Lazar Mathew Vadukoot, Eapen Malini, Nair Harikumar R, Siyad Ismail, Gopalakrishna Rajesh
Department of Gastroenterology, Amrita Institute of Medical Sciences, Kochi, Amrita Vishwa Vidyapeetham, AIMS Ponekkara P.O., Kochi, 682 041, India.
Department of Pathology, Amrita Institute of Medical Sciences, Kochi, Amrita Vishwa Vidyapeetham, AIMS Ponekkara P.O., Kochi, 682 041, India.
Indian J Gastroenterol. 2020 Feb;39(1):42-49. doi: 10.1007/s12664-020-01024-z. Epub 2020 Mar 28.
Insulin resistance (IR) plays a central role in pathogenesis of nonalcoholic steatohepatitis (NASH). The aim of this study was to correlate histopathological grading and IR in overweight/obese patients with NASH as compared with lean NASH.
Patients with NASH who underwent liver biopsy between January 2012 and December 2012 were included. Anthropometric, clinical, and biochemical features, necro-inflammatory grades, and fibrosis stage on liver biopsies were scored according to Brunt and non-alcoholic fatty liver disease (NAFLD) activity score (NAS).
Of 42 patients, 33 (78.6%) had body mass index (BMI) ≥ 23 kg/m (overweight/obese) while 9 had BMI < 23 kg/m (lean). Mean fasting blood sugar (FBS) and HbA1c levels in overweight/obese patients with NASH were higher than in lean NASH (p < 0.05). The median homeostatic model assessment-estimated insulin resistance (HOMA-IR) among NASH patients with BMI ≥ 23 kg/m was higher than among those with BMI < 23 kg/m (3.02 [0.34-17.22] vs. 2 [0.52-5.26]; p = 0.045). However, fasting insulin levels were comparable among lean and overweight/obese patients with NASH. Metabolic syndrome could be predicted with 75% sensitivity and 85.3% specificity at a HOMA-IR cutoff value of 3.9. No significant difference was observed with regard to HOMA-IR levels with Brunt grades, Brunt staging, Brunt grades 1 and 2, Brunt scores < 2 and > 2, and NAS scores, and NAS scores < 4 and > 4.
Although IR was significantly higher in overweight/obese patients with NASH as compared with that in lean patients with NASH, there was no difference in the correlation of HOMA-IR with histology between these groups.
胰岛素抵抗（IR）在非酒精性脂肪性肝炎（NASH）的发病机制中起核心作用。本研究的目的是比较超重/肥胖NASH患者与消瘦NASH患者的组织病理学分级与IR之间的关系。
纳入2012年1月至2012年12月期间接受肝活检的NASH患者。根据Brunt评分和非酒精性脂肪性肝病（NAFLD）活动评分（NAS）对人体测量学、临床和生化特征、肝活检的坏死性炎症分级和纤维化阶段进行评分。
42例患者中，33例（78.6%）体重指数（BMI）≥23kg/m²（超重/肥胖），9例BMI<23kg/m²（消瘦）。超重/肥胖NASH患者的平均空腹血糖（FBS）和糖化血红蛋白（HbA1c）水平高于消瘦NASH患者（p<0.05）。BMI≥23kg/m²的NASH患者中，稳态模型评估估计的胰岛素抵抗（HOMA-IR）中位数高于BMI<23kg/m²的患者（3.02[0.34-17.22]对2[0.52-5.26]；p=0.045）。然而，消瘦和超重/肥胖NASH患者的空腹胰岛素水平相当。在HOMA-IR临界值为3.9时，代谢综合征的预测敏感性为75%，特异性为85.3%。在Brunt分级、Brunt分期、Brunt 1级和2级、Brunt评分<2和>2以及NAS评分、NAS评分<4和>4方面，未观察到HOMA-IR水平有显著差异。
尽管超重/肥胖NASH患者的IR显著高于消瘦NASH患者，但两组之间HOMA-IR与组织学的相关性无差异。
