【摘要】 目的 探讨胰岛素抵抗对不同慢性肝病患者代谢紊乱的影响。方法 选取2020年1月至2021年12月就诊于赣州市人民医院消化内科门诊的638例慢性肝病患者,按照患者类型分为慢性乙型肝炎(chronic hepatitis B,CHB)组216例、非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)组225例、CHB合并NAFLD组197例。另选取2020年1月至2021年12月赣州市人民医院体检中心的262例健康体检者作为健康对照(healthy control,HC)组。比较四组研究对象的血脂指标、稳态模型胰岛素抵抗指数(homeostatic model assessment of insulin resistance index,HOMA-IR)和空腹胰岛素(fasting insulin,FINS)、空腹血糖(fasting blood glucose,FBG)水平及三组患者的并发症情况。结果 CHB组、NAFLD组及CHB合并NAFLD组患者的总胆固醇(total cholesterol,TC)、三酰甘油(triglyceride,TG)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)水平均比HC组高(P<0.05),且CHB合并NAFLD组比CHB组、NAFLD组及HC组高(P<0.05);CHB组、NAFLD组及CHB合并NAFLD组患者的高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)较HC组低(P<0.05),且CHB合并NAFLD组比CHB组、NAFLD组及HC组低(P<0.05)。CHB组患者的HDL-C高于NAFLD组(P<0.05)。CHB组、NAFLD组及CHB合并NAFLD组患者的HOMA-IR、FINS、FBG高于HC组(P<0.05),且CHB合并NAFLD组比CHB组、NAFLD组及HC组高(P<0.05)。CHB组患者的HOMA-IR和FBG低于NAFLD组(P<0.05)。CHB合并NAFLD组患者随访6个月的并发症发生率高于CHB组、NAFLD组(P<0.05)。结论 CHB、NAFLD及CHB合并NAFLD患者多出现代谢异常现象,同时易发生冠心病、高血压、糖尿病等并发症。更多还原

【Abstract】 Objebtive To investigate the effect of insulin resistance on metabolic disorder in patients with different chronic liver diseases. Methods A total of 638 patients with chronic liver disease who were treated in the outpatient Department of Gastroenterology of Ganzhou People’s Hospital from January 2020 to December 2021 were selected. According to the type of patients, they were divided into 216 cases of chronic hepatitis B(CHB) group, 225 cases of non-alcoholic fatty liver disease(NAFLD) group, and 197 cases of CHB combined with NAFLD group. In addition, 262 healthy subjects from the physical examination center of Ganzhou People’s Hospital from January 2020 to December 2021 were selected as the healthy control(HC)group. The blood lipid indexes, homeostatic model assessment of insulin resistance index(HOMA-IR), fasting insulin(FINS),fasting blood glucose(FBG) and complications of the three groups were compared. Results The total cholesterol(TC),triglyceride(TG) and low density lipoprotein cholesterol(LDL-C) of CHB group, NAFLD group and CHB combined with NAFLD group were higher than those of HC group(P<0.05), and the CHB combined with NAFLD group was higher than that of CHB group, NAFLD group and HC group(P<0.05). The high density lipoprotein cholesterol(HDL-C) in CHB group,NAFLD group and CHB combined with NAFLD group was lower than that in HC group(P<0.05), and CHB combined with NAFLD group was lower than that in CHB group, NAFLD group and HC group(P<0.05). HDL-C in CHB group was higher than that in NAFLD group(P<0.05). The HOMA-IR, FINS and FBG of CHB group, NAFLD group and CHB combined with NAFLD group were higher than those of HC group(P<0.05), and CHB combined with NAFLD group was higher than CHB group, NAFLD group and HC group(P<0.05). HOMA-IR and FBG in CHB group were lower than those in NAFLD group(P<0.05). The complication rate of CHB combined with NAFLD group with 6 months follow-up was higher than that in CHB group and NAFLD group(P<0.05). Conclusion Patients with CHB, NAFLD and CHB combined with NAFLD often have metabolic abnormalities and complications such as coronary heart disease, hypertension and diabetes.更多还原