慢性乙型肝炎患者血清脂联素水平及其与代谢指标的关系

摘要

Objective To investigate the relationship of serum adiponectin level with body fat,blood lipids,and insulin resistance (IR)in the patients with chronic hepatitis B (CHB)and patients with CHB and fatty liver.Methods Twenty patients CHB,20 cases of CHB with fat-ty liver,and 18 healthy controls were included in the study;there were no significant differences in sex and age between the three groups.Fast-ing body weight,waist circumference (WC),hip circumference (HC),fasting insulin (FINS),fasting blood glucose (FBG),total cholester-ol (TC),triglyceride (TG),high-density lipoprotein cholesterol (HDL-C),low-density lipoprotein cholesterol (LDL-C),alanine ami-notransferase (ALT),and aspartate aminotransferase (AST)were measured,and body mass index (BMI),waist-to-hip ratio (WHR),and homeostasis model assessment of insulin resistance were calculated.Serum concentrations of adiponectin were determined by enzyme-linked immunosorbent assay.Continuous data was expressed as x ±s,and comparisons between groups were made by one-way analysis of variance;comparisons of categorical data between groups were made by R ×Cχ2 test;correlation analysis was performed by Pearson correlation test.Re-sults The serum adiponectin concentrations of patients with CHB,patients with CHB and fatty liver,and healthy controls were 10.56 ±2.48, 4.46 ±2.16,and 6.38 ±2.91 mg/L,respectively,with significant differences between the three groups (F=30.537,P=0.000).The pa-tients with CHB and fatty liver had significantly higher BMI,WC,WHR,and serum TG level than the CHB patients and healthy controls (P<0.01);there were no significant differences in serum FINS,FBG,TC,HDL-C,LDL-C,and IR values between the three groups.Serum adiponectin level was only negatively correlated with TG in patients with CHB and fatty liver (r=-0.485,P=0.015),but not correlated with BMI,WC,WHR,IR,FINS,FBG,TC,HDL-C,and LDL-C in all patients with CHB.Conclusion Serum adiponectin level signifi-cantly increases in the patients with CHB,which may presumably be the result of adiponectin exerting a protective effect on the liver,while it significantly decreases in the patients with CHB and fatty liver,which is closely related to elevated TG.%目的：探讨慢性乙型肝炎（CHB）和CHB合并脂肪肝患者血清脂联素（ADP）变化及与体脂、血脂、胰岛素抵抗（IR）的关系。方法选择CHB和CHB合并脂肪肝患者各20例，健康对照组18例，3组年龄、性别比较差异无统计学意义。测量其空腹体质量、腰围（WC）和臀围，检测血清胰岛素（FINS）、糖（FBG）、血脂和ALT、AST等，计算身体质量指数（BMI）、腰臀比（WHR）和胰岛素抵抗指数（HOMA-IR）；采用ELISA法测定血清ADP浓度。计量资料采用均数±标准差（x ±s）表示，组间比较采用单因素方差分析，计数资料组间比较采用卡方检验，相关性分析用Pearson相关分析。结果 CHB患者ADP质量浓度为（10．56±2．48）mg/L，CHB合并脂肪肝患者为（4．46±2．16）mg/L，对照组为（6．38±2．91）mg/L，3组差异有统计学意义（F＝30．537，P＝0．000）。CHB合并脂肪肝患者的BMI、WC、WHR及血清三酰甘油（TG）均明显高于CHB组和对照组（P均＜0．01）；3组血清FINS、FBG、胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）及IR差异均无统计学意义。所有CHB患者ADP与BMI、WC、WHR、IR、FINS、FBG、TC、HDL-C及LDL-C均无相关性，仅在合并脂肪肝时与TG呈负相关（r＝-0．485，P＝0．015）。结论 CHB患者血清ADP水平明显升高，推测可能是ADP对肝脏产生保护作用的反应，而在合并脂肪肝时明显降低，与TG升高关系密切。