Studies Of RBP4 In T2DM With Nonalcoholic Fatty Liver Disease

[Background]NAFLD is a clinical pathologic syndrome mainly characterized by diffuse hepatic steatosis in the absence of alcohol and other clear factors of hepatic damages, including simple fatty liver, non-alcoholic steatohepatitis(NASH) and cirrhosis. With the improvement of living standards and lifestyle changes, obesity and the onset of diabetes, especially type 2 diabetes(T2DM) become increasingly common in NAFLD patients. But the mechanism of its occurrence and development are not yet fully-understood, many studies have shown that insulin resistance (IR)may be one of the common links in the incidence of both.Previous studies have found that the fat factors secreted by the fat organ participate in various metabolic processes in vivo through autocrine, paracrine and endocrine pathways,which plays and very significant role in the pathogenesis of insulin resistance. Yang and other researchers had identified a new factor-retinolbinding protein 4 (RBP4) by gene chip,. In the state of insulin resistance, RBP4 expression will be significantly higher than normal. It can affect the glucose utilization in the liver and the muscles through blood circulation,which is known as the whole body IR contact signaling molecule More and more studies have found that RBP4, as a new fat factor, is involved in insulin resistance and type 2 diabetes. At the same time,the RBP4 in the pathogenesis of NAFLD is also of great concern recently. But no research are reported of RBP4 in T2DM patients with NAFLD.[Objective]We measure the level of RBP4 and FFA in different groups and analyze the correlation between the clinical and laboratory indicators of IR and T2DM with NAFLD,which will also provide some evidences for the further research of RBP4 and FFA.[Methods]We chose 109 patients in Zhujiang Hospital of Southen Medical University from June.2010 to Nov.2010. We devided them according to "the Guideline of NAFLD"presented by Chinese Society of Hepatology,CMA in 2006 into 3 groups. Group A:normal control(25 cases), group B:T2DM(43 cases), group C:T2DM with NAFLD(41 cases). We collected the history of the patients,finished the baseline information, investigated the financial condition, did the liver ultrasound, measured the height,weight and BMI. We also take their fasting blood to test the RBP4 and FFA level by E1ISA sandwich technique together with TC,TG,FBG,ALT,AST,GGT,FINS and the HOMA-IR (HOMA-IR=FBG x FINS/22.5).SPSS 13.0 is used to do the analysis.[Results]1.RPB4 rised gradually in group A,Band C(A:5.661±3.043;B 12.701±7.145;C 18.954±8.459),the difference between every group has statistical significance.2.The FFA level:(A:0.121±0.067;B:0.262±0.216;C 0.557±0.276), the difference also has statistical significance.3. HOMA-IR:3.33±3.60; 5.80±3.55; 9.07±10.53.the Data in Group C is lower than the other groups, difference has statistical significance, but comparing A with B,there is no statistical significance. Waist circumference and waist-hip ratio, C group than in B group, B group than in A group, the difference was statistically significant.4.According to the Spearman Correlation Analysis:RBP4 is positively correlated with BMI,HOMA-IR,WC,WHR,FFA,TC,TG and FPG,but is not related to age and FINS.Conclusion1.The IR grades are higher in T2DM patients with or without NAFLD,which shows that IR is a pathogenic factor of T2DM and NAFLD.2. The RBP4 level goes obviously higher in T2DM patients with or without NAFLD, and is positively correlated with BMI,HOMA-IR, WC,WHR,FFA, FPG,TC, and TG level, which clues to the onset of Overweight,IR and NAFLD.3. Free fatty acids in type 2 diabetic patients with nonalcoholic fatty liver disease was the highest of all, and is linear correlated with RBP4, suggesting that FFA is another important factor in this disease.