CAJ | 학술논문

目的观察无糖尿病(DM)史的非酒精性脂肪肝(NAFLD)患者肝脂肪含量与胰岛素抵抗(IR)及代谢综合征(MS)的关系.方法经B超诊断脂肪肝者106例,除外糖尿病、大量饮酒、病毒性肝炎史等,测量形体参数与实验室指标,CT测定肝脏脂肪含量.结果研究对象肝脏脂肪含量在0～34%,根据中位数与四分位数,当肝脏脂肪含量分别为<3.11%,3.11%～6.34%,6.34%～10.82%,≥10.82%时,MS检出率分别为5例(19.2%),8例(29.6%),13例(48.1%),19例(73.1%)(P<0.05).强制肝脏脂肪含量进入模型逐步Logistic回归分析示性别、肝脏脂肪含量、空腹血糖、收缩压、体重指数、高血压史是MS独立危险因素,高密度脂蛋白胆固醇(HDL-C)与空腹胰岛素是MS独立保护因素.逐步多元线性回归分析表明,肝脏脂肪含量为胰岛素抵抗指数(HOMA-IR)独立危险因素.结论肝脏脂肪含量是IR及MS独立危险因素,肝脏脂肪含量更能反映内脏性肥胖.
목적 관찰무당뇨병(DM)사적비주정성지방간(NAFLD)환자간지방함량여이도소저항(IR)급대사종합정(MS)적관계.방법 경B초진단지방간자106례,제외당뇨병、대량음주、병독성간염사등,측량형체삼수여실험실지표,CT측정간장지방함량.결과 연구대상간장지방함량재0～34%,근거중위수여사분위수,당간장지방함량분별위<3.11%,3.11%～6.34%,6.34%～10.82%,≥10.82%시,MS검출솔분별위5례(19.2%),8례(29.6%),13례(48.1%),19례(73.1%)(P<0.05).강제간장지방함량진입모형축보Logistic회귀분석시성별、간장지방함량、공복혈당、수축압、체중지수、고혈압사시MS독립위험인소,고밀도지단백담고순(HDL-C)여공복이도소시MS독립보호인소.축보다원선성회귀분석표명,간장지방함량위이도소저항지수(HOMA-IR)독립위험인소.결론 간장지방함량시IR급MS독립위험인소,간장지방함량경능반영내장성비반.
Objective To observe the relationship of liver fat content to insulin resistance and metabolic syndrome (MS) in nonalcoholic fatty liver disease ( NAFLD ) patients without known diabetes mellitus (DM). Methods 106 patients diagnosed as with fatty liver by uhrasonography, 61 males and 45females, aged 47 ± 14, underwent anthropometric examination and laboratory tests including lipid profile,fasting and 2 hour serum glucose and insulin after 75 g glucose load. CT scanning was used to determine the fat content in liver. Homeostasis model assessment insulin resistance (HOMA-IR) was calculated.Metabolic syndrome was defined based on the ATP Ⅲ criteria. Results The liver fat content in all subjects was distributed from 0 to 34.7% [ median (quartile) 6.34% (3.11% - 10.82% ) ]. Forty-five of the 106patients (42.45 % ) were diagnosed as with MS. When the liver fat increased by quartile order [ ＜ 3.11%(n=26),3.11% -6.34% (n=27),6.34% -10.82% (n=27),and ≥10.82% (n=26)], the percentages of MS were 19.2% (n=5), 29.6% (n=8), 48.1% (n=13), and 73.1% (n=19)respectively (P ＜0.05). Stepwise Logistic regression analysis (forcing liver fat in the model) showed that being female, liver fat content, fasting glucose, systolic blood pressure, BMI, and history of hypertension were significant risk factors of MS, and HDL-C and fasting insulin were significant protection factors of MS.The standard partial regression coefficient of liver fat content was higher than those of fasting blood glucose,systolic blood pressure, and BMI. Stepwise multiple linear regression analysis demonstrated that liver fat content was a significant risk factor of HOMA-IR while BMI and waist circumference were not. Conclusion Compared with BMI and waist circumference, liver fat content is a stronger risk factor of IR and MS.