Nonalcoholic fatty liver disease in severely obese subjects
Nonalcoholic fatty liver disease in severely obese subjects
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DOI：
10.1111/j.1572-0241.2006.01041.x
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发表时间：
2007-02-01
影响因子：
9.8
通讯作者：
Kotler, Donald P.
中科院分区：
文献类型：
--
作者：
Gholam, Pierre M.;Flancbaum, Louis;Kotler, Donald P.
背景：非酒精性脂肪性肝病（NAFLD）一直与肥胖和胰岛素抵抗相关。非酒精性脂肪性肝炎（NASH）是NAFLD中的一种组织学实体，可进展为肝硬化。NASH在重度肥胖中的确切患病率尚不清楚。目前尚不清楚NASH和单纯性脂肪肝受试者之间是否存在胰岛素敏感性差异。目的：评估NASH和肝纤维化在严重肥胖受试者的种族多样性队列中的患病率和相关性。设计：97例受试者入选。肝活检，胰岛素抵抗的间接标志物，代谢参数和肝功能tests.Results：36%的受试者有NASH和25%的纤维化。组织学检查无肝硬化。高血糖、胰岛素抵抗和代谢综合征的标志物与NASH和纤维化的存在相关，但与体重指数无关。转氨酶水平升高与NASH和纤维化密切相关，但46%的NASH受试者转氨酶正常。与单纯性脂肪肝患者相比，NASH患者的胰岛素抵抗更严重。一个信号检测模型将AST和糖尿病的存在预测NASH的存在，而另一个将ALT和HbA1C预测fibrosis.Conclusions的存在：NAFLD与代谢综合征，而不是过量的脂肪组织在严重肥胖。NASH受试者的胰岛素抵抗高于单纯性脂肪肝受试者。合并肝损伤和高血糖标志物的统计模型可能有助于预测该人群中肝脏病理学的存在。
BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) has been consistently associated with obesity and insulin resistance. Nonalcoholic steatohepatitis (NASH) is a histological entity within NAFLD that can progress to cirrhosis. The exact prevalence of NASH in severe obesity is unknown. It is unclear whether differences in insulin sensitivity exist among subjects with NASH and simple fatty liver.OBJECTIVE: To evaluate the prevalence and correlates of NASH and liver fibrosis in a racially diverse cohort of severely obese subjects.DESIGN: Ninety-seven subjects were enrolled. Liver biopsies, indirect markers of insulin resistance, metabolic parameters, and liver function tests were obtained.RESULTS: Thirty-six percent of subjects had NASH and 25% had fibrosis. No cirrhosis was diagnosed on histology. Markers of hyperglycemia, insulin resistance, and the metabolic syndrome but not body mass index were associated with the presence of NASH and fibrosis. Elevated transaminase levels correlated strongly with NASH and fibrosis but 46% subjects with NASH had normal transaminases. Subjects with NASH had more severe insulin resistance when compared to those with simple fatty liver. A signal detection model incorporating AST and the presence of diabetes predicted the presence of NASH while another incorporating ALT and HbA1C predicted the presence of fibrosis.CONCLUSIONS: NAFLD is associated with the metabolic syndrome rather than excess adipose tissue in severe obesity. Insulin resistance is higher in subjects with NASH versus those with simple fatty liver. Statistical models incorporating markers of liver injury and hyperglycemia may be useful in predicting the presence of liver pathology in this population.