绝经后女性非酒精性脂肪肝患者血清性激素与胰岛素抵抗和肝酶学指标的关系  

Relationship between serum level of sex hormone and insulin resistance, the index of liver enzymes in postmenopausal women with non alcoholic fatty liver

作　　者：董彦军[1] 田玉峰[1] 翟木绪[2] 刘丽娟[1] 

机构地区：[1]日照市人民医院检验科,山东省276826 [2]淄博市妇幼保健院内分泌科

出　　处：《中华临床医师杂志（电子版）》2014年第12期82-86,共5页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的观察绝经后女性非酒精性脂肪性肝病患者血清性激素水平的变化,以及性激素水平与胰岛素抵抗、肝酶学异常的相关性。方法以86例无亲缘关系绝经后女性非酒精性脂肪肝(NAFLD)患者和90例年龄相匹配的健康绝经后女性对照人群为研究对象,血清总睾酮(TT)、雌二醇(E2)和胰岛素(INS)测定采用化学发光法,血清雌酮(E1)测定采用酶联免疫分析法,采用稳态模型评价胰岛素抵抗指数(HOMA-IR),并采用全自动生化分析仪测定肝肾功能、血脂。结果 NAFLD组患者谷丙转氨酶(ALT)、谷氨酰转肽酶(GGT)水平显著高于正常对照组(P<0.01),而谷草转氨酶(AST)、碱性磷酸酶(ALP)水平无显著差异(P>0.05)。NAFLD组患者INS、HOMA-IR显著高于正常对照组(Z=2.812和3.129,P<0.01),而TT、胰岛素敏感指数(HOMA-ISI)显著低于正常对照组(Z值为1.611和3.052,P<0.01);而两组间E1、E2水平无显著差异(Z值为0.564和0.946,P>0.05)。经年龄、血糖和血甘油三酯纠正后,NAFLD患者TT、E1和E2与HOMA-IR呈负相关,与HOMA-ISI呈正相关。与<95%可信区间相比,E1和E2=95%可信区间和>95%可信区间组NAFLD患者ALT水平显著降低(P<0.05);TT=95%可信区间和>95%可信区间的NAFLD患者ALT、GGT显著低于<95%可信区间(P<0.05)。结论绝经后女性性激素水平的下降可通过诱导胰岛素抵抗途径,介导NAFLD的发生,且与NAFLD的肝酶学异常密切相关。Objective To observe the change of serum level of sex hormone and its relation with insulin resistance and the index of liver enzyme in postmenopausal women with non-alcoholic fatty liver disease.Methods 86 patients with NAFLD and 90 control subjects matched for age and menopause were included. Serum testosterone, estradiol and insulin were measured by chemiluminescence method, serum estrone were measured by enzyme-linked immunosorbent assay, and insulin resistance was evaluate by the homeostasis model of insulin resistance.Results Serum levels of ALT, GGT levels were significantly higher in patients with NAFLD than those in control group （P〈0.01）, but there was no significant difference in serum level of AST, ALP between these two groups（P〉0.05）. The levels of INS, HOMA-IR were significantly higher and TT, HOMA-ISI significantly lower in patients with NAFLD than those in control group（Z=2.812, 3.129 and 1.611, 3.052,P〈0.01）.There was no significant difference in serum level of E1, E2 between these two groups（Z=0.564 and 0.946,P〉0.05）. After corrected by age, hyperglycemia and hypertriglyceridemia, the serum level of TT, E1 and E2 was negatively correlated with HOMA-IR and positively correlated with HOMA-ISI in patients with NAFLD. The serum level of ALT were significantly lower er in NAFLD patients with E1and E2〉 95% confidence interval than those with E1 and E2≤95% confidence interval（P〈0.05）, and ALT, GGT significantly lower in NAFLD patients with TT≤95% confidence interval than those with TT〉95% confidence interval（P〈0.05）, but after corrected by age, hyperglycemia and hypertriglyceridemia, only TT was negatively correlated with ALT.Conclusion Deficiency of sex hormones may increase the risk of NAFLD by inducing insulin resistance and also closely related to the abnormality of liver enzyme in postmenopausal women with non-alcoholic fatty liver disease.

关 键 词：性激素 非酒精性脂肪肝 绝经 

分 类 号：R575.5[医药卫生—消化系统]