作者单位：528200 佛山，南方医科大学附属南海医院内分泌科

胰岛素抵抗与HBV携带者合并非酒精性脂肪肝的关系

曾春平陈幼萍刘帅舒毅梁蕴谊

【摘要】目的探讨胰岛素抵抗(IR)与HBV携带者发生非酒精性脂肪肝(NAFLD)的相关性。 方法将携带HBV且合并NAFLD的68例患者设为NAFLD组，另将具可比性的携带HBV而未合并NAFLD(NNAFLD)的76例设为NNAFLD组。比较2组血压、BMI、腰臀比、空腹血糖、空腹胰岛素、总胆固醇、甘油三酯、ALT、谷氨酰转移酶(γ-GGT)、CRP、血尿酸、HBV DNA定量以及反映胰岛素抵抗情况的稳态模型评估的胰岛素抵抗指数(HOMA-IR)。采用Logistic回归对NAFLD与年龄、性别、BMI、腰臀比、空腹血糖、空腹胰岛素、甘油三酯、总胆固醇、ALT、γ-GGT、CRP、血尿酸、HBV-DNA定量及HOMA-IR等因素的相关性进行分析。 结果NAFLD组的血压、BMI、腰臀比、空腹血糖、空腹胰岛素、甘油三酯、总胆固醇、LDL-C、ALT、γ-GGT、CRP、血尿酸和HOMA-IR均高于NNAFLD组，2组比较差异均有统计学意义(P均<0.05)，而2组HBV DNA定量比较差异无统计学意义(P>0.05)。 HOMA-IR、腰臀比、甘油三酯、总胆固醇进入Logistic回归方程，与NAFLD的发生相关。 结论HOMA-IR可能与HBV携带者发生NAFLD有关，HBV DNA定量可能与此类患者发生NAFLD无明显相关性。

【关键词】胰岛素抵抗；非酒精性脂肪肝；HBV携带者

DOI:10.3969/g.issn.0253-9802.2015.02.007

收稿日期：(2014-09-28)

Relationship of insulin resistance with hepatitis B virus asymptomatic carriers complicated with non-alcoholic fatty liver diseaseZengChunping,ChenYouping,LiuShuai,ShuYi,LiangYunyi.Departmentofendocrinology,NanhaiHospitalAffiliatedtotheSouthernMedicalUniversity,Foshan528200，China

Abstract【】ObjectiveTo discuss the correlation between insulin resistance (IR) and the incidence of non-alcoholic fatty liver disease (NAFLD) in hepatitis B virus asymptomatic carriers. MethodsSixty-eight patients carrying HBV complicated with NAFLD were allocated into the NAFLD group. Seventy-six HBV carriers without NAFLD were enrolled in the NNAFLD group. The blood pressure, BMI, waist to hip ratio, fasting blood-glucose, fasting insulin, total cholesterol, triglyceride, ALT, glutamyltransferase (γ-GGT), CRP, blood uric acid, quantitative PCR detection of HBV DNA and homeostasis model assessment-estimated insulin resistance index (HOMA-IR) were measured and statistically compared between two groups. Logistic regression was adopted to analyze the correlation between NAFLD and age, gender, BMI, waist to hip ratio, fasting blood-glucose, fasting insulin, triglyceride, total cholesterol, ALT, γ-GGT, CRP, blood uric acid, quantitative PCR detection of HBV DNA and HOMA-IR. ResultsThe blood pressure, BMI, waist to hip ratio, fasting blood-glucose, fasting insulin, triglyceride, total cholesterol, LDL-C, ALT, γ-GGT,CRP and HOMA-IR in the NAFLD group were significantly higher compared with those in the NNAFLD group (all P<0.05). Quantitative PCR detection of HBV-DNA did not significantly differ between two groups (P>0.05). Logistic regression revealed that HOMA-IR, waist to hip ratio, triglyceride and total cholesterol were correlated with the incidence of NAFLD. ConclusionsHOMA-IR is probably correlated with the incidence of NAFLD in HBV carriers. Quantitative determination of HBV DNA possibly has no significant correlation with the incidence of NAFLD in these patients.

【Key words】Insulin resistance; Non-alcoholic fatty liver disease; HBV carrier

目前，我国HBV携带者数量庞大，而且随着我国人群生活方式的改变，HBV携带者合并非酒精性脂肪肝 (NAFLD)越来越常见[1]。虽然许多研究证实胰岛素抵抗(IR)或高胰岛素血症是NAFLD的危险因素，然而关于IR与HBV携带者发生NAFLD的关系，笔者见目前国内外相关研究较少，故对此问题进行了探讨，为HBV携带者预防NAFLD提供临床参考[2-3]。

对象与方法

一、研究对象

将2014年1月至2014年6月在我院进行体检时发现合并NAFLD的HBV携带者68例设为NAFLD组，按体检档案号随机抽取同期体检发现的76例未合并NAFLD的HBV携带者作为NNAFLD组。……