The Clinical Significance Of The Level Of Homocysteine In Type 2 Diabetes With Nonalcoholic Fatty Liver Disease

Background and ObjectiveNonalcoholic fatty liver disease (NAFLD) is a kind of clinical pathologic syndrome with diffuse hepatic cells big bubble sex fat change as main characteristics caused by the factors except alcohol and other obvious caustic liver factors, and it mainly consists of three types, including nonalcoholic fatty liver (NAFL), and its evaluation contents nonalcoholic steatohepatitis (NASH) and hepatocirrhosis. With the change of the people's life style and dietary structure, the incidence of NAFLD increases continuously and NAFLD has become one of the common chronic liver diseases in China. While, many type 2 diabetes mellitus (T2DM) are more complicated with NAFLD due to insulin resistance and lipid metabolism disturbance. In the past, it was viewed that NAFLD was a kind of benign pathological change, but it was found from recent research that the incidence of 10-20 year NAFL hepatocirrhosis was 0.6%～3%and that of less than 10-year NAFL hepatocirrhosis is 15%～25%.30%～40%of the hepatocirrhosis patients related to NASH died of liver diseases finally. It has been proved that NAFLD is the origin of some liver cancers without obvious causes.At present, there is no ideal curative medicine for NAFLD and the main curative measure is to correct potential dangerous factors and interfere and postpone the occurrence and development of NAFLD. But, clinically, there are few non-invasive inspection programs, so it is very important to seek the indexes indicating the occurrence and development of NAFLD and improve the diagnosis rate of NAFLD in its early stage. According to recent clinical and epidemic study, fatty liver is very common among total homocysteine academia (tHcy) patients. The relation between fatty liver and tHcy is paid more and more attention to. This study aims at probing into the relation between NAFLD and tHcy for T2DM patients so as to provide clues for the diagnosis, prevention and treatment of T2DM with the complication of NAFLD.Materials and MethodsTake 30 male physical examinees as control group (Group A),195 newly diagnosed male T2DM patients were divided into three groups based on color ultrasonic and liver functions:83 diabetes mellitus without nonalcoholic fatty liver disease(DM group ,Group B),60 diabetes mellitus with nonalcoholic fatty liver(NAFL group,Group C), and 52 diabetes mellitus with nonalcoholic steatohepatitis(NASH group,Group D). Their height and weight were measured, so were tHcy, TC, TG, HDL, LDL, ALT, AST, GGT,glycosylated hemoglobin(HbAlc), fasting blood glucose(FBG) and fasting insulin(FINS). Body mass index(BMI) and index of insulin resistance (HOMA-IR) were calculated. All the data were counted and analyzed with SPSS17.0 statistics software package and the obvious test level a is 0.05.Resuts1. The level of TG, TC, LDL, tHcy, BMI, HOMA-IR in the four groups A, B, C and D increased gradually while the level of HDL reduced gradually, and the differences among the groups were statistically significant (P<0.05 or.P<0.01). there was no obvious difference among the four groups in respect of age (P> 0.05). The level of ALT, AST, GGT in the four groups increased gradually, there was no obvious differences between control group and DM group (P> 0.05), while, comparing to the other groups, the differences were statistically significant (P<0.05 or P<0.01).The level of HbAlc in the four groups increased gradually, there were obvious differences between control group and all the diabetes mellitus groups (P<0.01), while there was no obvious meaning among the diabetes mellitus groups (P> 0.05). The level of FINS in the four groups increased gradually, but the difference between DM group and control group was not statistically significant (P> 0.05), while, comparing to the other groups, the differences were obvious (P<0.01). The level of FBG in the four groups increased gradually, there were obvious differences between DM groups and control group, and between DM group and NASH group (P<0.05 or P<0.01), while the differences have no obvious meaning (P> 0.05) between NAFL group and DM group, and between NASH group and NAFL group.2. According to relevant analysis:tHcy was positively correlated with BMI, TG, TC, LDL, HbAlc,FBG,FINS,HOMA-IR,ALT,AST and GGT (P<0.05 or P <0.01), and was negatively correlated with HDL (P<0.01). According to multiple stepwise regression analysis, the influence factors to tHcy values screened are FINS, TG, LDL, HDL, HOMA-IR,ALT and FBG while taking tHcy as dependent variable.Among all these factors,FINS(β=0.977,t=5.479,P< 0.01) and HOMA-IR(β=-0.743,t=-3.931,P< 0.01) effected the plasma level of tHcy significantly.3. According to logistic regression analysis,tHcy was correlated with NAFLD in type 2 diabetes mellitus(P<0.05).Conclusions1. With the development of NAFLD in type 2 diabetes mellitus, tHcy increased significantly. It may play an important role on the occurrence and development of NAFLD in type 2 diabetes mellitus.2. Plasma tHcy levels elevated with obesity, Lipid disorders, elevated liver enzymes and insulin resistance. Synergism of all these factors may lead to the occurrence and development of NAFLD in type 2 diabetes mellitus.3. tHcy was independent predictor for NAFLD in type 2 diabetes mellitus. Routine test of tHcy facilitates prevention and intervention of the future risk of type 2 diabetes mellitus with NAFLD.