Correlation Between Islet β Cell Function And Hepatic Transferases In Type 2 Diabetes Mellitus And Differentiated Syndrome Of TCM

Objective:The purpose of this study was to investigate the correlation between serum aspartate aminotransferase(AST),serum alanine aminotransferase(ALT),serum y-glutamyl transferase(GGT)and islet β cell function by observing serum liver transferase parameters in people with type 2 diabetes mellitus(T2DM).At the same time,summarize the distribution rule of TCM syndrome types of T2DM with different liver transferase levels,explore the correlation between TCM syndrome types and islet β cell function,and provide new ideas and basis for the diagnosis and treatment of islet β cell and liver function in T2DM patients with Chinese and Western medicine.Methods:A total of 505 T2DM patients were included according to the inclusion and exclusion criteria by collecting T2DM patients in the Department of Endocrinology,Affiliated Hospital of Nanjing University of Chinese Medicine.The general data,AST,ALT,GGT,total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),fasting glucose(FPG),fasting insulin(FINS),fasting C-peptide(FCP),glycosylated hemoglobin(HbAlc),abdominal ultrasound and other test indicators were collected.The OGTT test and C-peptide release test were perfected.The area under the curve of C-peptide was used to assess islet β cell function.At the same time,the included T2DM patients were subjected to TCM syndrome differentiation,a database was established,and statistical analysis was performed with SPSS 24.Results:1.Comparison of general data:A total of 505 patients with T2DM were included in the study,including 258 males(51.09%)and 247 females(48.91%).ALT,GGT in males were higher than those in females(P<0.05),age,FINS,insulin resistance index(HOMA-IR),TC and HDL-C were lower than those in females(P<0.05).There was no significant difference in disease course,body mass index(BMI),FPG,HbAlc,AST,TG,LDL-C,FCP,C-peptide area under the curve at 30 min(AUC30),C-peptide area under the curve at 60 min(AUC60),C-peptide area under the curve at 120 min(AUC120)and C-peptide area under the curve at 180 min(AUC180)between males and females(P>0.05).2.Correlation analysis between liver transferase and islet β cell function:Comparison between the hepatic transferase quartile groups showed that there were statistically significant differences in age,disease duration,BMI,prevalence of fatty liver,FCP,AUC30,AUC60,AUC120,and AUC180 among the four groups(P<0.05),and further pairwise comparisons between groups showed that FCP,AUC30,AUC60,AUC 120,and AUC 180 were the highest when the hepatic transferase quartile was 4(P<0.05);correlation analysis results showed that AST,ALT and GGT were positively correlated with FCP,AUC30,AUC60,AUC120 and AUC 180(P<0.05);Binary logistic regression results showed that after controlling for confounding factors,AST was an independent factor for islet β cell dysfunction at 30 min,120 min and 180 min(P for trend<0.05),ALT was an independent factor for islet β cell dysfunction at 30 min,60 min,120 min and 180 min(P for trend<0.05),and GGT had no significant effect on islet β cell dysfunction at each time point(P for trend>0.05);liver transferase analysis showed that T2DM population was divided into four groups,normal AST/ALT group,abnormal AST only,abnormal ALT only and abnormal AST/ALT.The results of inter-group comparison showed that there were statistical differences in age,disease duration,BMI,prevalence of fatty liver,FCP,AUC30,AUC60,AUC 120 and AUC 180 among the four groups(P<0.05).The results of pairwise comparison between the two groups showed that there were statistical differences in FCP,AUC30,AUC60,AUC 120 and AUC 180 between the normal and abnormal ALT groups(P<0.05);there was no statistical significance between the abnormal AST group and the other groups(P>0.05).3.Analysis of the relationship between TCM and islet β cell function in T2DM with different liver transferase levels:505 T2DM patients were divided into 2 groups,including 343 patients(67.9%)in the normal ALT group and 162 patients(32.1%)in the elevated ALT group;The distribution rule of TCM syndrome types showed that deficiency of both qi and yin(38.4%)and dampness-heat syndrome(30.5%)were predominant in T2DM patients,deficiency of both qi and yin(44.9%)was predominant in normal ALT group,and dampness-heat syndrome(46.9%)was predominant in elevated ALT group;Comparison of clinical data between TCM syndromes showed that there were statistically significant differences in age,disease duration,AST,ALT,GGT,BMI,HOMA-IR,FCP,AUC30,AUC60,AUC120,and AUC180 between TCM syndromes in T2DM patients(P<0.05),and there was no statistically significant difference in FPG and HbA1c(P>0.05),with BMI,AST,ALT,GGT,FCP,AUC30,AUC60,AUC120,and AUC180 being the highest in damp-heat syndrome(P<0.05).the comparison of islet β cell function between TCM showed that ALT was normal,and the BMI,FCP,AUC30,AUC60,AUC120,and AUC180 of damp-heat syndrome were greater than those of deficiency of both qi and yin and yang(P<0.05);FCP,AUC30,AUC60,AUC120,and AUC180 of heat syndrome were greater than those of deficiency of both qi and yin and deficiency of both yin and yang(P<0.05),and there was no statistical difference in FPG,HbAlc,and HOMA-IR between TCM(P>0.05).In ALT elevated group,FCP,AUC30,AUC60,AUC120 and AUC180 of dampness-heat syndrome were higher than those of deficiency of both qi and yin syndrome(P<0.05).There was no significant difference in FPG and HbAlc between TCM groups(P>0.05);The results of binary logistic regression analysis between TCM and islet β cell dysfunction showed that ALT was normal,TCM was an independent factor of fasting islet βcell dysfunction(P for trend<0.05),while in ALT elevation,TCM was an independent factor of fasting and 120 min islet β cell dysfunction(P for trend<0.05).Conclusion:1.Islet β cell function is independently and positively correlated with AST and ALT in patients with T2DM,especially closely related to ALT.ALT level can be used as an important indicator to monitor the changes of islet β cell function in patients with T2DM;2.Qi and Yin deficiency syndrome and damp-heat syndrome are common TCM syndromes in patients with T2DM,and Qi and Yin deficiency syndrome is predominant in patients with normal ALT,which is associated with fasting islet β cell function;ALT elevation syndrome is predominant in patients with damp-heat syndrome,which is associated with fasting and 120 min postprandial islet β cell function;3.Qingli damp-heat method is an important treatment for islet β cell function and liver function protection in patients with T2DM.