Increased prevalence of fatty liver in arterial hypertensive patients with normal liver enzymes: role of insulin resistance
Increased prevalence of fatty liver in arterial hypertensive patients with normal liver enzymes: role of insulin resistance
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DOI：
10.1136/gut.2003.027086
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发表时间：
2004-07-01
期刊：
影响因子：
24.5
通讯作者：
Bolondi, L
中科院分区：
文献类型：
--
作者：
Donati, G;Stagni, B;Bolondi, L
背景资料：与肝酶正常的脂肪肝相关的疾病及其发展机制仍有待充分阐明。目的：本研究的目的是检验肝酶正常的脂肪肝在动脉高血压患者中更常见的假设，并确定这种疾病是否与胰岛素抵抗相关。患者：共55例非肥胖、非糖尿病、非重度饮酒、动脉高血压和肝酶正常的患者和55例性别和年龄匹配的健康受试者被纳入研究。方法：血浆代谢参数、体重指数和脂肪肝的存在进行调查。以血浆胰岛素和血糖作为稳态模型评价指标，估计胰岛素抵抗。对合并样本进行逐步Logistic回归和多因素回归分析，以确定与脂肪肝和胰岛素抵抗独立相关的变量。结果：高血压患者脂肪肝的患病率显著高于非高血压患者（30.9% v12.7%; p< 0.041），胰岛素抵抗程度较高（平均值2.27（SD 1.81）v1.56（0.70）; p = 0.022），体重指数（24.9（3.0）v24.0（2.2）; p = 0.043）略高于对照组。多变量logistic回归分析确定胰岛素抵抗（比值比1.66（95%置信区间（CI）1.03 - 2.52））和体重指数（OR 1.22（95% CI 1.00 - 1.49））为与脂肪肝独立相关的因素。多因素回归分析显示，胰岛素抵抗可通过丙氨酸转氨酶（p = 0.002）、动脉高血压（p = 0.029）和体重指数（p = 0.048.Conclusion）预测，肝酶正常的非肥胖高血压患者非酒精性脂肪肝的患病率较高，与胰岛素抵抗和体重增加有关。
Background: The conditions associated with fatty liver disease presenting with normal liver enzymes and the mechanism involved in its development remain to be fully elucidated.Aims: The aim of the present study was to test the hypothesis that fatty liver with normal liver enzymes occurs more frequently in arterial hypertensive patients and to establish whether this condition is associated with insulin resistance.Patients: A total of 55 non-obese, non-diabetic, non-heavy alcohol drinking patients with arterial hypertensive and normal liver enzymes and 55 sex and age matched healthy subjects were enrolled into the study.Methods: Plasma metabolic parameters, body mass index, and the presence of fatty liver were investigated. Insulin resistance was estimated from plasma insulin and glucose as the homeostasis model assessment index. Stepwise logistic regression and multivariate regression analysis were used on the combined sample to identify variables independently associated with fatty liver and insulin resistance.Results: Hypertensive patients had a significantly higher prevalence of fatty liver (30.9% v 12.7%; p< 0.041), higher insulin resistance (mean 2.27 (SD 1.81) v 1.56 (0.70); p = 0.022), and slightly higher body mass index (24.9 (3.0) v 24.0 (2.2); p = 0.043) than controls. Multivariate logistic regression identified insulin resistance ( odds ratio 1.66 (95% confidence interval (CI) 1.03 - 2.52)) and body mass index (OR 1.22 ( 95% CI 1.00 - 1.49)) as factors independently associated with fatty liver. Multivariate regression analysis showed insulin resistance to be predicted by alanine transaminase ( p = 0.002), presence of arterial hypertension ( p = 0.029), and body mass index ( p = 0.048).Conclusion: The higher prevalence of non-alcoholic fatty liver in non-obese hypertensive patients with normal liver enzymes appears to be related to increases in insulin resistance and body weight.