糖代谢异常患者肝脏胰岛素抵抗与肝纤维化的关系研究  

Study on the relationship between hepatic insulin resistance and hepatic fibrosis in patients with abnormal glucose metabolism

作　　者：祝英娜 李晓辉[1] 袁明霞 Zhu Yingna;Li Xiaohui;Yuan Mingxia(Department of Endocrinology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院内分泌科,北京100050

出　　处：《中国医学前沿杂志(电子版)》2025年第1期56-63,共8页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

基　　金：首都卫生发展科研专项重点攻关项目(首发2022-1-1101)。

摘　　要：目的探讨糖代谢异常患者肝脏胰岛素抵抗与肝纤维化之间的关系。方法选取2022年1月至2023年12月在首都医科大学附属北京友谊医院内分泌科初诊行75 g口服葡萄糖耐量试验确诊糖代谢异常患者310例,检测糖脂代谢及肝脏血清学指标,计算肝脏胰岛素抵抗指数(Hepatic Insulin Resistance Index,HIRI)、肝纤维化4因子指数(Fibrosis Index Based on the 4 Factors,FIB-4)及肝脂肪变指数(Hepatic Steatosis Index,HSI)。分别以lgHIRI中位数、FIB-4中位数、HSI三分位数分组,比较不同组间糖脂代谢以及肝脏血清学指标的差异。采用Spearman相关分析和多因素logistic回归分析HIRI与FIB-4、HSI之间的关系。结果高HIRI组BMI[(30.81±5.01)kg/m^(2)比(26.73±3.92)kg/m^(2)],谷丙转氨酶(alanine aminotransferase,ALT)[(38.41±22.39)U/L比(26.79±17.03)U/L],谷草转氨酶(aspartate aminotransferase,AST)[(27.97±13.52)U/L比(24.01±9.96)U/L],HSI(46.22±6.17比40.04±5.28)均高于低HIRI组(均P<0.01);而FIB-4[0.70(0.55,0.97)比0.88(0.67,1.22)]显著低于低HIRI组(P<0.001)。高FIB-4组ALT、AST高于低FIB-4组,而lgHIRI、HSI、BMI显著低于低FIB-4组。随着HSI增加,ALT、AST、lgHIRI、BMI逐渐递增(均P<0.001),而FIB-4逐渐降低(P<0.001)。Spearman相关分析显示lgHIRI与HSI呈显著正相关、与FIB-4呈负相关,FIB-4与HSI呈显著负相关。多因素logistic回归分析显示,HSI为肝脏胰岛素抵抗的独立危险因素(OR=1.253,95%CI:1.123~1.397,P<0.001),而FIB-4与肝脏胰岛素抵抗呈负相关(OR=0.257,95%CI:0.072~0.922,P=0.037)。结论在糖代谢异常患者中,肝脏胰岛素抵抗与肝纤维化程度呈负相关,不能忽略相对较轻的肝脏胰岛素抵抗状态可能合并显著肝纤维化。Objective To investigate the relationship between hepatic insulin resistance and hepatic fibrosis in patients with abnormal glucose metabolism.Methods A total of 310 patients diagnosed with abnormal glucose metabolism underwent 75 g oral glucose tolerance test in Department of Endocrinology of Beijing Friendship Hospital Affiliated to Capital Medical University from January 2022 to December 2023 were selected.Glucose and lipid metabolism and liver indexes were detected.The Hepatic Insulin Resistance Index(HIRI)is calculated and logarithmically converted,the Fibrosis Index Based on the 4 Factors(FIB-4)and Hepatic Steatosis Index(HSI)were calculated.lgHIRI median,FIB-4 median and HSI quantile were used to compare the differences of glucose and lipid metabolism and liver serological indexes among different groups.Spearman correlation analysis and multivariate logistic regression was used to analyze the relationship between HIRI,FIB-4 and HSI.Results In the high HIRI group,BMI(30.81±5.01 kg/m^(2)vs.26.73±3.92 kg/m^(2)),ALT(38.41±22.39 U/L vs.26.79±17.03 U/L),AST(27.97±13.52 U/L vs.24.01±9.96 U/L),HSI(46.22±6.17 vs.40.04±5.28)were significantly higher than those of low HIRI group(P<0.01).FIB-4[0.70(0.55,0.97)vs.0.88(0.67,1.22)]was significantly lower than that in low HIRI group,P<0.001.ALT and AST in high FIB-4 group were higher than those in low FIB-4 group.LgHIRI,HSI and BMI were significantly lower than those in low FIB-4 group.With the increase of HSI,ALT,AST,lgHIRI and BMI gradually increased(P<0.001),while FIB-4 gradually decreased(P<0.001).Spearman correlation analysis showed that lgHIRI was significantly positively correlated with HSI and negatively correlated with FIB-4,and FIB-4 was significantly negatively correlated with HSI.Multivariate logistic regression analysis showed that HSI was an independent risk factor for hepatic insulin resistance(OR=1.253,95%CI:1.123-1.397,P<0.001),while FIB-4 was negatively correlated with hepatic insulin resistance(OR=0.257,95%CI:0.072-0.922,P=0.037).Conclusions In t

关 键 词：肝脏胰岛素抵抗 肝纤维化 肝脂肪变性 

分 类 号：R587.1[医药卫生—内分泌] R575.2[医药卫生—内科学]