非酒精性脂肪肝患者血清抵抗素水平与胰岛素抵抗关系的研究

目的检测非酒精性脂肪肝（NAFLD）患者血清抵抗素水平，探讨抵抗素与胰岛素抵抗（IR）的关系，及其在NAFLD发生发展中的作用。方法选择NAFLD患者53例（男30例，女23例），对照组28例（男16例，女12例）。以标准方法测量各研究对象身高、体重、腰围、臀围、血压。测定空腹血糖（FBG）、空腹胰岛素（FINS）、甘油三酯（TG）、总胆固醇（Tc）、高密度脂蛋白胆固醇（HDL-c）、低密度脂蛋白胆固醇（LDL-c）、丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、1-谷氨酰转移酶（GGT），电化学发光免疫分析法（ECLIA）测定FINS，酶联免疫方法（ELISA）测定空腹血清抵抗素水平。通过公式计算体重指数（BMI）、腰臀比（WHR）、脂肪百分含量（BF％），稳态模式评估法计算胰岛素抵抗指数（HOMA—IR），对抵抗素与各指标之间的关系进行统计学分析。结果两组例数、年龄、性别及BF％比较差异均无统计学意义（P〉0．05）。NAFLD组收缩压（SBP）、舒张压（DBP）、WHR、腰围、臀围及BMI高于对照组（t=3．54，3．32，3．56，5．85，5．56，4．10，P=0．001）。两组TC、HDL-C及LDL-C水平比较差异均无统计学意义（P〉0．05），而NAFLD组FBG、TG及AST高于对照组（P=0．001）。NAFLD组血清抵抗素水平、FINS、HOMA—IR、ALT、GGT均高于对照组（P=0．0005）。NAFLD组血清抵抗素与年龄、BMI、WHR、BF％、FBG、TG、TC、HDL-C、LDL-C、AST无关（P〉0．05）。血清抵抗素与GGT、ALT、FINS、HOMA-IR呈正相关（r=0．354，0．391，0．875，0．881，P〈0．05或P〈0．01）。多元逐步回归分析显示：HOMA-IR对血清抵抗素水平影响最显著。NAFLD组男性和女性患者血清抵抗素水平均高于对照组中的男性和女性受检者（P〈0．05），两组中男女性之间比较差异无统计学意义（P〉0．05）。结论NAFLD患者血清抵抗素水平显著高于正常人，其血清抵抗素与IR密切相关，可能主要与肝源性IR有关，且参与NAFLD的发生。血清抵抗素可能作为促炎因子参与脂肪肝炎症的发生。

Study of the relationships between insulin resistance and the levels of serum resistin in patients with nonalcoholic fatty liver disease

Objective To measure levels of serum resistin in patients with nonalcoholic fatty liver disease （NAFLD） and explore the relationship between serum resistin and insulin resistance, and the role of serum resistin in the pathogenesis and progression of NAFLD. Methods 53 patients （including 30 males and 23 females） with NAFLD and the 28 control subjects （including 16males and 12females） wereenrolled in this study. The height, weight, waist circumstance, hip girth and blood pressure of all subjects were obtained by standard methods. To all the subjects, the parameters including fasting blood glucose （ FBG）, triglyceride （ TG）, total cholesterol （ TC）, high-density lipoprotein cholesterol （ HDL-c）, low- density lipoprotein cholesterol （ LDL-c ）, alanine aminotransferase （ ALT ）, aspartate aminotransferase（AST） and gamma glutamyl transferase （GGT） were measured. Serum resistin was measured by electro- chemiluminescence immunoassay （ECLIA） and fasting serum insulin （FINS） were measured by enzyme- linked immunosorbent assay （ELISA）. Body mass indexes （BMI）, waist hip ratio （WHR）, body fat per- centage （ BF% ） were calculated with formula. Homeostasis model assessment was applied to assess the sta-tus of insulin resistance index （HOMA-IR）. The relationships between serum resistin and various parame- ters in patients with NAFLD were observed and analyzed by statistical methods. Results There were no significant differences in the number of cases, average age, compositions of sex and BF% between the NAFLD group and the control group （ P 〉 0. 05）. In the NAFLD group, systolic blood pressure （ SBP）,diastolic blood pressure （DBP）. The waist circumference, hip girth and BMI and WHR were higher than those of control group （ t = 3.54,3.32,3.56,5.85,5.56,4. 10, P = 0. 001 ）. There were no significant differences on the level of TC, HDL-c, LDL-c between the NAFLD group and the control group （ P 〉 O. 05）. In the NAFLD group, FBG, TG, AST were higher than those of control group （ P =0. 001, P = 0. 004, P = O. 001 ）. The levels of serum resistin, FINS, HOMA-IR, ALT and GGT in NAFLD group were significantly higher than those of control group, and there was significant difference between two groups （ P = 0. 0005 ）. There was no significant correlation between serum resistin and age, BMI, WHR, BF%,FBG, TG, TC, HDL-C, LDL-C, AST in NAFLD group （ P 〉 0. 05）. The levels of serum resistin in pa- tients with NAFLD were positively correlated with GGT, ALT, FINS, HOMA-IR （ r = 0. 354, 0. 391, 0. 875, 0. 881, P 〈0. 05 or 〈0. 01 ）. After multiple stepwise regression analysis, the results showed that HOMA-IR was the most important factor for affecting the levels of serum resistin. The levels of serum resis- tin in male and female patients with NAFLD were higher than those of control group （ P 〈 0.05 ）. But no statistical difference was found between males and females in two groups （ P 〉 0.05）. Conclusions Thelevels of serum resistin in patients with NAFLD were significantly higher than those of controls. Serum resis- tin in patients with NAFLD was closely correlated with insulin resistance, and it may participate in the path- ogenetic progress of NAFLD. Serum resistin in patients with NAFLD might be associated with hepatic insu- lin resistance, and it has no correlations with obesity-related insulin resistance. Serum resistin in patients with NAFLD may participate in the inflammation of fatty liver disease as inflammatory cytokines.