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目的探讨非酒精性脂肪性肝病(NAFLD)人群胰岛素抵抗(IR)与血浆抵抗素(resistin)水平的变化及吡格列酮干预对其影响。方法①筛选136例NAFLD人群,采用随机分为2组,治疗组吡格列酮片30mg·d-1,疗程12周;对照组吡格列酮片模拟片30mg·d-1,疗程12周。采用ELISA法检测2组的血浆抵抗素水平,采用稳态胰岛素抵抗指数(HOMA-IR)评估IR程度,观察2组血浆抵抗素水平与HOMA-IR的变化及与临床生化指标的关系。②采用病例自身对照方法,给予吡格列酮口服治疗12周,观察治疗前后生化指标、HOMA-IR血浆抵抗素水平变化。结果①NAFLD组的腰围(WC)、体重指数(BMI),空腹血糖(FPG)、空腹胰岛素(FINS)、甘油三酯(TG)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、HOMA-IR及血浆抵抗素水平等均显著高于对照组,高密度脂蛋白胆固醇(HDL-C)明显低于对照组,差异有统计学意义;②在NAFLD组与HOMA-IR相关的指标有WC、BMI、TG、HDL-C、FINS、抵抗素,P均<0.05,多元回归分析显示,WC、抵抗素是HOMA-IR的独立影响因子。③经吡格列酮干预12周后,NAFLD组的FPG、FINS、ALT、AST、HOMA-IR及血浆抵抗素水平等均显著降低,差异有统计学意义。结论NAFLD患者的IR与血浆抵抗素水平明显高于正常人群,其抵抗素水平升高可能与IR有关。吡格列酮干预能明显改善NAFLD人群的IR程度,降低血浆抵抗素水平,提示吡格列酮改善NAFLD人群IR的作用可能与抵抗素水平降低有关。
Objective To investigate the changes of insulin resistance (IR) and resistin in nonalcoholic fatty liver disease (NAFLD) and the effect of pioglitazone on it. Methods ① The 136 NAFLD patients were screened and randomly divided into 2 groups. The treatment group received pioglitazone 30 mg · d-1 for 12 weeks. The control group received pioglitazone 30 mg · d-1 for 12 weeks. The levels of plasma resistin in the two groups were detected by ELISA. The degree of IR was evaluated by homeostasis insulin resistance index (HOMA-IR). The changes of plasma resistin level and HOMA-IR and the relationship with clinical biochemical parameters were observed. (2) The patients were treated with pioglitazone orally for 12 weeks by self-control method. The changes of biochemical indexes and HOMA-IR plasma resistin level before and after treatment were observed. Results ① In the NAFLD group, WC, BMI, FPG, FINS, TG, ALT, (AST), HOMA-IR and plasma resistin levels were significantly higher than the control group, high-density lipoprotein cholesterol (HDL-C) was significantly lower than the control group, the difference was statistically significant; ② NAFLD group and HOMA- IR related indicators of WC, BMI, TG, HDL-C, FINS, resistin, P all <0.05, multiple regression analysis showed that WC, resistin HOMA-IR is an independent factor. ③ After 12 weeks of pioglitazone treatment, the level of FPG, FINS, ALT, AST, HOMA-IR and plasma resistin in NAFLD group decreased significantly, with statistical significance. Conclusion The levels of IR and plasma resistin in patients with NAFLD are significantly higher than those in normal people. The elevated levels of resistin may be related to IR. Pioglitazone intervention can significantly improve the degree of IR in NAFLD population and decrease the level of plasma resistin, suggesting that the effect of pioglitazone on improving IR in NAFLD population may be related to the decrease of resistin level.