中很常见，并且与更大的胰岛素抵抗、肝脂肪变性和门静脉炎症相关。虽然无MetS的患者有更大的铁过载，但患有MetS的患者可能更易患NASH。因此，无糖尿病的NAFLD患者中MetS的存在可能作为肝活检的潜在标准。
试验注册号
NCT00063622；预结果。
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