Effect Of Visfatin And TNF-α In Type 2 Diabetes Mellitus Patiens With Nonalcoholic Fatty Liver Disease

Objective: Nonalcoholic fatty liver disease (NAFLD) is characterized by a wide spectrum of liver damage spanning steatosis, nonalcoholic steatohepatitis (NASH), cryptogenic liver cirrhosis, and even to hepatocellular carcinoma. In type 2 diabetes mellitus and NAFLD, insulin resistance might be involved in the development of endocrine and metabolic abnormalities. NAFLD,which is often associated with obese individuals and patients with hyperinsulinemia, dyslipidemia , hepertension or type 2 diabetes mellitus , is a clinicopathological syndrome. The purpose of the present study is to investigate serum visfatin levels, serum tumor necrosis factor–alpha (TNF-α)levels,and to asses the relationship between serum visfatin , TNF-αconcentration and body mass index (BMI), waist hip ratio (WHR), blood glucose, serum insulin level as well as insulin sensitivity in the patients with type 2 diabetes mellitus and NAFLD.The final purpose of the study is to explore the possible mechanism of visfatin, TNF-αin the type 2 diabetes mellitus and NAFLD, and find a new method of preventing and treating type 2 diabetes mellitus and NAFLD.Method: The study involved 132 subjects and they were divided into four groups: 34 type 2 diabetes mellitus patients without NAFLD(group T,involved 19 males and 15 females), 36 type 2 diabetes mellitus patients with NAFLD(group FT,involved 20 males and 16 females),32 NAFLD patients without type 2 diabetes mellitus (group F,involved 17 males and 15 females) and 30 healthy controls(group N,involved 14 males and 16 females). After overnight fasting, weight, height, waist circumference, hip circumference and blood pressure were measured and a single blood sample was obtained. The parameters included fasting blood glucose (FBG), fasting blood insulin(FINS), alanine aminotransferase (ALT), aspartate aminotransferase (AST),triglycerides(TG),total cholesterol (TC),low density lipoprotein-cholesterol(LDL-c), high density lipoprotein-cholesterol(HDL-c).Serum visfatin was measured by enzyme linked immunosorbent assay (ELISA) and TNF-αconcentrations were measured through radioimmunoas- say(RIA).At the same time, body mass index(BMI), waist to hip ratio(WHR)and homeostasis model assessment of insulin resistance(HOMA-IR)were also calculated. We measured the relationship between visfatin, TNF-αand obesity , BMI, WHR and response to insulin sensitizers. All statistical analysis was performed with Windows SPSS13.0.Continuous datas are presented as mean±SD(x_±s). Analysis has been made when the included non-normal distributed data coheres with normal distribution via natural logarithm conversion and non-normal distributed data and data with heterogeneity of variable are expressed by median (quartile). One-factor analysis of variance is used in variable regular data between groups and q examination is used in pair wise comparison; Wilcoxon rank test is used in variable irregular data between groups and Nemenyi examination is used pair wise comparison. Pearson correlative analysis and multivariate stepwise regression analysis are used in relations among Visfatin, TNF-αand each influential factor. Statistical significance was defined as p<0.05.Results:1. The HOMA-IR levels of group FT,group F,group T are significantly higher than control group (p<0.05),the HOMA-IR levels of group F,group T are significantly lower than group FT(p<0.05).2.The fasting serum visfatin, TNF-αlevels of group FT,group F,group T are significantly higher than control group (p<0.05), The fasting serum visfatin, TNF-αlevels of group F,group T are significantly lower than group FT(p<0.05).3.The simple correlation analysis suggests that visfatin is significantly positive related to WC,WHR,SBP,TG,ALT,AST,FPG,FINS及HOMA-IR(p<0.05 or p<0.01), TNF-αis significantly positive related to BMI,SBP,TG,FPG,FINS及HOMA-IR(p<0.05 or p<0.01).4.The step regression analysis shows that FPG,WHR,ALT,AST are the independent relative factors to visfatin(p<0.05 or p<0.01), HOMA-IR,TG are the independent relative factors to TNF-α(p<0.05 or p<0.01). Conclusion: The results show that, in the patiens of type 2 diabetes mellitus and NAFLD, serum visfatin and TNF-a is increased. It is concluded that visfatin and TNF-a may play a role in the pathogenesis of type 2 diabetes mellitus and NAFLD,and they may be the markers of inflammatory in the patiens of type 2 diabetes mellitus and NAFLD.