【作者】 王莉莉；

【导师】 朱大龙；

【作者基本信息】 南京大学 ， 临床医学（内科学）（专业学位）， 2018， 硕士

【摘要】 目的:通过观察育龄期女性超重或肥胖合并及未合并非酒精性脂肪肝患者血清IGF-1水平,探讨IGF-1与育龄期女性超重或肥胖是否合并非酒精性脂肪肝的及代谢指标的相关性。方法:选取2017年12月至2018年03月至南京大学医学院附属鼓楼医院北院体重管理门诊治疗的156例育龄期女性超重或肥胖患者作为研究对象;根据是否合并非酒精性脂肪肝,选取合并非酒精性脂肪肝患者120例为病例组,选取未合并非酒精性脂肪肝患者36例作为对照组;比较病例组及对照组两组的性别、年龄、收缩压、舒张压、腰臀比、体质指数(Body Mass Index,BMI),及血清学指标:糖化血红蛋白(HbAlc)、空腹血糖、空腹胰岛素、30分钟血糖、30分钟胰岛素、60分钟血糖、60分钟胰岛素、120分钟血糖、120分钟胰岛素、胰岛素抵抗指数(HMOA-IR)、谷丙转氨酶、谷草转氨酶、肌酐、尿酸、尿素氮、肾小球滤过率(eGFR)、甘油三酯、胆固醇、低密度胆固醇、高密度胆固醇、直接胆红素、间接胆红素、25-羟维生素D;根据血清IGF-1水平,将156例患者分为52例低IGF-1水平组、52例中IGF-1水平组及52例高IGF-1水平组三组,分别为A组(IGF-1≤154.5ng/ml)、B 组(154.5<IGF-1<206.0ng/ml)、C 组(IGF-1≥ 206.0 ng/ml);比较低中高IGF-1三组的基线资料,并分析NAFLD发生的风险指数。选取120例育龄期女性超重或肥胖合并非酒精性脂肪肝患者,进行IGF-1与其他代谢指标的相关性分析。所有收录数据将通过SPSS22.0进行数据统计分析。结果:NAFLD组的 IGF-1 水平显著低于非 NAFLD 组(P<0.05)。且 NAFLD组的HbAlc、空腹血糖、60分钟血糖、120分钟血糖、谷丙转氨酶、谷草转氨酶及甘油三酯、总胆固醇水平显著高于非NAFLD组(P<0.05)。但在胰岛素抵抗指数方面,NAFLD组与非NAFLD组无统计学差异(P>0.05)。同时NAFLD的发病率随血清IGF-1的的升高而显著降低(P<0.05)。在校正了混杂因素后,低水平的IGF-1水平是NAFLD发生的独立危险因素。而在NAFLD组行IGF-1水平与其他代谢指标的相关性分析后发现,IGF-1与BMI、HbAlc、HOMA-IR、AST、TG、TC 呈负相关(P<0.05)结论:低水平的IGF-1水平,与育龄期女性超重或肥胖患者合并非酒精性脂肪肝的发生相关;随着IGF-1水平的降低,育龄期女性超重或肥胖合并非酒精性脂肪肝的患者BMI、血糖水平、血脂水平升高。更多还原

【Abstract】 Objective:This study aims to observe the relationship between serum IGF-1 and nonalcoholic fatty liver disease and other serological indicators in overweight or obese females within reproductive age.Methods:156 overweight or obese female patients who were hospitalized in weight control clinic of Nanjing drum tower hospital from December 2017to April 2018 are selected as a research subject.According to whether or not they have nonalcoholic fatty liver disease,156 patients were segmented into two groups:control group with 36 patients and case group with 120 patients.Then,compare the baseline of control group and case group including gender,age,systolic pressure,diastolic pressure,waist-hip ratio,body mass index,and serological indicators which include glycosylated hemoglobin(HbAlc),fasting plasma glucose,fasting insulin,insulin resistance index(HOMA-IR),30min plasma glucose,30min insulin glutamic-pyruvic,60min plasma glucose,60min insulin transaminase,120 min plasma glucose,120min insulin,glutamic-pyruvic transaminase,direct bilirubin,creatinine,uric acid,glomerular filtration rate,urea nitrogen,triglyceride(TC),total cholesterol(TC),C-reactive protein.low density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),25 hydroxyl vitamin D.Then,according to IGF-1 level,156 patients were segmented into three groups:group A with low level serum IGF-1(IGF-1 ≤154.5 ng/ml),group B with media level serum IGF-1(154.5<IGF-1<206.0 ng/ml)and group C with high level serum IGF-1(IGF-1≥206.0 ng/ml).and results of body composition by SPSS 22.0Results:A statistically significant difference was observed in IGF-1 between NAFLD group and non-NAFLD group(P<0.05),and there was a statistically significant difference in the serum in HbAlc,fasting plasma glucose,60min plasma glucose,120 min plasma glucose,triglyceride,total cholesterol,glutamic-pyruvic transaminase(P<0.05);There was a statistically significant difference in BMI among three groups(P<0.05),and a gradual decrease was noted in the prevalence og NAFLD along with the increased quartile of IGF-1.After adjusting for age,BMI,HbAlc,HOMA-IR as well as IGF-1,the odds ratios in the highest quartile of IGF-1 was 0.163 compared to the lowest quartileConclusion:Low levels of IGF-1 were associated with the occurrence of non-alcoholic fatty liver disease in women of childbearing age and overweight or obese patients.With the decrease of IGF-1 level,the BMI,blood glucose level and blood lipid level of women who were overweight or obese with non-alcoholic fatty liver were increased.更多还原