非酒精性脂肪性肝病进展性肝纤维化患者空腹血糖受损和胰岛素抵抗调查*

doi:10.3969/j.issn.1672-5069.2022.06.014

摘要/Abstract

摘要： 目的调查非酒精性脂肪性肝病(NAFLD)患者空腹血糖受损(IFG)和胰岛素抵抗情况及其与肝纤维化的关系。方法 2020年5月～2021年5月我院健康管理门诊诊治的NAFLD患者110例,接受口服葡萄糖耐量试验(OGTT)试验。计算稳态模型胰岛素抵抗指数(HOMA-IR),采用放射免疫法测定血清Ⅳ型胶原、Ⅲ型前胶原(PCⅢ)、层黏连蛋白(LN)和透明质酸(HA)。计算NAFLD纤维化评分(NFS),以NFS﹥0.676被定义为存在进展性肝纤维化。应用Logistic回归模型分析影响NAFLD患者发生进展性肝纤维化的因素。结果经OGTT试验,发现本组糖耐量正常(NGT)者43例,糖耐量异常(IGT)者35例和IFG者32例;IFG组空腹血糖(FPG)、胰岛素(FINS)和HOMA-IR指数分别为(6.6±0.3)mmol/L、(10.9±2.4)μU/mL和3.2±0.9,显著高于IGT组【分别为(5.6±0.7)mmol/L、(8.5±2.2)μU/mL和2.4±0.5,P＜0.05】或NGT组【分别为(5.5±0.6)mmol/L、(7.4±1.9)μU/mL和1.8±0.4,P＜0.05】,而IGT组FINS和HOMA-IR指数显著高于NGT组(P＜0.05);IFG组血清Ⅳ型胶原、PCⅢ、LN和HA水平分别为(75.7±9.6)ng/mL、(146.3±13.1)ng/mL、(132.7±15.2)ng/mL和(189.6±17.5)ng/mL,显著高于IGT组【分别为(63.9±8.4)ng/mL、(133.3±10.7)ng/mL、(122.4±13.4)ng/mL和(163.9±18.6)ng/mL,P＜0.05】或NGT组【分别为(59.4±7.4)ng/mL、(128.6±11.6)ng/mL、(109.4±8.9)ng/mL和(150.2±13.2)ng/mL,P＜0.05】,而IGT组Ⅳ型胶原、LN和HA水平显著高于NGT组(P＜0.05);本组18例患者被判断为存在进展性肝纤维化。多因素Logistic回归分析结果显示,IFG(OR=1.528)和IR(OR=1.714)是NAFLD患者发生进展性肝纤维化的独立危险因素(P＜0.05)。结论 NAFLD患者发生IFG时已存在明显的胰岛素抵抗,可能促进了肝纤维化进程。

关键词: 非酒精性脂肪性肝病, 空腹血糖受损, 胰岛素抵抗, 肝纤维化

Abstract: Objective The aim of this study was to analyze the impact of impaired fasting glucose (IFG) and insulin resistance (IR) on liver fibrosis in patients with nonalcoholic fatty liver disease (NAFLD). Methods A total of 110 patients with NAFLD were encountered in the Health Management Clinic between May 2020 and May 2021. All individuals underwent oral glucose tolerance test (OGTT), and the homeostasis model insulin resistance index (HOMA-IR) was calculated. Serum type IV collagen, type III procollagen (PCIII), laminin (LN) and hyaluronic acid (HA) levels were detected by radioimmunoassay. The NAFLD fibrosis score (NFS) was calculated and the progressive liver fibrosis (PLF) was defined as the NFS﹥0.676. The multivariate Logistic regression analysis was applied to reveal the risk factors for PLF occurrence. Results Based on the OGTT results, the normal glucose tolerance (NGT) was found in 43 cases, the impaired glucose tolerance (IGT) in 35 cases and the IFG in 32 cases; the fasting plasma glucose, insulin and HOMA-IR in patients with IFG were (6.6±0.3) mmol/L, (10.9±2.4) μU/mL and 3.2±0.9, significantly higher than [(5.6±0.7) mmol/L, (8.5±2.2) μU/mL and 2.4±0.5, P<0.05] in patients with IGT or [(5.5±0.6) mmol/L, (7.4±1.9) μU/mL and 1.8±0.4, P<0.05] in patients with NGT; serum collagen IV, PCIII, LN and HA levels in patients with IFG were (75.7±9.6) ng/mL, (146.3±13.1) ng/mL, (132.7±15.2) ng/mL and (189.6±17.5) ng/mL, significantly higher than [(63.9 ± 8.4) ng/mL, (133.3 ± 10.7) ng/mL, (122.4 ± 13.4) ng/mL and (163.9 ± 18.6) ng/mL, P<0.05] in patients with IGT or [(59.4 ± 7.4) ng/mL, (128.6 ± 11.6) ng/mL, (109.4 ± 8.9) ng/mL and (150.2 ± 13.2) ng/mL, P<0.05] in patients with NGT; the PLF was found in 18 patients in our series, and the multivariate Logistic regression analysis showed that the IFG (OR=1.528) and IR (OR=1.714) were the independent risk factors for PLF in patients with NAFLD (P<0.05). Conclusion When the IFG occurs in patients with NAFLD hint the IR, which might promote liver fibrosis progression.

Key words: Nonalcoholic fatty liver disease, Impaired fasting glucose, Insulin resistance, Liver fibrosis

王晓华, 曾雅琳, 郭萃蓉. 非酒精性脂肪性肝病进展性肝纤维化患者空腹血糖受损和胰岛素抵抗调查^*[J]. 实用肝脏病杂志, 2022, 25(6): 812-815.

Wang Xiaohua, Zeng Yalin, Guo Cuirong. Impact of impaired fasting glucose and insulin resistance on liver fibrosis in patients with nonalcoholic fatty liver diseases[J]. Journal of Practical Hepatology, 2022, 25(6): 812-815.

参考文献

[1] 温林. 非酒精性脂肪性肝病并发2型糖尿病患者血尿酸水平变化及其临床意义. 实用肝脏病杂志, 2021, 24(1):55-58.
[2] Lee G, You H J, Bajaj J S, et al. Distinct signatures of gut microbiome and metabolites associated with significant fibrosis in non-obese NAFLD. Nat Commun, 2020, 11(1):4982.
[3] 李珺. NAFLD患者TE成像特点与其病情严重程度及胰岛素抵抗的关系研究. 影像科学与光化学, 2020, 38(2):225-230.
[4] Tanase D M, Gosav E M, Costea C F, et al. The intricate relationship between type 2 diabetes mellitus (T2DM), insulin resistance (IR), and nonalcoholic fatty liver disease (NAFLD. J Diabetes Res, 2020, 2020:3920196.
[5] Mirabelli M, Chiefari E, Arcidiacono B, et al. Mediterranean diet nutrients to turn the tide against insulin resistance and related Diseases. Nutrients, 2020, 12(4):1066.
[6] 中华医学会肝病学分会脂肪肝和酒精性肝病学组, 中国医师协会脂肪性肝病专家委员会, 范建高,等. 非酒精性脂肪性肝病防治指南(2018年更新版). 实用肝脏病杂志, 2018, 21(2):30-39.
[7] Phillips PJ. Oral glucose tolerance testing. Aust Fam Physician, 2012, 41(6):391-393.
[8] Gobato A O, Vasques A C, Zambon M P, et al. Prevalence of metabolic syndrome in obese Turkish children and adolescents. Rev Paul Pediatr, 2014, 32(1):55-62.
[9] Angulo P, Hui J M, Marchesini G, et al. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology, 2007, 45(4):846-854.
[10] Akshatha N S, Diwakar S, Santhekadur P K, et al. Extracellular vesicles as inflammatory drivers in NAFLD. Front Immunol, 2021, 11:627424.
[11] 罗娟, 刘立伟, 刘纪民, 等. 非酒精性脂肪性肝病临床和病理特点及进展期纤维化危险因素性别差异的对比研究. 中华肝脏病杂志, 2021, 29(4):356-361.
[12] Lomonaco R, Leiva E G, Bril F, et al. Advanced liver fibrosis is common in patients with type 2 diabetes followed in the outpatient setting: the need for systematic screening. Diabetes Care, 2021, 44(2):399-406.
[13] Pierantonelli I, Svegliati-Baroni G. Nonalcoholic fatty liver disease: basic pathogenetic mechanisms in the progression from NAFLD to NASH. Transplantation, 2019, 103(1):e1-e13.
[14] 杨燕, 姚艺璇, 洪秀韬, 等. 应用胰岛素抵抗替代指标评估2型糖尿病患者非酒精性脂肪肝及进展性肝纤维化的价值. 中华内分泌代谢杂志, 2021, 37(4):281-287.
[15] Li C H, Chou Y T, Shen W C, et al. Increased risks of different grades of non-alcoholic fatty liver disease in prediabetic subjects with impaired fasting glucose and glucose tolerance, including the isolated glycosylated hemoglobin levels of 5.7-6.4% in a Chinese population. J Diabetes Investig, 2020, 11(5):1336-1343.
[16] Li Y, Feng D, Esangbedo I C, et al. Insulin resistance, beta-cell function, adipokine profiles and cardiometabolic risk factors among Chinese youth with isolated impaired fasting glucose versus impaired glucose tolerance: the BCAMS study. BMJ Open Diabetes Res Care, 2020, 8(1):e000724.
[17] Schwabe R F, Tabas I, Pajvani U B. Mechanisms of fibrosis development in nonalcoholic steatohepatitis. Gastroenterology, 2020, 158(7):1913-1928.
[18] Stefano J T, Guedes L V, Souza A, et al. Usefulness of collagen type IV in the detection of significant liver fibrosis in nonalcoholic fatty liver disease. Ann hepatol, 2020, 20:100253.
[19] Slimin Y, Hadi P. Diagnostic accuracy of glycoproteins in the assessment of liver fibrosis: A comparison between laminin, fibronectin, and hyaluronic acid. Turk J Gastroenterol, 2019, 30(6):524-531.
[20] Govaere O, Cockell S, Tiniakos D, et al. Transcriptomic profiling across the nonalcoholic fatty liver disease spectrum reveals gene signatures for steatohepatitis and fibrosis. Scie Transl Med, 2020, 12(572):eaba4448.
[21] Fujii H, Imajo K, Yoneda M, et al. HOMA-IR: An independent predictor of advanced liver fibrosis in nondiabetic non-alcoholic fatty liver disease. J Gastroenterol Hepatol, 2019, 34(8):1390-1395.

非酒精性脂肪性肝病进展性肝纤维化患者空腹血糖受损和胰岛素抵抗调查^*

Impact of impaired fasting glucose and insulin resistance on liver fibrosis in patients with nonalcoholic fatty liver diseases

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	李向阳, 丁光伟, 靳铭. 恩替卡韦治疗慢性乙型肝炎合并NAFLD患者临床疗效研究^*[J]. 实用肝脏病杂志, 2022, 25(6): 776-779.
[2]	孙峥, 王笑烨, 袁景, 梁丽. 达格列净联合利拉鲁肽治疗非酒精性脂肪性肝病合并2型糖尿病患者短期疗效研究^*[J]. 实用肝脏病杂志, 2022, 25(6): 796-799.
[3]	蔡勇, 李璟, 欧琴. 2型糖尿病合并非酒精性脂肪性肝病患者血清网膜素、视黄醇结合蛋白4和Ⅰ型原胶原氨基端前肽水平及意义分析^*[J]. 实用肝脏病杂志, 2022, 25(6): 800-803.
[4]	孙凌, 杭玮, 邓国忠. 二甲双胍联合吡格列酮治疗非酒精性脂肪性肝病合并2型糖尿病患者疗效研究^*[J]. 实用肝脏病杂志, 2022, 25(6): 804-807.
[5]	樊叶, 张喜梅, 张岩. 非酒精性脂肪性肝病患者血清胱抑素C、脂蛋白α和nesfatin-1水平变化及其临床意义探讨^*[J]. 实用肝脏病杂志, 2022, 25(6): 816-819.
[6]	曾婷, 雷向阳, 白晓苏. 氧化苦参碱对非酒精性脂肪性肝病大鼠肝脏保护作用研究^*[J]. 实用肝脏病杂志, 2022, 25(5): 624-627.
[7]	刘彦彤, 姚杨, 卢博. 荷叶调脂疏肝汤对非酒精性脂肪性肝病患者脂代谢的影响研究^*[J]. 实用肝脏病杂志, 2022, 25(5): 657-660.
[8]	奚佳颖, 汤佳美, 刘玲玉, 王韦. 超声三维斑点追踪技术评价非酒精性脂肪性肝病合并2型糖尿病患者左心功能研究^*[J]. 实用肝脏病杂志, 2022, 25(5): 661-664.
[9]	潘飞, 寿涓, 张冬青. 不同他汀类药物治疗非酒精性脂肪性肝病合并高脂血症患者效果分析^*[J]. 实用肝脏病杂志, 2022, 25(5): 665-668.
[10]	王慧, 汤展, 常文娟, 芦超. 非肥胖型与肥胖型非酒精性脂肪性肝病患者代谢特征和肝脂肪变程度比较^*[J]. 实用肝脏病杂志, 2022, 25(5): 669-672.
[11]	骆苏彦, 李婷婷, 王亚奇, 齐林. 原发性胆汁性胆管炎患者外周血Treg/Th17细胞相关细胞因子水平变化^*[J]. 实用肝脏病杂志, 2022, 25(5): 673-676.
[12]	陈梦绮, 范建高. 美国非酒精性脂肪性肝病诊断与治疗临床实践指南简介^*[J]. 实用肝脏病杂志, 2022, 25(5): 0-S16.
[13]	王晴, 张利莉. 当2型糖尿病遇上非酒精性脂肪性肝病:1+1＞2 ？[J]. 实用肝脏病杂志, 2022, 25(4): 460-463.
[14]	汪晓燕, 钟雪玉, 吴春燕. 沙格列汀干预非酒精性脂肪性肝病合并2型糖尿病大鼠肝组织AMPK/mTOR-TFEB自噬信号通路蛋白表达变化^*[J]. 实用肝脏病杂志, 2022, 25(4): 476-479.
[15]	莫金英, 余希, 余雪平, 吴丽华, 瞿志军. FibroTouch诊断乙型肝炎病毒携带者肝纤维化价值研究^*[J]. 实用肝脏病杂志, 2022, 25(4): 480-483.