Shipovskaya A A, Dudanova O P, Kurbatova I V
Petrozavodsk State University, Institute of Medicine, Department of Propaedeutics of Internal Diseases and Hygiene, Petrozavodsk, Russia.
The Institute of Biology - a separate subdivision of Karelian Research Centre of Russian Academy of Sciences, Petrozavodsk, Russia.
Ter Arkh. 2018 Aug 27;90(8):63-68. doi: 10.26442/terarkh201890863-68.
To assess the presence of insulin resistance (IR) in non-diabetic patients with early forms of non-alcoholic fatty liver disease (NAFLD) - liver steatosis (LS) and steatohepatitis (SH) of mild activity and the influence of IR on the clinical course of these diseases.
134 patients with NAFLD were examined: 54 with LS and 80 with SH. The control group consisted of 37 healthy donors. Anthropometric parameters (body mass index (BMI), waist circumference (WC)), clinical and biochemical blood indices, including the blood level of cytokeratin-18 fragments (CK-18), TNF-α and IL-6 cytokines, insulin were evaluated. The HOMA index and the fibrosis index (NAFLD FS) were calculated. Patients were divided into groups: I - with the absence of IR (HOMA-index <2.7), II - with the presence of IR (HOMA-index> 2.7).
Indicators of hepatic injury, inflammation, cholestasis, fibrosis and atherogenic dyslipidemia are higher in patients with LS of group II (with IR) than in group I patients (without IR). BMI, WC, γ-glutamil transpeptidase, CK-18 and fibrosis index are significantly higher in group II patients with SH compared with group I, there is no significant difference in the level of cytolysis, inflammation and dyslipidemia indices. A high incidence of IR in non-diabetic patients with LS (37.0%) and SH (55.0%) was found and the effect of IR on the clinical course of these diseases was revealed.
Insulin resistance in non-diabetic patients with NAFLD was detected in SH (55.0%) with higher frequency than in LS (37.0%). In LS, IR is associated with impaired hepatic cell damage, intrahepatic cholestasis, atherogenic dyslipidemia and fibrosis. In SH, IR is combined with reliable growth in indicators of hepatocyte apoptosis, cytokine proinflammatory status and fibrosis. IR determines the progressing course of NAFLD, promoting the transformation of steatosis into steatohepatitis and steatohepatitis into fibrosis and liver cirrhosis.
评估非酒精性脂肪性肝病（NAFLD）早期形式——肝脂肪变性（LS）和轻度活动的脂肪性肝炎（SH）的非糖尿病患者中胰岛素抵抗（IR）的存在情况以及IR对这些疾病临床进程的影响。
对134例NAFLD患者进行检查：54例为LS患者，80例为SH患者。对照组由37名健康供者组成。评估人体测量参数（体重指数（BMI）、腰围（WC））、临床和生化血液指标，包括细胞角蛋白-18片段（CK-18）、TNF-α和IL-6细胞因子、胰岛素的血液水平。计算HOMA指数和纤维化指数（NAFLD FS）。患者分为两组：I组——无IR（HOMA指数<2.7），II组——有IR（HOMA指数>2.7）。
II组（有IR）的LS患者中，肝损伤、炎症、胆汁淤积、纤维化和致动脉粥样硬化血脂异常的指标高于I组患者（无IR）。II组SH患者的BMI、WC、γ-谷氨酰转肽酶、CK-18和纤维化指数显著高于I组，细胞溶解、炎症和血脂异常指标水平无显著差异。发现非糖尿病LS患者（37.0%）和SH患者（55.0%）中IR的发生率较高，并揭示了IR对这些疾病临床进程的影响。
在非糖尿病NAFLD患者中，SH患者（55.0%）检测到胰岛素抵抗的频率高于LS患者（37.0%）。在LS中，IR与肝细胞损伤受损、肝内胆汁淤积、致动脉粥样硬化血脂异常和纤维化有关。在SH中，IR与肝细胞凋亡指标、细胞因子促炎状态和纤维化的可靠增长相关。IR决定了NAFLD的进展过程，促进脂肪变性向脂肪性肝炎转化以及脂肪性肝炎向纤维化和肝硬化转化。
