The Effect Of Leptin And Adiponectin Upon To Insulin Resistance Of Hepatic Diabetes Patients

Objective: The liver plays an important role in glucose metabolism, all kinds of chronic hepatopathy that would cause chronic liver parenchyma lesion can affect the normal glycogen metabolism, even can lead to impaired glucose tolerance or diabetes mellitus. The diabetes secondary to chronic liver parenchyma lesion is called the hepatic diabetes. Previous study showed that hepatic diabetes is significantly important for the development and prognosis of chronic liver disease, even could increases the risk of developing the carcinoma. Liver disease and diabetes coexists simultaneously results in not only the double whammy for patients, but also the new challenges for treatment and judging the prognosis by clinicians.The pathogenesis of hepatic diabetes is complex. Now we believe that hyperinsulinemia and insulin resistance is an independent dangerous factor for hepatic diabetes, and insulin resistance plays a major role during illness.The relationship between insulin resistance and cytokines, which is secreted by adipose tissue conducted as endocrine organization, like leptin, adiponectin, etc, has become a worldwide issue in recent years. Leptin and adiponectin is not only related with insulin resistance closely, but also involved in the occurrence and development of chronic liver disease. We studied to evaluate the level of leptin,adiponectin of hepatic diabetes patients, for exploration the effects of leptin and adiponectin upon insulin resistance of hepatic diabetes patients, and for offering a new treatment idea to improve glucose metabolism of liver cirrhosis patients.Methods:1.The study comprised 25 patients with hepatic diabetes(18 male / 7 female), 23 patients with cirrhosis (17 male /6 female), 20 patients with type 2 diabetes(14 male /6 female) and 20 control subjects(13 male /7 female). Measured the height, weight, Waistline, hipline and blood pressure by specialized people. Then the BMI and WHR of those four groups were calculated. Blood samples were fasting collected in the morning to be used in measuring plasma glucose and blood lipid,fasting insulin,glycosylated hemoglobin A-1,liver function. Use the abstracted plasma,which be reserved in the refrigerator at minus 20 degrees Celsius, to detect the fasting leptin and adiponectin. To observe the difference between the indices of those groups, and to analyse the relation between plasma leptin and adiponectin, and their relation with insulin resistance. 2.Insulin sensitivity was evaluated by using Homestasis Model Assessment Insulin Resistance(HOMA-IR) formula. HOMA-IR=FINS(mU/L)×FPG(mmol/L)/22.5; ISI=1/FINS(mU/L)×FPG(mmol/L).Results:1. The levels of FPG,HbA1,FINS and HOMA-IR were significantly increased, and the ISI were significantly decreased in hepatic diabetes group compared with liver cirrhosis group and normal control group(p<0.05). Compared with normal control group,the levels of FPG and HbA1 in liver cirrhosis group have no significant difference, but the FINS and HOMA-IR were significantly increased, and the ISI were significantly decreased(p<0.05). 2. The levels of ALT,GGT and TBIL were significantly increased, and the levels of ALB were significantly decreased in hepatic diabetes group compared with liver cirrhosis group(p<0.05). 3. The plasma leptin levels were significantly increased in hepatic diabetes group compared with liver cirrhosis group and normal control group (p<0.05), but have no significant difference compared with Type 2 Diabetes Mellitus group (p>0.05). 4. The plasma adiponectin levels were significantly increased in hepatic diabetes group compared with Type 2 Diabetes Mellitus group and normal control group(p<0.05), but have no significant difference compared with liver cirrhosis group (p>0.05); The plasma adiponectin levels were significantly increased in liver cirrhosis group compared with normal control group(p<0.05); The plasma adiponectin levels were significantly decreased in Type 2 Diabetes Mellitus group compared with normal control group(p<0.05). 5. Leptin has no significant correlation with BMI and adiponectin. Significant negative correlation were observed between the plasma leptin levels and ISI(r= -0.613,p<0.05). And significant positive correlation were observed between the plasma leptin levels and HbA1,FPG, FINS as well as HOMA-IR(r= 0.532,0.431,0.671,0.613,p<0.05). Adiponectin has no significant correlation with all indexes.Conclusions: 1. There were increased level of blood insulin and insulin resistance in patients with hepatic diabetes, even non-diabetic cirrhosis patients have decreased insulin sensitivity. 2. Plasma leptin levels in patients with hepatic diabetes were significantly higher than that of normal controls and liver cirrhosis group(p<0.05). It showed that leptin may involved in the occurrence of hepatic diabetes; Plasma adiponectin levels in patients with hepatic diabetes were significantly higher than that of normal controls and type 2 diabetes group(p<0.05). It showed that adiponectin may involved in the occurrence of hepatic diabetes. The occurrence and development of hepatic diabetes is a complex process invoved in various active substances. The metabolic disorders of various active substances may affect the glucose metabolism of patients with liver disease. 3. Significant positive correlation were observed between the plasma leptin levels and HbA1,FPG,FINS as well as HOMA-IR, and significant negative correlation were observed between the plasma leptin levels and ISI. It showed that leptin may trigger or aggravate abnormal glucose metabolism through insulin resistance.