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超声测定肝脏衰减系数与糖脂代谢关系的研究
Relationship between liver attenuation coefficient and glucose and lipid metabolism

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DOI:
作者:
郝亚平， 张磊 ，刘德红， 朱家安， 王晔 ，杨蓉， 马晓静， 包玉倩， 贾伟平
Hao Ya-ping，Zhang Lei，Liu De-hong，Zhu Jia-an
作者单位:
上海交通大学附属第六人民医院内分泌代谢科 上海市糖尿病研究所 上海市糖尿病重点实验室 上海市糖尿病临床医学中心；2上海闸北区宝山路街道社区卫生服务中心；3上海交通大学附属第六人民医院超声科
1 Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Shanghai Diabetes Institute; Shanghai Key Laboratory of Diabetes Mellitus; Shanghai Clinical Center for Diabetes，2 Baoshan Street Community Health Center，Zhabei，Shanghai; 3 Department of ultrasound, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital; Shanghai Institute of Ultrasound in Medicine
关键词:
非酒精性脂肪性肝病；脏脏衰减系数；肝脏脂肪含量；胰岛素抵抗
Liver attenuation coefficient ; Hepatic fat ; Nonalcoholic fatty liver disease ; Insulin resistance
摘要:
【摘要】 目的 探讨肝脏衰减系数与糖脂代谢的关系。方法 入选411例具备完整的体格检查、血压、糖、脂代谢及肝脏超声结果的男性，年龄36-65岁。以超声测定肝脏衰减系数作为肝脏脂肪含量的评价指标，以肝脏衰减系数三分位点将研究对象分为三组，比较各组临床参数，并以年龄50岁为界进行亚组分析。结果 （1）411例研究对象中，106（25.8%）例为超声定性诊断非酒精性脂肪性肝病(NAFLD)。（2）与肝脏衰减系数处于下1/3位点组比较，上1/3位点组年龄、收缩压(SBP)、餐后两小时血糖(2hPG)、餐后两小时胰岛素（2hINS）以及高血糖频率、NAFLD患病率明显升高（P＜0.05-0.01），而胰岛素敏感性(ISIc)降低（P＜0.05）。（3）50岁及以上亚组人群中，肝脏衰减系数处于上1/3位点者的胰岛素抵抗指数（HOMA-IR）、2hINS、甘油三酯（TG）及高血糖频率、NAFLD患病率高于下1/3位点组（P＜0.05-0.01），而ISIc低于下1/3位点组（P＜0.05）。（4）50岁及以上超声定性诊断为非NAFLD人群中，肝脏衰减系数处于上1/3位点者的2hINS及TG高于下1/3位点组（P＜0.05）。(5)多元逐步回归分析显示，肝脏衰减系数是2hINS的独立危险因素。结论 在50岁及以上超声定性诊断为非NAFLD男性人群中，超声测定肝脏衰减系数对估测脂代谢异常及胰岛β细胞对糖负荷后的反应具有一定的临床意义。
【Abstract】 Objective To explore the value of liver attenuation coefficient in relation to glucose and lipid metabolism. Methods A totle of 411 male individuals aged from 36 to 65 years old with complete data on physical examination, plasma glucose, blood pressure and lipid profiles underwent liver ultrasound scan, and were divided into three groups according to liver attenuation tertiles. Results (1) Ultrasonography revealed that 106 (25.8%) subjects had non-alcoholic fatty liver disease (NAFLD). (2) Compared with those in the lowest tertile of the level of liver attenuation coefficient, subjects in the highest tertile had significantly higher level of age, systolic blood pressure(SBP), postprandial blood glucose （2hPG）, postprandial blood insulin（2hINS）and increased frequency of hyperglycemia, NAFLD , but the level of insulin sensitivity index（ISIc）was decreased（all P＜0.05-0.01）.(3) In subjects above 50 years, HOMA-IR, TG, 2hINS and frequency of hyperglycemia, NAFLD was higher in the highest tertile group than the lowest tertile group, however, the level of ISIc was opposite（all P＜0.05-0.01）.(4) In the non-NAFLD subgroup above 50 years old, subjects in the highest tertile had a lower level of BMI and a higher level of 2hINS and TG than those in the lowest tertile of the level of liver attenuation coefficient（P＜0.05）. (5) Multiple regression analysis showed that liver attenuation coefficient was independently correlated with 2hINS after adjustment of age, blood pressure, body fat parameters, FIN and lipid. Conclusion Liver attenuation coefficient was related with lipid metabolism and pancreatic β-cell response after glucose load in the subjects above 50 years old diagnosed as non-NAFLD by ultrasonic qualitative diagnosis method who had no increase in BMI.

 

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