【作者】 李霞；

【导师】 黄杰安；

【作者基本信息】 广西医科大学 ， 内科学（专业学位）， 2020， 硕士

【摘要】 目的:非酒精性脂肪肝性肝病(Non-alcoholic fatty liver disease,NAFLD)是一种与胰岛素抵抗(Insulin Resistance,IR)和遗传易感性密切相关的代谢应激性肝脏损伤的总称,以肝实质细胞弥漫性脂肪病变为基本病理特征导致过量的脂质沉积,且同时无过量饮酒史,疾病谱包括非酒精性单纯性肝脂肪变(Nonalcoholic simple fatty liver,NAFL)、非酒精性脂肪性肝炎(NASH)及相关肝硬化和肝细胞癌(HCC)。本研究主要目的探究不同代谢水平人群肝脏脂肪含量及肝纤维化程度及相互之间的关系、影响因素及临床生化指标特点分析,为临床干预及治疗提供依据。方法:1.筛选从2018年1月至2020年4月在广西医科大学第二附属医院消化内科、内分泌科、心血管内科的住院、门诊患者及体检中心健康体检者共2107例,男女不限,根据排除标准排除不符合条件者后共纳入研究对象550例。采集研究对象人口学资料、查体资料、实验室检查结果,并计算体重指数。所有研究对象均行Fibro Touch检查测定肝脏脂肪衰减值(CAP)、肝硬度值(LSM)。根据不同代谢水平对入选者进行分组,比较不同代谢组间临床特征及CAP值、LSM值的变化特点。2.采用SPSS 23.0统计学软件进行统计学分析,p<0.05表示差异有统计学意义。正态分布资料采用均数±平均差描述数据,偏态分布资料采用中位数及四分位数间距描述数据,两组间偏态分布计量资料比较采用两样本秩和检验,多组间偏态分布计量资料比较采用多个样本的秩和检验,计数资料采用卡方检验。Spearman相关性分析评估变量间的相关性,单因素分析、多因素分析肝脏脂肪变性及肝纤维化独立危险因素。结果:1.存在多重代谢紊乱的人群,CAP值、LSM值较代谢正常人群明显升高,同时伴随着腰围、BMI、FPG、2hPG、HbA1c、TG、HDL、GGT、ALT、SUA、收缩压的明显升高,而HDL水平明显降低,差异具有统计学意义。2.不同糖代谢水平人群,CAP值、LSM值随着糖代谢异常程度的加重逐渐升高,而其他指标如腰围、体重指数(BMI)、空腹血糖(FPG)、餐后2小时血糖(2hPG)、糖化血红蛋白(HbA1c)、甘油三酯(TG)、同型半胱氨酸(Hcy)、γ-谷胺酰转移酶(GGT)、血清尿酸(SUA)、胱抑素C(Cys C)也随着糖代谢紊乱的加重呈现递增趋势。3.针对CAP值升高人群的多因素分析发现,BMI、腰围、2hPG、TG为引起该人群CAP值升高的独立危险因素(p<0.05);在针对全部研究人群研究中,引起LSM值升高的独立危险因素为ALT、SBP(p<0.05)。4.在非肥胖人群中,代谢综合征的人群CAP值、LSM值较非代谢综合征人群相比明显升高,且餐后2小时血糖(2hPG)是引起非肥胖人群CAP值升高的独立危险因素。结论:1.肝脏脂肪变、脂肪变相关肝纤维化是多种代谢因素紊乱共同作用的结果,肝脏脂肪变程度及纤维化程度随着代谢紊乱组分增加及紊乱程度的加重而逐渐加重。2.肥胖、糖代谢异常、脂代谢异常是引起肝脏脂肪样变的独立危险因素。3.脂肪肝相关肝纤维化程度随着肝细胞损伤程度加重及收缩压水平升高而逐渐升高。4.在非肥胖人群中,代谢是否健康是影响肝脏脂肪沉积及相关肝纤维化的主要因素。更多还原

【Abstract】 Objective: The main purpose of this study is to explore the characteristics of clinical biochemical indicators of different metabolic statuses,detect the relationship and interaction between different metabolic levels and liver fat content and the degree of liver fibrosis,and provide new basis for clinical intervention and treatment.Methods: A total of 550 subjects were selected according to the exclusion criteria.Collecting the data of gender,age,height,weight,waist circumference and calculate the body mass index.After fasting for8 hours,we collected venous blood to detect serum Alanine transferase(ALT),Aspartate aminotransferase(AST),γ-glutamyl transferase(GGT),Uric-acid,total bolirubin(TB),phosphatase(ALP),triglyceride(TG),total cholesterol(TC),lipoprotein(LDL),fasting plasma glucose(FPG),etc.All subjects were conducted Fibro Touch examination.Results:1.The incidence rate of abdominal girth,BMI,SBP,FPG,2hPG,HbA1c,TG,HDL,GGT,ALT and serum uric acid in patients with metabolic syndrome were significantly higher than those in normal metabolism group.HDL was significantly lower than normal group,and CAP and LSM also increased significantly in metabolic syndrome group.2.With the aggravation of abnormal glucose metabolism,abdominal girth,BMI,SBP,FPG,2hPG,HbA1 c,TG,homocysteine,GGT,serum uric acid,Cystatin C,CAP value and LSM value gradually increased.3.BMI,2hPG,TG and abdominal girth were independent risk factors of increasing of CAP(p<0.05),ALT and SBP were independent risk factors of increasing of LSM(p< 0.05).4.In the non-obese population,CAP and LSM values were significantly higher in the metabolic syndrome population than in the non metabolic syndrome population,and 2hPG,Lipoprotein a,HDL,GGT may be the risk factors for the increase of CAP and LSM values.Conclusion:1.Liver steatosis and fibrosis are the result of many metabolic factors.With the increase of metabolic disorder components and severity of metabolic disorder,the degree of liver fatty content and fibrosis gradually increased.2.Obesity,glucose and metabolism disorder are independent risk factors for fatty content change of liver.3.The degree of hepatic fibrosis associated with fatty liver gradually increased with the aggravation of liver cell damage and the increase of systolic blood pressure.4.In non-obese population,metabolism status is the main factor that affects liver fat content and liver fibrosis.更多还原