Drug Intervention Study And Relationship Between IR And NAFLD In Nonobese Type 2 Diabetes Mellitus

Objective:To investigate drug intervention and relationship between insulin resistance and Non- alcoholic fatty liver disease in nonobese type 2 diabetes mellitus. Methods: 92 patients with non-obese patients with type 2 diabetes were divided into the fatty liver group (observation group) and not with fatty liver group (control group) according to results of B-ultrasonic, These patients were observed body mass index (BMI), biochemical indicators, HoMA-IR; observation group was divided into A group (basic treatment and rosiglitazone) and B group(basic treatment), followed by 24 weeks, liver histology, biochemical, HoMA-IR of patients in both groups before and after treatment were observed and comparative study. Results:①Observation group TG, FBG, Fins, HoMA-IR was higher than control group, Logistic regression analysis showed that NAFL and HoMA-IR was independently associated.②A group after treatment, the Fins, AST, ALT, HoMA-IR significantly improved compared with before treatment, TG better than before; B group of Fins, AST, ALT, TG, HoMA-IR indicators have improved trend, though not statistically significant; A group therapy was superior to B group treatment. Conclusion: Insulin resistance in non-obese type 2 diabetic patients with non-alcoholic fatty liver plays an important role in development.As people's living standards improved and lifestyle changed, type 2 diabetic patients with non-alcoholic fatty liver disease showed a rising trend in the clinical practice. The author investigated clinical data aboat 92 cases of non-obese patients with type 2 diabetes of the Second Hospital of Jilin University from December 2008 to December 2009 , that cleared the relevant factors and provided clinical reference for the prevention and treatment of diabetic patients with non-alcoholic fatty liver disease.1 Data and methods1.1 General Information 92 cases of the non-obese with type 2 diabetic patients were admitted from December 2008 to December 2009, who were divided into two groups according to results of B-ultrasonic: the observation group (with NAFL) 49 cases, including 29 males and 20 females, mean 47±5 years of age; the average duration of 42±6 months. The control group (without NAFL) 43 patients, including 24 males and 19 females, mean 45±7 years, mean duration 44±6 months; type 2 diabetes with fatty liver group were randomly divided into two groups, A group (rosiglitazone group), 15 males and 10 females, mean age 47±6 years; B group ( the control group), 14 males and 10 females, mean age 47±4 years; two sets of gender, age, degree of fatty liver were comparabled.1.2 methods of giving medicineAll patients of type 2 diabetes with NAFL were given basic knowledge of education that contain low-fat diabetes diet, exercise therapy and hypoglycemic therapy. A group received treatment with rosiglitazone (GlaxoSmithKline production, the brand name Avandia ), 8mg, daily time, oral; B groupdid not increase with rosiglitazone treatment, only control diet, exercise and hypoglycemic treatment. The treatment lasted 24 weeks.1.3 index of Detection taken Elbow fasting venous blood samples to measure FPG, FIns, TG, TC, AST, ALT; taken two hours after the meal elbow venous blood samples 2hPG, 2 hIns; recorded observation of the object's height, weight, systolic blood pressure (SBP), diastolic blood pressure (DBP), calculate BMI, BMI = weight (kg) / (height) 2(m2); HOMA - IR = FPG×FIns / 22.5; all patients of 2 diabetes with NAFL recheck liver function every 2 months later and review B-ultrasonic of the liver every 6 months later.1.4 Clinical Efficacy evaluationAccording to the liver ultrasound characteristics of the fatty liver is divided into mild, moderate and severe; based on imaging findings to judge: markedly, liver imaging restore to normal; effective, the extent of fatty liver compared with pre-treatment drop a level or above; invalid, does not meet the Effective treatment standards.1.5 Statistical MethodsData were processed using SPSS11.5 statistical package, testing the standard of 0.05. Measurement data to indicate that the two groups using t test measurement data, the same group before and after treatment using paired t test, grade data were compared with rank sum test, HoMA-IR index was non-normal distribution, taking into natural logarithm transformed into normal distribution after statistical analysis (t test), multi-factor correlation analysis using Logistic regression analysis.2 Results 2.1 Observer Group TG, FBG, Fins, HoMA-IR were higher than control group, Logistic regression analysis showed NAFL and HoMA-IR was independently associated.2.2 A group after treatment, the Fins, AST, ALT, HoMA-IR significantly improved compared with before treatment, TG better than before; B group of Fins, AST, ALT, TG, HoMA-IR indicators had improved trend, but no statistically significant difference ; A Group therapy was superior to B group therapy.3 Discussion:It should be said the pathogenesis of diabetes mellitus with NAFLD have not yet clarified at present, the results of this study support the basis of NAFLD is insulin resistance.The role of insulin on fat metabolism is mainly to promote fat synthesis and inhibit lipolysis of fat, insulin resistance can reduce the regulation of insulin effect on fat metabolism, so that fat tissue decomposition, the release of free fatty acid (FFA) increase, resulting in increased circulating FFA; visceral adipose tissue to mobilize more than subcutaneous tissue, FFA may be directly through hepatic portal vein inflow, causing FFA accumulation of liver cells; inhibition of FFA oxidation by reducing FFA to the liver, causing accumulation of liver FFA.Insulin resistance not only lead to accumulation of fat in the liver, but also cause liver inflammation, necrosis, formation of non-alcoholic steatohepatitis and even cirrhosis. Insulin sensitizers can significantly improve the non-alcoholic steatohepatitis in patients with liver function and liver tissue enzyme target lesions, also demonstrated that insulin resistance plays an important role in the occurrence and development of non-alcoholic steatohepatitis.Edition insulin sensitizer may reduce the degree of fatty liver and improve liver function enzymes indicators through the following mechanisms: thiazolid- inediones, TZDs can reduce the release of FFA and TNF-аof the fat cells, increase glucose utilization, at the same time by activating the peroxisome proliferator-activated receptorγ(PPARγ) to improve insulin sensitivity, regulat- ing blood glucose and FFA levels, thus inhibiting lipid peroxidation and the role of TNF-аand can selectively transfer fat from the visceral to the subcutaneous tissue.