【作者】 陈璐；

【导师】 曾天舒；

【作者基本信息】 华中科技大学 ， 内分泌与代谢病学（专业学位）， 2023， 硕士

【摘要】 目的:代谢相关脂肪性肝病(MAFLD)是全球最常见的慢性肝脏疾病,与肥胖和2型糖尿病关系密切,同时也会增加代谢心血管疾病的发生风险。但不同肥胖程度和不同血糖状态与肝脏脂肪含量的关系并不完全清楚,而且肝脏脂肪含量与胰岛素抵抗、β细胞功能以及心血管代谢危险因素的关系目前也尚未完全阐明。因此,本研究旨在对不同超重肥胖人群进行肝脏脂肪定量检测来探讨上述关系。方法:纳入2022年1月至2022年9月于武汉协和医院内分泌科诊断为超重/肥胖的129名患者。收集患者一般临床资料以及常规生化资料,计算人体体质学、胰岛素抵抗和β细胞功能相关指数以及心血管代谢衍生指标。通过肝脏瞬时弹性成像仪(Fibro Touch)测量患者肝脏受控衰减系数(CAP)、核磁共振成像技术测量患者肝脏质子密度脂肪分数(MRI-PDFF),并比较两者的一致性。将患者按照不同体质指数(BMI)、腰高比(WHt R)、糖耐量、肝脏脂肪含量进行分组,分析不同BMI、WHt R和糖耐量组组间肝脏脂肪含量的差异以及不同肝脏脂肪含量组组间糖代谢状态的差异,并探讨肝脏脂肪含量与临床特征、胰岛素抵抗和β细胞功能相关指数(HOMA-IR、HOMA-β)、心血管代谢衍生指标(CMI、Ty G、Ty G-BMI、Ty G-WC、Ty G-WHt R)的关系。结果:1.肝脏瞬时弹性成像技术测得的CAP值定量肝脏脂肪含量与核磁共振测得的MRI-PDFF值呈正相关,相关性系数rs=0.570(P<0.001);两者之间存在线性关系,可建立线性回归方程y=1.738x+287.2,R2=0.32(P<0.001);2.不同BMI、WHt R组组间肝脏脂肪含量差异有统计学意义(P<0.001);不同糖耐量组组间肝脏脂肪含量无显著性差异(P>0.05);不同肝脏脂肪含量组组间糖代谢状态无明显差异(P=0.758);3.校正年龄、性别后,肝脏脂肪含量与BMI(r=0.652)、WC(r=0.309)、WHt R(r=0.315)、HOMA-IR(r=0.283)、Ty G(r=0.190)、Ty G-BMI(r=0.687)、Ty G-WC(r=0.360)、Ty G-WHt R(r=0.360)呈正相关(P<0.05)。结论:肝脏瞬时弹性成像技术定量肝脏脂肪含量与核磁共振具有较好的一致性;随着肥胖程度的加重,肝脏脂肪含量逐渐增加;肝脏脂肪含量与胰岛素抵抗程度以及多种心血管代谢危险因素呈正相关。更多还原

【Abstract】 Objective:Metabolic-associated fatty liver disease(MAFLD)is the most common chronic liver disease worldwide,which is closely related to obesity and type 2 diabetes,and also increases the risk of cardiometabolic diseases.But the relationship between different levels of obesity and glucose tolerance and liver fat content is not entirely clear.Moreover,the relationship between liver fat content and insulin resistance,βcell function,and cardiometabolic risk factors has not been fully elucidated.Therefore,this study aims to explore the above relationship by quantitative measurements of liver fat content in different populations.Methods:A total of 129 patients diagnosed with overweight/obesity were included in the Department of Endocrinology,Wuhan Union Hospital from January 2022 to September2022.The general clinical data and routine biochemical data of patients were collected,and the indices related to anthropometry,insulin resistance andβcell function and cardiometabolic derivative indexes were calculated.Controlled attenuation parameter(CAP)was measured by the liver transient elastography(Fibro Touch)and the proton density fat fraction(MRI-PDFF)was measured by magnetic resonance imaging technology,and the consistency between the two was compared.The patients were grouped according to different body mass index(BMI),waist to height ratio(WHt R),glucose tolerance and CAP,and the differences of CAP between different BMI,WHt R and glucose tolerance groups were compared,and the relationship between CAP and clinical features,insulin resistance andβcell function related indices(HOMA-IR,HOMA-β),and cardiometabolic derivative indexes(CMI,Ty G,Ty G-BMI,Ty G-WC,Ty G-WHt R)were analyzed.Results:1.The liver fat content quantified by CAP was positively correlated with MRI-PDFF,and the correlation coefficient r_s=0.570(P<0.001);there was a linear relationship between the two,and the linear regression equation y=1.738x+287.2,R~2=0.32(P<0.001)could be established;2.There were significant differences in CAP between different BMI and WHt R groups(P<0.05);3.There was no significant difference in CAP between different glucose tolerance groups(P>0.05);4.After adjusting for age and sex,CAP was positively correlated with BMI(r=0.652),WC(r=0.309),WHt R(r=0.315),HOMA-IR(r=0.283),Ty G(r=0.190),Ty G-BMI(r=0.687),Ty G-WC(r=0.360),Ty G-WHt R(r=0.360)(P<0.05).Conclusions:Liver transient elastography had good consistency with nuclear magnetic resonance for quantitative liver fat content.With the aggravation of obesity,the liver fat content gradually increased;Liver fat content was positively correlated with insulin resistance and multiple cardiometabolic risk factors.更多还原