Relationship Between Cystatin C And Type2Diabetes Mellitus Combined With Nonalcoholic Liver Disease

ObjectiveDiabetes mellitus is a set of metabolic syndrome characterized by chronic increasing blood glucose level. In recent years, diabetes is widely prevalent all over the world. It has become the third chronic disease which brings serious health hazard for human just behind tumor and cardiovascular. Nonalcoholic fatty liver disease(NAFLD) and type2diabetes mellitus(T2DM) are both important components of the metabolic syndrome X, a number of studies have shown they are closely related to each other. Cystatin C(Cys-c) is also called cysteine proteinase inhibiting protein C,expressed in all nucleated cells, participating in a variety of cell protein hydrolysis regulation. Cys-c not only has closely relationship with T2DM, insulin resistance, metabolic syndrome, also refers to the degree of liver fibrosis of chronic liver disease, It links the glycometabolism, lipid metabolism and the process of chronic liver disease. However, few researches have focused on Cys-c and NAFLD in T2DM. The aim of our study is to analysis the relationship between Cys-c and T2DM complicated with NAFLD and its influencing factors, to preliminary discuss the role of cys-c in the pathophysiological mechanism of T2DM with NAFLD.To explore cys-c acting as serum marker to predict the poor prognosis of T2DM with NAFLD.MethodsFrom January1,2011to December31,2013,343patients diagnosed as T2DM were enrolled in this study by the department of endocrinology and metabolism of the Qilu Hospital, which was affiliated to the Shandong University School of Medicine. Among these objects,145were men and198were women, the average age was59.2±11.4,including208patients diagnosed as NAFLD (NAFLD group) and135patients diagnosed as non-NAFLD by B ultrasound(T2DM group), futhermore the NAFLD patients were differentiated into two groups(the mild group and the moderate to severe group). All the objects were collectted basic case history, measured height, weight, waist circumference, blood pressure on admission, determined liver and kidney function, blood lipids, blood glucose, uric acid, blood and urine routine, glycosylated hemoglobin, fasting C peptide, fasting insulin, urine trace albumin and other biochemical indicators in fasting state, examined by the fundus camera, nerve conduction velocity examination and calculated BMI, WHR, HOMA-IR, NAFLD fibrosis score. Use SPSS17.0software for statistical analysis of relevant data. Normal distribution data was expressed by mean±standard deviation, non-normal data was expressed by the median. Normal distribution measurement data’s comparison between the two groups used independent sample t-test. Non-normal distribution data used nonparametric test. Count data comparison between the two groups used X2test. The factors associated with Cys-c level used Spearman rank correlation analysis and multivariate linear regression analysis. The association between the degree of fatty liver and glycosylated hemoglobin, Cys-c,HOMA-IR used the spearman rank correlation analysis. Influence factors of NAFLD used two classification variable Logistic regression. Difference was statistically significant was defined by P<0.05.Results1. Compared with T2DM group, the patients of T2DM combined with NAFLD group were younger (P<0.05),BMI, WHR,DBP was higher(P<0.05)and they also had a higher percentage of insulin treatment than T2DM group (P<0.01). Patients of T2DM combined with NAFLD group had higher ALT,AST,GGT than DM group (P<0.01) and they also had higher TG、TC、FBG、FCP、HOMA-IR、ALB(P<0.05), but a lower HDL-C level than DM group (P<0.01)2. Correlation analysis between Cys-c and the other clinic indicator:There was a positive correlation between Cys-c and age,WC,Cr, urine microalbumin,SBP,UA, NAFLD fibrosis score. But further multivariate linear regression showed age, Cr, UA independently related to Cys-c.3. NAFLD fibrosis scores of NAFLD group was-0.53±1.22,according to the score standard11.06%of the patients had advanced liver fibrosis, while23.56%of the patients could except for advanced liver fibrosis.4. Dividing subgroups according to fat liver degree and using the spearman rank correlation analysis,the results showed patients with heavy fatty liver had higher BMI,WC,HOMA-IR than patients with mild fatty liver (P<0.05)5. Two classification variable multi-factor Logistic regression showed the independent risk factors of T2DM complicated with NAFLD included BMI,FCP,TG.6. Diabetic peripheral neuropathy of T2DM complicated with NAFLD apparently higher than the T2DM group (P<0.05)Conclusion:1. Compared to patients solely with type2diabetes,the patients of diabetes who complicated with NAFLD were more obese, especially abdominal obesity, insulin resistance was also more obvious, more severe chronic complications of diabetes, and had the potential liver damage.2. Cys-c had significant positive correlation with age, serum creatinine, uric acid in patients of T2DM.3. According to the score of NAFLD fibrosis model showed about one over ten of the patients with T2DM and NAFLD had advanced hepatic fibrosis.4. The independent risk factors of T2DM with NAFLD were BMI, FCP, TG.