非酒精性脂肪肝纤维化评分在胰岛素抵抗及向心性肥胖中的应用

摘要

Objective:To explore the relationship between nonalcoholic fatty liver disease fibrosis score ( NAFLD fibrosis score ) and central obesity and insulin resistance ( IR) .Methods:A total of 2 891 subjects from Medical Examination Center of Central Hospital of Xuzhou were included in the study .All of the subjects'blood test were collected to calculate NAFLD fibrosis score .IR was calculated by the homeostasis model ( HOMA-IR) , which was equal to fasting insulin (mU· L-1) ×fasting glucose (mmol· L-1)/22.5.Subjects were divided by whether they are suffering the pathema:A1(non-central obesity), A2(central obesity);B1(non-IR), B2(IR).Results:Neck circumference, waist circumference, hip circumference, WHR, WBC, neutrophile granulocyte,weight, HbA1c were associated with the NAFLD fibrosis score .Among M1, M2 and M3, the nosometry of central obesity was significantly different ( P<0.001 ) and increases with the score , IR was the same ( P<0.001 ) .Conclusion:NAFLD fibrosis score constructed from routine clinical and laboratory variables is associated with the prevalence rate of central obesity and IR , it is a useful clinical practical evaluation index of IR .%目的：验证非酒精性脂肪肝（ nonalcoholic fatty liver disease ，NAFLD）纤维化评分对向心性肥胖、胰岛素抵抗的评估效能及分析与其他代谢组分的相关性。方法：研究江苏徐州地区的2891名医院体检人群，男性1866人，女性1025人。分别检测受试者的血糖、空腹胰岛素（ Fins ）、人体三围、血清丙氨酸氨基转移酶（ALT）等相关指标。 NAFLD纤维化评分＝-1.675＋0.037×年龄（年）＋0.094×体重指数（kg· m-2）＋1.13×空腹血糖调节受损或者糖尿病（是＝1，否＝0）＋0.99×天冬氨酸转氨酶/ALT -0.013×血小板（×109 L-1）-0.66×白蛋白（ g· dl -1），计算出肝纤维化评分后与各种代谢组分做相关性分析。将样本按NAFLD纤维化评分的低截点和高截点分为3组，组间再按是否患有向心性肥胖、胰岛素抵抗分别分组并计算其患病率，比较各组间的差异，从而验证此评分的效能。结果：颈围、腰围、臀围、腰臀比、白细胞、中性粒细胞、体重、糖化血红蛋白与NAFLD纤维化评分具相关性。 NAFLD纤维化评分在向心性肥胖和非向心性肥胖组中的患病率差异有统计学意义（ P＜0.001），在胰岛素抵抗与非胰岛素抵抗组中患病率差异有统计学意义（ P＜0.001）。结论：NAFLD纤维化评分与向心性肥胖及胰岛素抵抗密切相关，在临床上可将其作为简易评价胰岛素抵抗的指标。