·胰岛素抵抗及其相关疾病·

　　【摘要】 目的 观察非酒精性脂肪肝(NAFLD)患者肝脏脂肪含量(LF)与IR及胰岛β细胞功能的关系。 方法 将286例NAFLD患者分为正常糖调节(NGR)组和糖调节受损(IGR)组，以校正CT半定量方法测定LF，根据LF≤5.0%、5.1%～9.9%、10.0%～20.0%，将两组各分为3个亚组：NGR-1、2、3组及IGR-1、2、3组。以OGTT,Ins释放试验评估IR及β细胞功能，分析LF与IR及β细胞功能的关系。 结果 ⑴随LF增加，在NGR各亚组中ΔI30/ΔG30分别为13.04±9.71、17.27±9.86、15.66±10.56，NGR-2亚组高于NGR-1亚组(P<0.05)，NGR-3亚组轻微低于NGR-2亚组(P>0.05);在IGR各亚组中分别为15.27±19.86、14.04±9.71、12.36±21.56，IGR-3亚组低于IGR-1亚组(P<0.05);⑵随LF增加，NGR各亚组中HOMA-β分别为106.03±55.03、118.44±60.69、124.20±39.65，NGR-2、NGR-3亚组均高于NGR-1亚组(P<0.05);在IGR各亚组中分别为92.03±34.37、94.44±46.54、82.20±33.67，IGR-3亚组低于IGR-1亚组和IGR-2亚组(P<0.05)。⑶多元线性回归分析提示LF是影响HOMA-IR最强的独立危险因素(P<0.01)。 结论 在NGR人群中，LF增加至5.1%～9.9%时，IR增加，β细胞早相和整体分泌代偿性增高;当LF达10.0%～20.0%时，β细胞早相分泌功能可能出现减退。对IGR人群，LF增加至5.1%～9.9%时，β细胞早相分泌功能已开始降低;当LF达10.0%～20.0%时，β细胞整体分泌功能恶化。

　　【关键词】 非酒精性脂肪肝病;正常糖调节;糖调节受损;胰岛素抵抗;β细胞功能

Association between liver fat content with insulin resistance and islet β-cell function in subjects with non-alcoholic fatty liver disease(NAFLD) and different levels of glucose regulation   WEN Zhen, JIANG Tao, SONG Xiu-xia ,et al .Department of Endocrinology, Beijing Shijitan Hospital, Beijing100038, China

　　【Abstract】 Objective To observe the relationship between liver fat content with insulin resistance and islet β-cell function in subjects with non-alcoholic fatty liver disease and different glucose regulation. Methods 286 subjects with NAFLD and different glucose regulation were divided into two groups :NGR and IGR. LF was measured by CT. According to the LF≤5.0%、5.1%～9.9%、10.0%～20.0%, the two groups were divided into three subgroups respectively: NGR-1,2,3 and IGR-1,2,3. The insulin resistance and cell function were evaluated by oral 75 g glucose tolerance test. Results ⑴With the increase of LF, theΔI30/ΔG30 in subgroup NGR were 15.27±19.86, 14.04±9.71, 12.36±21.56 ,respectively. Subgroup NGR-2 were significantly higher than subgroup NGR-1(P<0.05). Subgroup NGR-3 were slightly lower than NGR-2(P>0.05); In the group IGR were 15.27±19.86, 14.04±9.71, 12.36±21.56，respectively. Subgroup IGR-3 were significantly lower than IGR-1.(P<0.05). ⑵With the increase of LF, HOMA-β in the subgroup NGR were 106.03±55.03, 118.44±60.69, 124.20±39.65,respectively. Subgroup NGR-2 and NGR-3 were significantly higher than NGR-1(P<0.05). In the subgroup IGR were 92.03±34.37, 94.44±46.54, 82.20±33.67,respectively. Subgroup IGR-3 were significantly lower than IGR-1 and IGR-2(P<0.05). ⑶Linear regression analysis suggested that LF was the strongest risk factor for IR. Conclusion In NGR subjects, when LF accumulated to 5.1%～9.9%, IR increased and the early phase of insulin secretion and the total insulin secretion were compensatory increased ; when LF accumulated to 10.0%～20.0%, the early phase of insulin secretion probably declined. In IGR subjects, when LF accumulated to 5.1%～9.9%, the early phase of insulin secretion was already declined ; when LF accumulated to 10.0%～20.0%, β cell function in whole were deteriorated.

　　【Key words】 Non-alcoholic fatty liver disease;Normal glucose regulation;Impaired glucose regulation;insulin resistance;β-cell function