Lee J H, Rhee P L, Lee J K, Lee K T, Kim J J, Koh K C, Paik S W, Rhee J C, Choi K W
Department of Medicine, Sung Kyun Kwan University College of Medicine, Samsung Medical Center, Seoul, Korea.
Korean J Intern Med. 1998 Feb;13(1):12-4.
The pathogenesis of nonalcoholic fatty liver in non-obese persons is poorly understood. We aimed to elucidate whether hyperinsulinemia and glucose intolerance are associated with development of fatty liver in patients with normal body weight.
Forty-seven patients with fatty liver were divided into non-obese (n = 25) and obese groups (n = 22) according to age adjusted body mass index. Inclusion criteria were as follows: (1) elevated transaminase levels during more than 3 months of follow up period, (2) no detectable HBsAg or anti-HCV in the serum, (3) alcohol consumption less than 40 gm/week, (4) no use of potential hepatotoxic drugs within 3 months and (4) sonographic evidence of fatty liver(moderate to severe degree). Baseline insulin levels and oral glucose tolerance test using 75gm of glucose were performed and the results were compared in each group of patients.
Mean baseline insulin levels were elevated in both groups above the reference value, 9.3 +/- 3.5 microU/L in non-obese group and 9.9 +/- 3.5 microU/L in obese group (p = 0.26). Seventeen of non-obese patients (68%) had elevated basal insulin level and 16 of obese patients (73%) had elevated basal insulin level (p = 0.39). In oral glucose tolerance test, there was no difference in glucose level between non-obese and obese groups from O minute to 180 minutes (p > 0.05). Eleven patients from the non-obese group (44%) and 8 patients from the obese group (36%) had either impaired glucose tolerance or diabetes (p = 0.29).
Our data suggest that hyperinsulinemia and glucose intolerance may play a role in the pathogenesis of fatty liver in patients with normal body weight as well as in patients with obesity.
非肥胖人群非酒精性脂肪肝的发病机制尚不清楚。我们旨在阐明高胰岛素血症和葡萄糖耐量异常是否与体重正常患者的脂肪肝发生有关。
根据年龄校正体重指数，将47例脂肪肝患者分为非肥胖组（n = 25）和肥胖组（n = 22）。纳入标准如下：（1）随访3个月以上转氨酶水平升高；（2）血清中未检测到HBsAg或抗HCV；（3）每周酒精摄入量少于40克；（4）3个月内未使用潜在肝毒性药物；（5）超声检查有脂肪肝证据（中度至重度）。进行基础胰岛素水平测定及口服75克葡萄糖的葡萄糖耐量试验，并比较每组患者的结果。
两组患者的平均基础胰岛素水平均高于参考值，非肥胖组为9.3±3.5微单位/升，肥胖组为9.9±3.5微单位/升（p = 0.26）。非肥胖患者中有17例（68%）基础胰岛素水平升高，肥胖患者中有16例（73%）基础胰岛素水平升高（p = 0.39）。在口服葡萄糖耐量试验中，非肥胖组和肥胖组在0分钟至180分钟的血糖水平无差异（p>0.05）。非肥胖组有11例患者（44%）、肥胖组有8例患者（36%）存在葡萄糖耐量受损或糖尿病（p = 0.29）。
我们的数据表明，高胰岛素血症和葡萄糖耐量异常可能在体重正常患者以及肥胖患者的脂肪肝发病机制中起作用。
