Analysis Of Risk Factors In Patients Of Type 2 Diabetes Complicated With Nonalcoholic Fatty Liver Disease And Discussion Of Its Mechanism

Objective: Along with the higher morbidity of diabetes and obesity, currently, nonalcoholic fatty live disease (NAFLD)has become the first pathogen of chronic liver disease in western developed countries and tending to the globalizational trend, besides it also has become the second liver disease to the chronic viral hepatitis in our country. Obesity, Type 2 Diabetes Mellitus (T2DM) and dyslipidemia is the most common risk factors of NAFLD, and insulin resistance (IR) is their common pathophysiological basis. Serum retinol binding protein 4 (RBP4) is found as a new adipokine in recent years, and studies have found that it participated in the mechanism of obesity and IR .This study is by means of analysising the morbidity of NAFLD in T2DM patients and the risk factors, and discussing the correlation of serum RBP4 and NAFLD, to expound the possible pathogenesis of NALFD, thus provide new guidance for the early discover, prevention and treatment in NAFLD.Methods: (1) From September 2009 to December 2010,104 cases of T2DM (all of them conform to the diagnosis and classification standards of diabetes in 1999 of WHO) in-patients were collected from Department One of Endocrinology, the Third Clinical Hospital of HeBei Medical University. According to the Chinese Medical association for the Study of Liver Diseases in 2006《Guidelines for diagnosis and treatment of nonalcoholic fatty liver disease》,we divided them into NAFLD group and NO-NAFLD group based on whether or not it complicated with NAFLD.(2)Venous blood samples were collected in the morning,serum were frozen and stored at -70℃,RBP4 was determined by ELISA method.(3)Detected all the patients general clinical data, including gender, age, medical history, height, weight, waistline(W), hipline (H), systolic blood pressure (SBP), diastolic blood pressure(DBP), and calculate body mass index(BMI), waistline and hipline radio(WHR). When BMI≥25kg/m~2 we defined it as overweight or obesity; when waistline in the male≥85cm and in the female≥80cm we defined it as central obesity (abdominal obesity). (4)Laboratory tests included fasting plasma glucose(FPG), fasting insulin(FINS),trig1yceride(TG),total cholesterol (TC), high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C), liver enzyme (AST,ALT,GGT), HbA1c, uric acid(UA),and calculate insulin resistance index(HOMA-IR). (5)Measured abdominal fat area by computed tomography.(6) Abdominal ultrasonography was measured by one chief physician using the same color Doppler ultrasonography. SPSS 13.0 was used to do the statistical analysis. Data was expressed by mean number +standard deviation( x±s), non-normal data can be analyzed after logarithmic conversion. Variance analysis and t test were applied in the comparison among many groups. Simple correlation and Multiple regression analysis was used in my study.P<0.05 means that there was statistically significant.Result:1 In the 104 cases, NAFLD group were 58 cases,according for 55.8%, and age were( 57.1+9.9) years old, in witch 36 cases were male,22 cases of women. NO-NAFLD group had the age of( 56.3+10.3) years old, in witch 27 cases were male,19 cases of women. There was no statistically significant in age and gender of two groups (P>O.05).2 W, H, WHR, BWI, visceral adipose area(VAA) and subcutaneous adipose area(SAA) were higher in NAFLD group than in NO-NAFLD group(P<0.01). There were 50 obesity cases,according for 86.2% in NAFLD group, and central obesity were 58 obesity cases,according for 100%.3 SBP and DBP were higher in NAFLD group than in NO-NAFLD group(P<0.05).There were 39 high blood pressure patients in NAFLD group, according for 67.2%.4 RBP4, TG, ALT, AST, GGT and UA were higher in NAFLD group than in NO-NAFLD group (P<0.01), but there was no statistically significant in FPG, FINS, HOMA-IR and HbA1c between two groups(P>0.05).5 Simple correlation: NAFLD was positively correlated with W, H, WHR, BWI, VAA, SAA, DBP, RBP4, TG, ALT, AST, GGT, UA (P<0.01). RPB4 was positively correlated with W, H, WHR, BWI, VAA, SAA, DBP, TG, ALT, AST, GGT, FINS, UA (P<0.01).6 Multiple regression analysis: W, smoking, ALT, GGT, RBP4 were the independent risk factors of NAFLD. LogitP=-42.802+0.292(W)+2.128(smoking)-0.142(ALT)+0.659(GGT)+0.052(RPB4).GGT, VAA, FINS, DBP were the independent risk factors of RBP4, Y=-90.078+2.731(GGT)+0.003(VAA)-2.508(FINS)+0.950(DBP).Conclusion:1 In this study population, the morbidity of NAFLD was 55.8%, and it pointed out that T2DM patients were susceptible population of NAFLD.2 RBP4 was independent risk factor of NAFLD,and GGT,VAA,FINS and DBP were independent risk factors of RBP4 .Maybe RBP4 participated in the occurrence and development of the NAFLD through GGT, visceral fat , hyper- tension and hyperinsulinemia.3 Obesity, smoking, lipid metabolism disorder, and hypertension may be the risk factors of NAFLD.4 NAFLD often appeared liver damage, and mainly was elevated ALT.