| Background：Non-alcoholic fatty liver disease (NAFLD) refers to aclinical and pathological syndromethe which the main feature is diffusebullous fatty liver cells,in addition of ethanol-induced liver damage and otherspecific factors.According to the degree of hepatic steatosis, inflammationand fibrosis, NAFLD is divided into simple fatty liver, steatohepatitis, hepaticfibrosis and liver cirrhosis.The pathogenesis of NAFLD is not yet entirely clear,the present studysuggests that the incidence of NAFLD is closely related with insulin resistance,lipid metabolism, lipid peroxidation and other factors.Recently, some scholarsbelieve that the changes of the gut flora can directly regulate expression ofgene related to body fat synthesis and storage,Influences energy absorptionand storage,so it can impact energy metabolism through the mechanisms suchas promoting the formation of obesity and insulin resistance.And in this way,the gut flora participate in the development and progression of NAFLD[1].The gene of fasting-induced adipose factor（Fiaf）is responsible forencoding lipoprotein lipase (LPL) inhibitor.LPL can hydrolyze triglyceridesin lipoprotein particles, thereby it can promote the lipid deposition. Fiaf caninhibit triglyceride cycle through through inhibition of LPL.Research hasshown that in animals,Fiaf may be regulated by intestinal flora,an increase inE. coli can inhibit the expression of Fiaf, increased expression of LPL andpromote the lipid deposition,but the specific mechanism needs to be studiedfurther.[2,23]Also studies show that the peripheral blood Fiaf of patients withtype2diabetes decreases,and is associated with insulin resistance.[24]Therefore,we preliminary study the change of intestinal flora in patients withNAFLD,and whether it is related to Fiaf factor and insulin resistance.Objective: to detect the changes of intestinal flora in patients with NAFLD, detect the serum levels of Fiaf factor,Analysis the correlation of theintestinal flora, Fiaf factor and insulin resistance.To explore intestinal flora’s role in the development of NAFLD.Methods: in this study we collected30patients with NAFLD which isdiagnosis through the clinical, laboratory, B ultrasonic in our hospital clinicand a medical department as the case group,30healthy volunteers as controlgroup.The diagnosis of NAFLD according to nonalcoholic fatty liver diseasediagnosis and treatment guidelines which is developed by the Chinese medicalassociation branch of hepatology fatty liver and alcoholic liver disease groupIn2010.[3]All the research object except for the recent use intestinal probiotics,yogurt, and use of antibiotics which may affect the preparation of intestinalflora.Measure height, weight and abdominal circumference of twogroups,calculate BMI. Five kinds of typical bacteria in intestinal flora werecultured quantitatively by the method established by Mit-suoka,and Countedthe number respectively.Collected serum samples of all subjects,we detected serum levels of ALT, AST, CHOL, TG, LDL,FPG,FINS,calculated homeostatic model assessment-insulin resistance(HOMA-IR). Detect plasma Fiaf mRNA expression of two groups byRT-PCR.According to test results, analyzed the correlation of the intestinalflora changes, serum levels of Fiaf and insulin resistance.Results:1The two groups of intestinal flora numbercomparison:Compared with control group,the number of Proteus spp andenterococcus in NAFLD group was significantly increased(9.20±0.20vs8.73±0.41，7.70±0.55vs7.18±0.36，P＜0.05), the number of Bifidobacterium,Bacteroides,Lactobacillus were significantly decreased(8.89±0.28vs9.16±0.22，7.29±0.36vs7.94±0.15，9.21±0.36vs9.76±0.22，P＜0.05)2Thetwo groups of age, sex, BMI, abdominal circumference comparison:There isnonsense in age, sex differences in the two groups（P>0.05）,Compared withthe normal control group, abdominal circumference, BMI of NAFLD groupstudy were significantly increased(90.5±8.86vs81.67±8.89，27.42±3.14vs24.22±2.37， P＜0.05）3The two groups of serological indicator comparison:Compared with the normal control group,the ALT（37.75±29.93vs11.17±1.72）, AST（27.96±18.99vs10.83±1.47）, CHOL（5.17±0.80vs4.44±0.54）, TG （2.16±1.04vs0.94±0.41） of the case group weresignificantly increased,P＜0.05;the Fiaf of the case group were significantlydecreased(1.21±0.05vs1.26±0.03，P＜0.05),but the HOMA-IR of the casegroup were significantly increased（4.91±1.21vs2.86±0.51，P＜0.05）.Therewas no statistically significant difference in the two groups of LDL.4Correlation Analysis:In five kinds of intestinal flora, there was only thenumber of proteus spp and the serum mRNA expression level of Fiaf wassignificant negative correlation（r=-0.734，P<0.01）,and the serum mRNAexpression level of Fiaf and HOMA-IR was significant negative correlation（r=-0.819，P<0.01）,the number of Proteus spp was positively correlated withHOMA-IR（r=0.614，P<0.01）.Conclusion:1There was intestinal flora imbalance in the patients withNAFLD, manifested as the number of Bifidobacterium, Bacteroides andLactobacillus were reduced, but the number of Proteus spp and Enterococcusincreased.2The number of proteus spp and the expression level of Fiaf factorwas significantly negative correlation, but was positively correlated withHOMA-IR.The expression level of Fiaf factor and HOMA-IR wassignificantly negatively correlated.3The above shows that in the process ofthe pathogenesis of NAFLD, intestinal flora imbalance and IncreasingEnterobacteriaceae caused IR, participated in the occurrence and developmentof NAFLD,because of inhibiting the expression of Fiaf factor Possibility. |
