High fasting insulin concentrations may be a pivotal predictor for the severity of hepatic fibrosis beyond the glycemic status in non-alcoholic fatty liver disease patients before development of diabetes mellitus．
High fasting insulin concentrations may be a pivotal predictor for the severity of hepatic fibrosis beyond the glycemic status in non-alcoholic fatty liver disease patients before development of diabetes mellitus．
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对于非酒精性脂肪肝患者，在发展为糖尿病之前，高空腹胰岛素浓度可能是除了血糖状态之外肝纤维化严重程度的一个关键预测因素。
DOI：
10.1111/hepr.12832
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发表时间：
2016
期刊：
影响因子：
4.2
通讯作者：
Masuda K，Noguchi S，Ono M，Ochi T，Munekage K，Okamoto N，Suganuma N，Saibara T
中科院分区：
文献类型：
--
作者：
Ishikawa T;Shiratsuki S;Matsuda T;Iwamoto T;Takami T;Uchida K;Terai S;Yamasaki T;Sakaida I.;Masuda K，Noguchi S，Ono M，Ochi T，Munekage K，Okamoto N，Suganuma N，Saibara T
背景胰岛素抵抗和 2 型糖尿病 (T2DM) 会导致非酒精性脂肪肝 (NAFLD) 的进展。然而，NAFLD 患者在发展为 T2DM 之前，葡萄糖代谢因素与组织学严重程度之间的关系尚不清楚。方法在 103 名经活检证实的血红蛋白 A1c <6.5%、空腹血糖 <126 mg/dL 的 NAFLD 患者（68 名男性和 35 名女性）中，我们研究了葡萄糖代谢因素是否影响事先不知道 T2DM 的肝纤维化的严重程度。纤维化阶段 F3 组的血清天冬氨酸转氨酶、天冬氨酸转氨酶/丙氨酸转氨酶比值、空腹免疫反应性胰岛素 (f-IRI)、稳态模型评估——胰岛素抵抗、血红蛋白 A1c、透明质酸和 IV 型胶原 7s 显着高于 F0-2 组，1,5-脱水葡萄糖醇显着降低。多元逻辑回归分析显示，只有 f-IRI（P= 0.006；比值比，1.15151；95% 置信区间，1.04198–1.27254）显着被认为是 F3 的预测因素。根据优化模型的前向和后向逐步选择分析确定，f-IRI（P= 0001；优势比，1.16788）仍然是 F3 的独立预测因素。为了区分 F3 组和 F0-2 组，受试者工作特征曲线下面积显示空腹胰岛素为 0.7219，受试者工作特征曲线分析中 f-IRI 的最佳截断值为 13.2 μU/mL。 结论 高空腹胰岛素浓度可能是 NAFLD 患者发展为 T2DM 之前血糖状态之外的肝纤维化严重程度的关键葡萄糖代谢预测因子。
BackgroundInsulin resistance and type 2 diabetes mellitus (T2DM) contribute to the progression of non‐alcoholic fatty liver disease (NAFLD). However, the relationship between glucose metabolic factors and the histological severity in NAFLD patients before development of T2DM is not well known.MethodsIn 103 biopsy‐proven NAFLD patients (68 men and 35 women) with hemoglobin A1c of <6.5% and fasting blood glucose of <126 mg/dL, we investigated whether glucose metabolic factors influenced the severity of hepatic fibrosis without prior known T2DM.ResultsFemale gender, age, serum aspartate aminotransferase, the aspartate aminotransferase/alanine aminotransferase ratio, fasting immunoreactive insulin (f‐IRI), homeostasis model assessment – insulin resistance, hemoglobin A1c, hyaluronic acid, and type IV collagen 7 s were significantly higher, and 1,5‐anhydroglucitol was significantly lower, in the fibrosis stage F3 group than in the F0–2 group. Multiple logistic regression analysis showed that only f‐IRI (P= 0.006; odds ratio, 1.15151; 95% confidence interval, 1.04198–1.27254) was significantly indicated as a predictive factor for F3. As determined by both forward and backward stepwise selection analyses to optimize the model, f‐IRI (P= 0001; odds ratio, 1.16788) remained an independent predictive factor for F3. To discriminate the F3 group from the F0–2 group, the area under the receiver operating characteristic curves showed that fasting insulin was 0.7219, and the best cut‐off value of f‐IRI was 13.2 μU/mL in the receiver operating characteristic curve analysis.ConclusionsHigh fasting insulin concentrations may be a pivotal glucose metabolic predictor for the severity of hepatic fibrosis beyond the glycemic status in NAFLD patients before development of T2DM.