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首页> 外文期刊>Journal of Clinical and Diagnostic Research >Assessment of Insulin Resistance in Ultrasonographically Diagnosed Cases of Non-Alcoholic Fatty Liver Disease
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Assessment of Insulin Resistance in Ultrasonographically Diagnosed Cases of Non-Alcoholic Fatty Liver Disease

机译：超声诊断非酒精性脂肪肝病例中胰岛素抵抗的评估

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Non-Alcoholic Fatty Liver Disease (NAFLD) is the excessive accumulation of fat primarily in form of triacylglycerols in more than 5% of the hepatocytes without significant consumption of alcohol and other known causes of steatosis. Literature suggests an association of NAFLD with Insulin Resistant (IR) Metabolic Syndrome (MetS). In clinical settings, ultrasonography is commonly used for diagnosis of NAFLD as opposed to expensive biopsy procedures.Aim: To assess the diagnostic utility of the surrogate markers of IR in ultrasonographically diagnosed cases of NAFLD.Materials and Methods: The cross-sectional study was carried out at College of Medicine and Sagore Dutta Hospital (CMSDH), Tertiary Care Hospital and Teaching Institute in Kolkata, West Bengal, India. Ultrasonographically diagnosed 116 cases (aged 32-65 years) of NAFLD were selected and 100 apparently healthy age and sex-matched individuals were recruited as controls. Overnight fasting blood samples were analysed for fasting glucose, insulin, glycated haemoglobin (HbA1C), lipid profile and transaminases levels. IR was estimated with the Homeostasis Model Assessment index for Insulin Resistance (HOMA-IR). One-way analysis variance (ANOVA) was used for normally distributed data and Kruskal Wallis for a non-parametric data. Receiver Operator Curve (ROC) were generated to identify the cut-off values of HOMA-IR, Aspartate aminotransferase (AST), Alanine aminotransferase (ALT), the AST/ALT ratio and fasting triglycerides to predict the existence of fatty liver. Adjusted Odds Ratio (OR) was also calculated to measure the independent effect of the risk factors.Results: Statistically significant differences were observed in insulin (p-value=0.033), HOMA-IR (p-value=0.049), triglycerides (p-value=0.00008), HbA1C (p-value=0.030), AST/ALT ratio (p-value=0.012), AST (p-value=0.015), ALT (p-value 0.00001) levels among cases and controls. The predictive cut-off for possibility of existence of fatty liver was HOMA-IR was >2.9 (sensitivity was 63.27%, specificity of 93.94), triglycerides =137 mg/dL, (60.67% sensitivity and 60.98% specificity) and AST/ALT ratio of 0.74 (specificity of 65.15% and a sensitivity of 62.50%). For HOMA-IR >2.5, the relative risk was 5.56 and OR was 7.15. For triglycerides >150 mg/dL, the relative risk was 1.88 and OR was 2.87.Conclusion: While ultrasound remains method of choice for diagnosis of NAFLD, assessment of parameters like IR, AST/ALT ratio aids in detection of associated MetS such as Cardiovascular Disorders (CVD) and Diabetes Mellitus (DM) that warrants proper lifestyle modification and therapeutic intervention.
机译：非酒精性脂肪肝病（NAFLD）是主要以三酰基甘油形式在超过5％的肝细胞中过度积累脂肪，而没有大量饮酒和其他已知脂肪变性的原因。文献表明NAFLD与胰岛素抵抗（IR）代谢综合症（MetS）相关。在临床环境中，与昂贵的活检程序相反，超声通常用于诊断NAFLD。目的：评估超声替代物在IR超声诊断的NAFLD病例中的诊断效用。材料和方法：横断面研究是在印度西孟加拉邦加尔各答的医学院和Sagore Dutta医院（CMSDH），三级护理医院和教学学院进行的。经超声检查诊断的116例NAFLD患者（年龄32-65岁），并选择了100名年龄和性别相匹配的健康个体作为对照。对过夜禁食的血液样本进行了禁食葡萄糖，胰岛素，糖化血红蛋白（HbA1C），脂质谱和转氨酶水平的分析。 IR用胰岛素抵抗的稳态模型评估指数（HOMA-IR）估算。单向分析方差（ANOVA）用于正态分布数据，Kruskal Wallis用于非参数数据。生成接收者操作曲线（ROC）来识别HOMA-IR，天冬氨酸转氨酶（AST），丙氨酸转氨酶（ALT），AST / ALT比和空腹甘油三酸酯的临界值，以预测脂肪肝的存在。还计算了调整后的赔率（OR），以衡量危险因素的独立作用。结果：在胰岛素（p值= 0.033），HOMA-IR（p值= 0.049），病例之间的甘油三酸酯（p值= 0.00008），HbA1C（p值= 0.030），AST / ALT比（p值= 0.012），AST（p值= 0.015），ALT（p值0.00001）控制。脂肪肝存在的可能性的预测临界值是：HOMA-IR> 2.9（敏感性为63.27％，特异性为93.94），甘油三酸酯= 137 mg / dL，（敏感性为60.67％和60.98％）和AST / ALT比率为0.74（特异性为65.15％，灵敏度为62.50％）。对于HOMA-IR> 2.5，相对风险为5.56，OR为7.15。对于甘油三酸酯> 150 mg / dL，相对危险度为1.88，OR为2.87。结论：虽然超声仍然是诊断NAFLD的首选方法，但评估IR，AST / ALT比等参数有助于检测相关的MetS例如心血管疾病（CVD）和糖尿病（DM），这些疾病需要适当的生活方式改变和治疗干预。

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