脂联素与非酒精性脂肪性肝病肝纤维化及胰岛素抵抗的关系_医学论文.docVIP

脂联素与非酒精性脂肪性肝病肝纤维化及胰岛素抵抗的关系_医学论文 脂联素与非酒精性脂肪性肝病肝纤维化及胰岛素抵抗的关系_医学论文 【摘要】 研究脂联素水平与非酒精性脂肪性肝病(NAFLD)患者肝纤维化指标及胰岛素抵抗指数(HOMA-IR)的关系。方法 采用ELISA法检测NAFLD患者和正常对照组的脂联素水平及肝纤维化指标Ⅲ型前胶原(PCⅢ)、透明质酸(HA)、Ⅳ型胶原(CⅣ)、层黏蛋白(LN)水平，采用稳态模式胰岛素抵抗指数（HOMA-IR）评估胰岛素抵抗。结果 NAFLD组脂联素水平显著低于对照组，HOMA-IR及肝纤维化指标显著高于对照组（P＜0.05）。IR与PCⅢ、PCⅣ、HA和LN呈显著正相关（P＜0.05），脂联素水平与腰臀围比(WHR)、体重指数(BMI)、空腹血糖(FBG)、甘油三酯(TG)、空腹胰岛素(FINS)、HOMA-IR、PCⅢ、PCⅣ、HA和LN呈显著负相关（P＜0.01或＜0.05)。结论 NAFLD患者血清脂联素水平降低，脂联素的表达在NAFLD患者肝纤维化与胰岛素抵抗进程中可能起重要作用。 【关键词】 非酒精性脂肪性肝病 胰岛素抵抗 肝纤维化 Abstract：Objective To investigate the relationship between the level of serum adiponectin and the indexes of liver fibrosis and insulin resistance (IR) in nonalcoholic fatty liver disease (NAFLD)．Methods ELISA was used to measure the serum levels of PCⅢ, PCⅣ, HA, LN and adiponectin, of which a comparative study was made between those in NAFLD patients and normal controls． IR was calculated by using homeostasis model assessment．Results The level of adiponectin was decreased （P＜0.05）, while the indexes of IR and liver fibrosis were significantly increased in NAFLD patients （P＜0.05）, compared with the controls． Positive correlation was found between IR index and serum levels of PCⅢ, PCⅣ, HA and LN （P＜0.05）, while negative correlation was evident between serum adiponectin and the values of WHR, BMI, FBG, TG, FINS, HOMA-IR, PCⅢ, PCⅣ, HA and LN （P＜0.01 or P＜0.05).Conclusion The level of adiponectin is decreased in NAFLD patients, implying that the expression of adiponectin may have important significance in the development of liver fibrosis and insulin resistance. Key words: nonalcoholic fatty liver disease adiponectin insulin resistance liver fibrosis 非酒精性脂肪性肝病(nonalcoholic fatty liver disease， NAFLD)是西方国家的常见疾病，在我国发病率呈逐渐增多的趋势，早期发现和治疗NAFLD已越来越受到重视。NAFLD是指病变主要在肝小叶，以肝细胞脂肪变性和脂肪沉积为病理特征，但患者无过量饮酒史的临床综合征，包括从单纯脂肪肝到脂肪性肝炎(NASH)、肝纤维化最后到肝硬化。成年人NAFLD的发病率约17％ 33％。而脂联素是近几年新发现的由脂肪细胞分泌的肽类激素，在脂肪组织中最为丰富，血中的浓度也是脂肪分泌蛋白中最高的，约占血浆蛋白的0.01%。本研究经B超结合临床诊断NAFLD，采用ELISA法检测体检和门诊人群中NAFLD患者和正常对照组的脂联素水平及PCⅢ、HA、P