The Relationship Between Leptin, TNF-α, Insulin Resistance And TCM SDT In Patients With Nonalcoholic Fatty Liver

Objective: To measure the level of leptin, TNF- α in patients with nonalcoholic fatty liver disease (NAFLD), analyse relationship with insulin resistance(IR) , and discuss relationship with traditional Chinese medicine(TCM ) syndrome differentiation typing(SDT) .Methods: 85 patients with NAFLD were performed with oral glucose tolerance test(OGTT). Serum lipid, leptin, TNF-α, free fatty acid(FFA), serum glucose and insulin (fasting and 2-hour postprandial) were measured in patients of 48 NAFLD with type 2 diabetes (DFL) , 30 NAFLD (FL) , 45 type 2 diabetes without NAFLD (DM) and 32 control subjects (NC) . All patients with NAFLD were divided into three types: liver stagnation and splem deficiency, stagnation of phlegm in the interior, connection of phlegm and congestion by TCM SDT and were divided into mild moderate severe three groups by B type ultrasound. Homeostasis model assessment (HOMA), Insulin sensitive index (ISI) were applied for the status insulin resistance(IR).Result: (1) The morbidiry of NAFLD merging with type 2 diabets is 56.47%(48/85), with impaired glucose tolerance(IGT) is 10.59%(9/85), with obesity is 63.53%(54/85), with high triglyceride is 69.41%(59/85). Loglistic stepwise regression analysis showed that body mass index(BMI), Fasting blood glucose(FBG), TG, TNF-α were the mainly risk factors for forming NAFLD. (2)FINS , HOMA-IR significantly more elevated and ISI significantly descented in the groups of DFL and FL compared with those ofgroup DM and NC (P<0.01). The difference of HOMA-IR was no statistical significance in mild, moderate. severe three groups of NAFLD(P>0.05). (3)leptin, TNF- α significantly more elevated in the groups of DFL and FL compared with those of groups DM and NC(P<0.01).Correlation analysis showed: leptin was marked positive correlated with HOMA-IR, TG, VLDL, BMI, sex, age and negative with ISI; TNF- α was marked positive correlated with leptin and BMI; Multiple stepwise regression analysis showed that BMI, OGTT2HINS were the mainly risk factors for IR; BM1, WHR, FINS, sex, age were the mainly risk factors for leptin; BMI was the mainly risk factors for TNF- α . (4) The severity degree of fatty liver, BMI, level of serum leptin and TNF- α were gradually increase from liver stagnation and splem deficiency type , stagnation of phlegm in the interior type to connection of phlegm and congestion type of TCM SDT in NAFLD patients. The blood glucose and insulin(fasting and OGTT2h), HOMA-IR, ISI, FFA were no difference among the three group of TCM SDT in NAFLD patients.Conclusion: (1) Obesity, hyperglycemia, diabetes, hyperlipemia were the mainly risk factors for forming NAFLD. (2) Insulin resistance is uniformly present in subjects with NAFLD and may initially result in fatty liver. (3) The level of serum leptin, TNF- α in patient with NAFLD are increased; they closely correlate with obesity, IR and play important role in pathogensis and progression of NAFLD. (4) The severity degree of fatty liver, BMI, level of serum leptin and TNF-α were closely correlated with TCM SDT of NAFLD patiens, thus they could become one of objective indexs for TCM SDT.