Nonalcoholic fatty liver disease - A feature of the metabolic syndrome
Nonalcoholic fatty liver disease - A feature of the metabolic syndrome
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DOI：
10.2337/diabetes.50.8.1844
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发表时间：
2001-08-01
期刊：
影响因子：
7.7
通讯作者：
Melchionda, N
中科院分区：
文献类型：
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作者：
Marchesini, G;Brizi, M;Melchionda, N
对30名经活检证实患有非酒精性脂肪性肝病（NAFLD）、葡萄糖耐量正常且体重指数（BMI）<30 kg/m²的受试者进行了胰岛素敏感性（正常血糖钳夹试验，胰岛素输注速率：40 mU·m⁻²·min⁻¹）研究。在这30名受试者中，9人患有单纯性脂肪肝，21人有脂肪性肝炎的证据。此外，还对10名代谢控制良好的2型糖尿病患者和10名健康受试者进行了研究。
- 大多数NAFLD患者存在中心性脂肪堆积、甘油三酯和尿酸升高以及高密度脂蛋白胆固醇降低的情况，与BMI无关。在钳夹试验期间，NAFLD患者以及体重正常的患者的葡萄糖处置率降低了近50%，其程度与2型糖尿病患者相似。基础游离脂肪酸升高，而胰岛素介导的脂解抑制作用减弱（NAFLD患者为 -69%，对照组为 -84%；P = 0.003）。通过[6,6 - H - 2(2)]葡萄糖测量的吸收后肝糖生成（HGP）正常。在胰岛素输注时，NAFLD患者的HGP仅比基础值降低63%，而对照组为84%（P = 0.002）。与2型糖尿病患者相比，NAFLD患者的基础HGP较低，但胰岛素介导的HGP抑制作用同样降低。许多NAFLD患者有铁过载的实验室证据，但临床、组织学和生化数据（包括胰岛素敏感性）与铁状态无关。4名受试者为家族性血色素沉着症HFE基因His63Asp突变的杂合子。
我们得出结论，在血糖正常且体重正常或适度增加的情况下，NAFLD具有与糖尿病和肥胖症相似的临床和实验室特征。NAFLD可被视为代谢综合征的一个附加特征，具有特异性的肝脏胰岛素抵抗。
Insulin sensitivity (euglycemic clamp, insulin infusion rate: 40 mU.m(-2).min(-1)) was studied in 30 subjects with biopsy-proven nonalcoholic fatty liver disease (NAFLD), normal glucose tolerance, and a BMI < 30 kg/m(2). Of those 30 subjects, 9 had pure fatty liver and 21 had evidence of steatohepatitis. In addition, 10 patients with type 2 diabetes under good metabolic control and 10 healthy subjects were studied.-Most NAFLD patients had central fat accumulation, increased triglycerides and uric acid, and low HDL cholesterol, irrespective of BMI. Glucose disposal during the clamp was reduced by nearly 50% in NAFLD patients, as well as in patients with normal body weight, to an extent similar to that of the type 2 diabetic patients. Basal free fatty acids were increased, whereas insulin-mediated suppression of lipolysis was less effective (-69% in NAFLD vs. -84% in control subjects; P = 0.003). Postabsorptive hepatic glucose production (HGP), measured by [6,6-H-2(2)]glucose, was normal. In response to insulin infusion, HGP decreased by only 63% of basal in NAFLD vs. 84% in control subjects (P = 0.002). Compared with type 2 diabetic patients, NAFLD patients were characterized by lower basal HGP, but with similarly reduced insulin-mediated suppression of HGP. There was laboratory evidence of iron overload in many NAFLD patients, but clinical, histological, and biochemical data (including insulin sensitivity) were not correlated with iron status. Four subjects were heterozygous for mutation His63Asp of the HFE gene of familiar hemochromatosis. We concluded that NAFLD, in the presence of normoglycemia and normal or moderately increased body weight, is characterized by clinical and laboratory data similar to those found in diabetes and obesity. NAFLD may be considered an additional feature of the metabolic syndrome, with specific hepatic insulin resistance.