The Studies On The Relationships Between The Distributions Of Abdominal Adipose Tissue, The Diversity Of Adipocytokine And NAFLD

Nonalcoholic fatty liver disease (NAFLD) is one of the most common etiologies of the well-known chronic liver disease worldwide. NALFD encompasses a continuum of histological findings ranging from steatosis, to nonalcoholic steatohepatitis (NASH), fibrosis and eventually liver cirrhosis.Obesity is the most common risk factor associated with NAFLD. For the past decades,the prevalence of NAFLD is incredibly increasd mainly due to the increase of obesity subjects,especially abdomen type obesity.Its primary feature is the accumulation of visceral adipose tissue in abdomen.The studies in humans and animals has shown the inextricable relationships between visceral obesity (central obesity) and steatosis.However, it is obscure the relationships between the distribution of abdominal adipose tissue,the adipocytokine and the pathology of NAFLD. To obtain the further valuable relations,this study was designed to elucidate the relationships between the clinic feature, distribution of abdominal adipose tissue, plasma adipocytokine concentration, adipocytokine of the abdominal adipose tissue and the pathology of NAFLD.METHODS AND PROCEDURES:45 cholecystolithiasis operation patients, including 18 men, age 34～69 and 27 women, age 28～70,were enrolled in the study.1. The clinic features of NAFLDAll patients were observed to survey the height , body weight and waist circumference(WC). All patients were collected venous blood to assay fasting plasma glucose(FPG),fasting insulin(FIN),fasting total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-c),low density lipoprotein cholesterol(LDL-c), apolipoprotein B(ApoB) , Lipoprotein A1(LPA1),free fatty acid(FFA) and Alanine aminotransferase(ALT) , Aspartate aminotrasferase (AST), Albumin (ALB) and platelet(PLT) were detected.Then the body mass index(BMI),the waist-to-hip ratio(WHR)and the Homeostasis Model Assessment (HOMA) were calculated.All patients had the ultrasonic exam.Pathological changes in the liver tissue were observed by HE staining and masson staining through light microscopy. The relatived liver steatosis patients were divided into three groups:control group, F1 group and F2 group.2. Computed tomography in NAFLD patients 16 patients,including 8 men,age 37～69 and 8 women,age 41～65 were enrolled in the study .The liver attenuation values,spleen attenuation values and the liver-to-spleen ratio (L/S ratio) were determined by computed tomography (CT). All patients were observed to measure the visceral adipose tissue area and the subcutaneous adipose tissue area by computed tomography.In succession, the total abdominal adipose tissue, volume of visceral adipose tissue and abdominal subcutaneous adipose tissue were calculated by computed tomography scans.3.The level of adiponectin and visfatin in the plasma , visceral adipose tissue and abdominal subcutaneous adipose tissueThe plasma concentrations for adiponectin and visfatin were assayed by enzyme-linked immunosorbent assay kits. By using the Real-time RT-PCR and Western blotting, the mRNA and protein expression of adiponectin and visfatin in the visceral adipose tissue and abdominal subcutaneous adipose tissue were assessed.RESULTS:1. The clinic feature of NAFLDNo significant association between the inflammation or fibrosis and the steatosis existed (both P >0.05).ALT,AST,ALB and PLT were no significant deviation. Correlation analysis indicated that WC (r=0.357,P=0.028) , WHR(r=0.463,P=0.002) were positively correlation with hepatic steatosis. TC (r=0.386,P=0.009),TG (r=0.346,P=0.021),LDL-C (r=0.415,P=0.005),ApoB (r=0.433,P=0.003),LDL-C/HDL-C(r=0.416,P=0.005) were correlated positively with hepatic steatosis. HDL-C,LPA1,FFA were no site difference among the three groups. FPG, HOMA-IR were higher in F1 group or F2 group compared with control group,respectively. The missed diagnosis rate of ultrasonic exam was 27.27%.The positive predictive value was 100%. On the contrary, the negative predictive value was 57.14%.2. Computed tomography in NAFLD patientsCorrelation analysis indicated that liver value (r=-0.772,P=0.000),liver-to-spleen ratio (r=-0.703,P=0.002) were negatively correlated with hepatic steatosis. There were positively correlation with total abdominal adipose tissue area (r=0.857,P=0.000), visceral adipose tissue area (r=0.806,P=0.000) and subcutaneous adipose tissue area (r=0.532,P=0.034), volume of abdominal adipose tissue (r=0.514,P=0.041) , volume of visceral adipose tissue(r=0.823,P=0.000) and hepatic steatosis.3. The level of adiponectin and visfatin in the plasma , visceral adipose tissue and abdominal subcutaneous adipose tissueAdiponectin and visfatin plasma concentrations decreased with the aggravation of the hepatic steatosis.The adiponectin expresstion of visceral adipose tissue in F1 group and that in F2 group were down-regulationed than that in F0 group. The adiponectin expresstion of visceral adipose tissue was no difference between F2 and F1. The adiponectin expression of subcutaneous adipose tissue was similar among the three groups. Adiponectin expression was not different between visceral and subcutaneous adipose tissue in the entire study group nor in the selected subgroups.The visfatin expresstion of visceral adipose tissue in F2 group was lower than that in F0 group. The visfatin expresstion of visceral adipose tissue was not different between other groups. The visfatin expression of subcutaneous adipose tissue was similar among the three groups. Visfatin expression was not different between visceral and subcutaneous adipose tissue in the entire study group nor in the selected subgroups.CONCLUTIONS:1. These results suggest that the level of aminotransferase is not parrellel developed with the aggraviation of hepatic steatosis. ApoB is a specific marker for blood fat indicatrix in NAFLD patients.2. Perhaps, someone with normal hepatic ultrasonography is maybe the NAFLD patient. The liver value of NAFLD patients is lower by computed tomography. Liver biopsy is the only way to confirm the presence or absence of steatosis,inflammation, fibrosis.3. Visceral and subcutaneous adipose tissue play different roles in the pathogenesy of NAFLD. The accumulation of visceral tissue in patients is closely correlated to the increase of morbility of NAFLD.4. The low expresstion of adiponectinemia is concluded to be involved in the etiology of hepatic steatosis.The down-regulation of visfatin in the visceral adipose tissue induced the aggravation of hepatolic steatosis. Adipocytikine secreted by visceral adipose tissue is considered to be an important factor in the progression of NAFLD.