【作者】 攸然；

【导师】 高鑫； 刘蒙； 姚秀忠；

【作者基本信息】 复旦大学 ， 内科学， 2009， 硕士

【摘要】 目的:采用质子磁共振波谱(~1H MRS)法测定代谢正常人肝脏脂肪含量,并采用动态血糖监测系统观察全天血糖波动情况,旨在观察肝脏脂肪含量与血糖波动特征之间的关系。方法:通过询问病史,测量身高、体重、腰围、臀围、血压,检测肝功能、肾功能、血脂谱。口服75g葡萄糖耐量试验(OGTT),将47例各项检查均在正常范围的受试者确定为代谢正常人。然后对这组受试者应用~1H MRS法测定肝脏脂肪含量,应用动态血糖监测系统进行为期3日连续血糖监测。定量参数根据其分布正态性与否应用均值±标准差或中位数表示,采用Spearman相关分析,结果以P＜0.05为差异具有统计学意义。结果:47例代谢正常人中,肝脏脂肪含量＜5%者37人(78%),≥5%～＜10%者4人(9%),≥10%者6人(13%)。根据中位数将47例代谢正常人分为肝脏脂肪含量＜2.21%组(n=23),肝脏脂肪含量≥2.21%组(n=24)。肝脂肪含量较高组的HDL-c显著低于较低组,而TG、空腹C肽、空腹胰岛素及HOMA-IR显著高于较低组。肝脏脂肪含量≥2.21%组的葡萄糖曲线下面积(OGTT-AUC)、胰岛素曲线下面积(Insulin-AUC)及胰岛素30分钟增量(Insulin-Plus)均高于肝脏脂肪含量＜2.21%组,其中后两者差异有统计学意义(P=0.003,P=0.003)。根据肝脏脂肪含量水平,将代谢正常人分为肝脏脂肪含量＜5%组(n=37)、肝脏脂肪含量5%～10%组(n=4)及肝脏脂肪含量≥10%组(n=6)。空腹胰岛素、胰岛素曲线下面积及胰岛素增量在三组间各不相同,随肝脏脂肪含量的增加而增高;肝脏脂肪含量≥10%组的HOMA-IR值明显高于肝脏脂肪含量＜5%组(P=0.003)。Spearman相关分析发现,肝脏脂肪含量与TG(r=0.329)、AST(r=0.323)、GGT(r=0.308)、空腹胰岛素水平(r=0.413)、2h胰岛素水平(r=0.333)、空腹C肽水平(r=0.334)、HOMA-IR(r=0.423)之间存在线性正相关(P值均＜0.05),其中以HOMA-IR相关性最强。肝脏脂肪含量与年龄、BMI、血压、TC、LDL-c、HDL-c、ALT、AKP、GGT、空腹及OGTT后2小时后血糖、2小时C肽水平之间没有相关性。共获CGMS有效数据35例,其中男性20人,女性15人;年龄44.51±12.74岁,BMI22.43±1.81 kg/m~2,收缩压112.03±9.88mmHg,舒张压75(60-80)mmHg,甘油三酯0.96±0.37mmol/L,LDL-c:2.78±1.05 mmol/L,HDL-c:1.62±0.63 mmol/L,肝脏脂肪含量2.20(0-18.73)%,空腹血糖4.76±0.66 mmol/L,餐后2小时血糖5.30(2.79-7.50)mmol/L,CGMS所得平均血糖5.75±0.09 mmol/L,最高值8.35(6.50-12.25)mmol/L,最低值3.90±0.13 mmol/L,标准差0.80(0.45-1.85)mmol/L,平均血糖波动幅度(MAGE)2.32±0.83 mmol/L,大于7.8血糖时间比:2.50(0.00-25.00)%,小于3.9血糖时间比:0.00(0.00-28.00)%,大于5.6曲线下面积0.48(0.10-1.45)mmol/L~*h,大于6.1曲线下面积0.23(0.00-1.15)mmol/L~*h。根据肝脏脂肪含量水平,将代谢正常人分为肝脏脂肪含量＜5%组(n=28)、肝脏脂肪含量≥5%组(n=7)。两组代谢正常人的动态血糖监测曲线中,肝脏脂肪含量较高组的平均血糖及大于5.6曲线下面积显著高于肝脏脂肪含量较低(P=0.027,P=0.023)。Spearman相关分析发现,肝脏脂肪含量与CGMS所得平均血糖水平(r=0.338,P=0.047)、大于5.6曲线下面积(r=0.408,P=0.015)、大于6.1曲线下面积(r=0.409,P=0.015)呈正相关。肝脏脂肪含量与最高血糖值、最低血糖值、血糖标准差、平均绝对标准差、平均血糖波动幅度、高低血糖所占时间比无相关性。结论:在这组代谢正常人中,已有22%的人脂肪含量大于5%,并且随着肝脏脂肪含量增加胰岛素抵抗程度及血糖水平呈升高趋势。随着肝脏脂肪含量的增加,代谢正常人中动态血糖谱有所改变,表现为平均血糖水平的升高,尤其以餐后血糖升高明显。更多还原

【Abstract】 ObjectTo observe the association of liver fat content and blood glucose variation among normal population using ¹H magnetic resonance spectroscopy and continuous glucose monitoring system.Materials and MethodsClinical data of 47 normal subjects had been chosen using demographic data and OGTT test.¹H magnetic resonance spectroscopy was used then to measure liver fat content,while continuous glucose monitoring system was used to acquire blood glucose profile for 3 consecutive days.Differences were considered statistically significant if P＜0.05.ResultsAmong 47 normal subjects,liver fat content of 37 subjects（78%） were＜5%, 4（9%） were≥5%～＜10%,6（13%） were≥10%.According to the median value of liver fat content,normal population were divided into two groups:fat content＜2.21%group（n=23）,and fat content≥2.21% group（n=24）.HDL-c was significantly lower among the group whose fat content was relatively higher,but TG,fasting C peptide,fasting insulin level and HOMA-IR were significantly lower.The Insulin-AUC and 30 minutes Insulin-plus were significantly higher in fat content≥2.21%group（P=0.003,P=0.003）.Liver fat content showed statistically significant positive correlations with TG（r=0.329）,AST（r=0.323）,GGT（r=0.308）,fasting insulin level（r=0.413）,2h insulin level（r=0.333）,fasting C peptide level（r=0.334）,HOMA-IR（r=0.423）（P＜0.05）,and no correlations with age,BMI,BP,TC,LDL-c,HDL-c,ALT,AKP,GGT,fasting and 2h blood glucose,2h C peptide level.According to liver fat content,normal population were divided into three groups: fat content＜5%group（n=37）,fat content 5%～10%group（n=4） and fat content＞10%group（n=6）.Fasting insulin level,Insulin-AUC and 30 minutes Insulin-plus were different among 3 groups,and increased with liver fat content. HOMA-IR is significantly higher in fat content≥10%group than that in fat content＜5%group（P=0.003）.CGMS data of 35 subjects had been acquired,Among whom 20 were male, 15were female.Mean age was 44.51±12.74years,BMI was 22.43±1.81 kg/m²,SBP was 112.03±9.88mmHg,DBP was 75（60-80） mmHg,TG was 0.96±0.37mmol/L, LDL-c was 2.78±1.05 mmol/L,HDL-c was 1.62±0.63 mmol/L,liver fat content was 2.20（0-18.73）%,FBG was 4.76±0.66 mmol/L,2h-BG was 5.30（2.79-7.50）mmol/L, CGMS mean BG was 5.75±0.09 mmol/L,maximum BG was 8.35（6.50-12.25） mmol/L,minimum BG was 3.90±0.13 mmol/L,SDBG was 0.80（0.45-1.85） mmol/L,MAGE was 2.32±0.83 mmol/L,Time%_7.8 was 2.50（0.00-25.00）%, Time%_3.9 was 0.00（0.00-28.00）%,AUC_5.6 was 0.48（0.10-1.45） mmol/L^*h, AUG_6.1 was 0.23（0.00-1.15） mmol/L^*h.According to liver fat content,normal subjects were divided into two groups:fat content＜5%group（n=28） and fat content≥5%group（n=7）.Mean BG and AUC_5.6 are significantly higher among the group whose fat content was above normal （P=0.027,P=0.023）.Spearman analysis showed there was a significant positive correlation between liver fat content and mean CGMS BG（r=0.338,P=0.047）,AUC_5.6（r=0.408, P=0.015） and AUC_6.1（r=0.409,P=0.015）.No correlation was showed between liver fat content and maximum BG,minimum BG,SDBG,MAGE,Time%_7.8 and Time% _3.9.ConclusionsWe found that 22%of population who had normal glucose metabolism had fatty liver.Liver fat content was associated with insulin resistance and blood glucose level, especially postprandial blood glucose.更多还原