Objective To investigate early kidney injury in the patients with non-alcoholic fatty liver disease (NAFLD) without hypertension,diabetes and history of kidney diseases,as so to provide evidence for preventing early kidney injury in patients with NAFLD.Methods From December 2014 to January 2016,169 subjects visiting Sichuan Provincial People's Hospital were recruited.Among them,104 cases were in NAFLD group,31 cases were in simple obesity group (overweight or obesity),and 34 subjects were in the healthy control group.The general data,biochemical indexes,metabolic indexes,biochemical indexes of kidney,and early kidney injury makers,including serum β2-microglobulin,urinary albumin and creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR),were detected.Least significant difference-t test,chi-square test and Spearman correlation analysis were performed for statistical analysis.Results Compared with simple obesity group,alanine aminotransferase (ALT),aspartate aminotransferase (AST),γ-glutamyl transpeptadase (GGT),fasting insulin level,homeostasis model assessment-insulin resistance (HOMA-IR),serum creatinine,ACR and β2 microglobulin were higher in NAFLD group ((21.13 ± 8.14) U/L vs.(66.20 ± 44.34) U/L,(24.80 ±9.57) U/Lvs.(49.78 ±25.41) U/L,(19.26 ±7.88) U/Lvs.(66.53 ±56.34) U/L,(7.03± 1.52) mU/Lvs.(9.55 ±5.41) mU/L,1.22 ±0.38 vs.2.23 ±2.01,(62.90 ± 10.01) μmol/L vs.(71.75 ±10.80) μmol/L,(4.41 ±1.16) μg/mg vs.(13.76 ±9.56) μg/mg,(1.46 ±0.26) mg/L vs.(2.01 ±0.53) mg/L);however the eGFR was lower (112.46 ±11.90) mL · min-1 · (1.73 m2) 1 vs.(101.09± 17.17) mL · min-1 · (1.73 m2)-1).The differences were statistically significant (t =9.825,8.250,8.288,4.229,4.121,4.007,9.732,7.792 and-3.443,all P ＜ 0.01).There was no statistically significant difference in the remaining indicators (all P ＞ 0.05).Compared with healthy control group,the renal injury indexes serum creatinine,ACR and 32 microglobulin of NAFLD group were higher ((58.78 ± 7.77) μmol/Lvs.(71.75±10.80) μmol/L,(1.01 ±0.32) μg/mg vs.(13.76 ±9.56) μg/mg,(1.12 ± 0.15) mg/L vs.(2.01 ±0.53) mg/L),and the eGFR was lower ((115.10 ± 12.59) mL · min-1 (1.73 m2)-1 vs.(101.09 ± 17.17) mL · min-1 · (1.73 m2)-1).The differences were statistically significant (t =7.621,13.591,15.126 and-5.120,all P ＜ 0.01).Compared with healthy control group,the renal injury indexes ACR and β2 microglobulin of simple obesity group were higher ((1.01 ± 0.32) μg/mg vs.(4.41 ± 1.16) μg/mg,(1.12 ± 0.15) mg/L vs.(1.46-± 0.26) mg/L),and the differences were statistically significant (t =9.732 and 7.792,both P ＜ 0.01).ACR of NAFLD patients was positively correlated with body mass index,waist circumference,triglyceride level,total cholesterol level,low density lipoprotein level,fasting blood glucose level,two-hour postprandial blood glucose,fasting insulin level and HOMA-IR (r =0.554,0.327,0.314,0.353,0.176,0.195,0.552,0.364 and 0.987,all P ＜ 0.05),and was negatively correlated with high density lipoprotein (r =-0.330,P ＜ 0.01).Conclusions NAFLD is closely related with chronic kidney disease at same baseline of gender,age,blood glucose,blood lipids,and blood pressure.Abnormal metabolism of glycolipids,obesity and insulin resistance may be the mechanisms of early kidney injury in NAFLD patients.Combination of ACR and β2 microglobulin are more sensitive than serum creatinine and eGFR in detecting early renal injury in NAFLD patients.%目的 探讨无糖尿病、高血压和肾病史的非酒精性脂肪性肝病(NAFLD)患者慢性肾脏病早期肾脏损伤情况,为NAFLD患者预防早期肾脏损伤提供依据.方法 纳入2014年12月至2016年1月就诊于四川省人民医院的研究对象169例,其中NAFLD组104例,单纯肥胖组(超重或肥胖患者)31例,健康对照组34名.收集人体学资料、生物化学指标、代谢指标、肾脏生物化学指标,以及早期肾损伤指标血清β2微球蛋白、尿微量白蛋白和肌酐比值(ACR)、估算肾小球滤过率(eGFR).通过最小显著差异法-t检验、卡方检验、Spearman相关分析等进行统计学分析.结果 与单纯肥胖组相比,NAFLD组ALT、AST、GGT、空腹胰岛素、稳态模型评估胰岛素抵抗指数(HOMA-IR)、血肌酐、ACR和β2微球蛋白水平均较高[分别为(21.13±8.14) U/L比(66.20±44.34) U/L,(24.80±9.57) U/L比(49.78±25.41) U/L,(19.26±7.88) U/L比(66.53±56.34) U/L,(7.03±1.52)mU/L比(9.55 ±5.41)mU/L,1.22±0.38比2.23 ±2.01,(62.90±10.01) μmol/L比(71.75±10.80) μmol/L,(4.41±1.16) μg/mg比(13.76±9.56) μg/mg,(1.46±0.26) mg/L比(2.01 ±0.53) mg/L],eGFR则较低[(112.46±11.90) mL·min-1·(1.73 m2)-1比(101.09±17.17) mL· min-1·(1.73 m2)-1],差异均有统计学意义(t=9.825、8.250、8.288、4.229、4.121、4.007、9.732、7.792、-3.443,P均＜0.01),其余指标差异均无统计学意义(P均＞0.05).与健康对照组相比,NAFLD组肾脏损伤指标血肌酐、ACR、ββ2微球蛋白均较高[分别为(58.78±7.77) μmol/L比(71.75±10.80) μmol/L,(1.01 ±0.32)μg/mg比(13.76±9.56) μg/mg,(1.12±0.15) mg/L比(2.01±0.53) mg/L],eGFR则较低[(115.10±12.59) mL·min-1·(1.73 m2)-1比(101.09±17.17) mL· min-1·(1.73 m2)-1],差异均有统计学意义(t=7.621、13.591、15.126、-5.120,P均＜0.01);与健康对照组相比,单纯肥胖组肾脏损伤指标ACR和β2微球蛋白均较高[分别为(1.01 ±0.32) μg/mg比(4.41±1.16) μg/mg,(1.12±0.15) mg/L比(1.46±0.26) mg/L],差异均有统计学意义(t=9.732、7.792,P均＜0.01).NAFLD患者ACR与BMI、腰围、总胆固醇、三酰甘油、低密度脂蛋白、空腹血糖、餐后2h血糖、空腹胰岛素和HOMA-IR均呈正相关(r=0.554、0.327、0.314、0.353、0.176、0.195、0.552、0.364、0.987,P均＜0.05),与高密度脂蛋白呈负相关(r=-0.330,P＜0.01).结论 在性别、年龄、血糖、血脂、血压等基线相同的情况下,NAFLD仍与慢性肾脏病密切相关.糖脂代谢异常、肥胖和胰岛素抵抗等综合因素可能是NAFLD患者发生慢性肾脏病早期肾脏损伤的机制.ACR联合β2微球蛋白评估NAFLD较血肌酐和eGFR可能更敏感.
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