肝脏脂肪含量与胰岛素抵抗及胰岛β细胞功能的关系  

Association of liver fat content with insulin resistance and islet p cell function in individuals with various statuses of glucose metabolism

作　　者：卞华[1] 林寰东[1] 饶圣祥[2] 姚秀忠[2] 曾蒙苏[2] 周健[3] 贾伟平[3] 高鑫[1] 

机构地区：[1]复旦大学附属中山医院内分泌代谢科,上海200032 [2]复旦大学附属中山医院放射科,上海200032 [3]上海交通大学附属第六人民医院内分泌代谢科

出　　处：《中华内分泌代谢杂志》2010年第7期535-540,共6页Chinese Journal of Endocrinology and Metabolism

基　　金：上海市科委重点项目（07JC14011;8dj1400601）;上海市市级医院新兴前沿技术联合攻关项目（SHDC12006101）

摘　　要：目的 观察肝脏脂肪含量（LFC）与胰岛素抵抗及胰岛β细胞功能的关系.方法 109例受试者分为糖调节受损组（IGR,31例）、新诊断2型糖尿病组（NT2DM,31例）和正常对照组（NC,47例）,采用质子磁共振波谱分析（^1H MRS）定量测定LFC;口服75 g葡萄糖耐量和胰岛素、C肽释放试验评估胰岛素抵抗及B细胞功能,分析LFC与胰岛素抵抗及B细胞功能的关系.结果 （1）LFC在NC、IGR、NT2DM组中分别为3.83%（2.35%～7.59%）、12.82%（8.10%～21.37%）、21.99%（11.89%～34.43%）,随着糖代谢异常程度增加依次增高（P〈0.01）;（2）根据LFC四分位数分组,由低至高分为Quartile 1（LFC〈4.04%）、Quartile 2（4.04%≤LFC〈9.77%）、Quartile 3（9.77%≤LFC〈20.78%）、Quartile 4（LFC≥20.78%）组,稳态模型评估的胰岛素抵抗指数（HOMA-IR）随着LFC增加从Quartile 2开始依次升高（P〈0.01）;（3）胰岛素30 min增量（△I30）、△I30/血糖30 win增量（△G30）与C肽30 min增量（△CP30）在Quartile 2时均呈现增高趋势,从Quartile 3开始呈逐步下降趋势;△CP30和△I30/△G30在Quartile 4明显降低（P〈0.05或P〈0.01）.△CP30/△G30从Quartile 3开始降低（P〈0.05）.C肽曲线下面积与血糖曲线下面积的比值（CPAUC/GAUC）从Quartile 3开始降低（P〈0.05）.与之相应血糖增高,在Quartile 3达到空腹血糖受损和糖耐量受损水平（P〈0.01）;（4）LFC与HOMA-IR（rs=0.618,P〈0.01）呈正相关;与△CP30（rs=-0.282）、△CP30/△G30（rs：-0.404）、CPAUC/GAUC（rs=-0.308）呈负相关（均P〈0.01）;（5）多元回归分析显示LFC是HOMA-IR独立影响因子（P〈0.01）.结论 本研究发现LFC增加至4%时.开始出现胰岛素抵抗,β细胞早相分泌代偿增高;当增加至10%时,早相和整体β细胞分泌功能恶化伴血糖升高.Objective To study the association of liver fat content （LFC） with insulin resistance and β cell function. Methods One hundred and nine subjects including 31 cases with impaired glucose regulation （IGR）, 31 newly diagnosed type 2 diabetes （NT2DM） and 47 normal controls （NC） with normal metabolic parameters were involved in the study. LFC was measured by ^1H magnetic resonance spectroscopy （1H MRS） and the insulin resistance and β cell function were evaluated by oral 75 g glucose tolerance test. Results （1 ） LFCs were3.83% （2.35% ～7.59% ） ,12. 82% （8.10%～21.37%）, and 21.99% （11.89%～34.43%）, being progressively raised in the respective NC, IGR, NT2DM groups（P〈0.01）. （2） The subjects were divided into four subgroups according to LFC Quartile： Quartile 1 （LFC〈4. 04% ） , Quartile 2（4. 04% ≤LFC〈9. 77% ）, Quartile 3 （9.77% ≤LFC〈20.78% ） ,and Quartile 4（ LFC≥20.78% ）. Homeostasis model assessment of insulin resistance index （HOMA-IR） values were elevated significantly and progressively starting from Quartile 2（P〈0. 01）. （3） Insulin from 0 to 30 min （ △I30）, the ratio of insulin from 0 to 30 min to glucose from 0 to 30 min （ △I30/ △G30） , C peptide from 0 to 30 min （△CP30） had a trend of increase in Quartile 2,then trended to decrease in Quartile 3. In Quartile 4, △CP30 and △I30/△G30 sharply decreased （P〈0.05 or P〈0.01）. The ratio of C peptide from 0 to 30 min to glucose from 0 to 30 min （ △CP30/△G30） began to decrease from Quartile 3 （P〈0. 05）. The ratio of area under curve of C peptide to area under curve of glucose （CPAUC/GAUC） was significantly decreased from Quartile 3（P〈0.05）. From Quartile 3,glucose level became abnormally elevated to impaired fasting glucose and impaired glucose tolerance （P〈0.01）. （4） LFC was positively correlated with HOMA-IR （rs =0. 618 ,P〈0.01）, but was negatively correlated with △CP30（rs =-0.282）, △CP30/△G30（rs

关 键 词：糖调节受损 糖尿病 磁共振波谱 胰岛素抵抗 Β细胞功能 

分 类 号：R587.1[医药卫生—内分泌]