Related Studies In Newly Diagnosed Type 2 Diabetic Patients With Abnormal Liver Enzymes

Objective:This study of clinical data in 56 cases of the newly diagnosed type 2 diabetic patients were retrospectively statisticed and analyzed,whose aim is to understand the correlation between the clinical changes of liver enzyme levels in blood serum and insulin resistance and other indicators.Which was designed to investigate whether there was necessary link between the liver enzyme’s abnormalities or not and insulin resistance in the newly diagnosed type 2 diabetic patients.Therefore,we can broaden our ideas and thoughts in the prevention and treatment of type 2 diabetes.Methods:Collected 56 cases of the newly diagnosed type 2 diabetic patients who were hospitalized in Endocrinology Departments of Yan’an University Affiliated Hospital in the period from August,2011 to January,2015.The standarded diagnosis and classification of diabetes were in accordance with those who were established by The World Health Organization(WHO) in 1999. In the group,there were 34 male patients and 22 females, male: female was 1.5: 1, aged 27 to 79 years, an average aage was 49 years old. According to abnormal liver enzymes in the laboratory check,they were divided into two groups, one is normal liver enzymes, a total of 40 cases, including 20 males and 20 females, male: female was 1: 1, with an average age of 49.22 ± 10.53 years, mean diabetic duration is 11.38 ± 11.15 months; the other one is abnormal liver enzyme of 16 cases, including 10 males and 6 females, male: female was 1.7: 1, with an average age of 48.80 ± 9.67 years, mean diabetic duration is 12.44 ± 11.50 months. All subjects were recorded: ① General information: gender, age, clinical presentation, duration of diabetes(DD)(ie, diagnosed with diabetes before significant symptoms or diagnosis of diabetes time), previous physical condition, drug use, Systolic blood pressure(SBP), diastolic blood pressure(DBP). the body indexes: Waist(WR), height, weight, and body mass ②index(BMI) = weight / height(kg / m2). biochemical ind③ icators: After all the subjects were in the fasting 12 h, in the next morning, venous blood serum that was separated by automatic biochemical analyzer were used to detect glycated hemoglobin(Hb A1c), triglyceride(TG), high density lipoprotein protein(HDL-C), uric acid(UA),cholesterol(TC), low-density lipoprotein(LDL-C), liver function contains alanine aminotransferase(ALT), aspartate aminotransferase(AST), total bilirubin(TBIL), direct bilirubin(DBIL),alkaline phosphatase(ALP),γ- glutamyl endopeptidase(GGT), total protein(TP), albumin(ALB), globulin(GLOBU), prealbumin( PALB),besides, before Glucose Tolerance Test-100 g standarded bread meal), 2 houres after it,sample and separation of serum fasting blood glucose(FBG), 2h postprandial blood glucose(PBG)fasting insulin(FINS), must be done, insulin resistance index(HOMA-IR) = FBG × FINS / 22.5, and the relevant checks must be done to determine whether there were abnormal liver function caused by other diseases. ④B ultrasound of liver. The statistical analysis of each index in the two groups was all from the application of SPSSl7.0 software.Results: 1.In the retrospective statistics of 4000 diabetes patients who were hospitalized in our hospital Within 4years,There were 425 cases of the newly diagnosed type diabetes, Excluding fatty liver,there were total 136 cases, which also excluded viral hepatitis, cirrhosis, liver cholelithiasis, diabetic ketoacidosis and ketones acidosis syndrome, infection, acute cerebral infarction, severe heart, pulmonary insufficiency and other cases, a total of 56 cases remained who in accordanc with qualification of our group.there were 34 male patients and 22 females, male: female was 1.5: 1, aged 27 to 79 years, an average aage was 49 years 2.Comparison with the two groups in the aspect of the basic information There was no significant difference between the sex constitutinal ratio and age of the data of two groups,they were comparable. The clinical manifestations, course(DD), systolic blood pressure(SBP), diastolic blood pressure(DBP), glycated hemoglobin(Hb A1c), body mass index(BMI), body weight(Wt), waist circumference(WR), and other means in the two groups,by statistical analysis, P> 0.05, the difference between the two was not statistically significant(P> 0.05).(See in Table 1) 3.The check of abnormal liver function in the data of type 2 diabetes In 56 cases of newly diagnosed type 2 diabetes, there were abnormal liver function in 19 patients(33.9%), 11 males and 8 females, aged 30-63 years, average age is 48.4 years. Manifestations of liver enzymes, bilirubinincreased and albumin decreased. Most of liver enzymes mildly elevated,the incidence was 28.6%(16/56), which mainly showed significantly elevated GGT, a total of 14 cases, increased to 1.5 times the upper limit of normal; ALT increased in 3 patients elevated to a more than 1 times the upper limit of normal, only AST was within the normal range; albumin decreased in 17 cases declined mildly; bilirubin with six cases, in addition to four cases increased significantly, the rest are for mildly elevated. All subjects related to liver injury almost had no specific clinical symptoms, only some patients had some symptoms those are in common with diabetes, such as fatigue, weight loss and other, there areless signs.(Seen in Table2) 4.Comparison with the two groups in the aspect of the biochemical information The high density lipoprotein- cholesterol(HDL-C) triglyceride(TG), low-density lipoprotein- cholesterol(LDL-C),total cholesterol(TC), and other means in the two groups,by statistical analysis, P> 0.05, the difference between the two was not statistically significant(P> 0.05)., the difference of the uric Acid(UA)between the two was statistically significant(P< 0.05).(See in Table 3) 5.Comparison of two groups in the blood glucose and Homeostasis model assessment insulin resistance index Fasting blood glucose(FBG) and 2-hour postprandial blood glucose(PBG) in the group of type 2 diabetes abnormal liver enzyme were significantly higher than those of normal liver enzymes,especially after a meal two hours increased more significantly, but there was no significant differenc showed within FBG, PBG, and fasting insulin(FINS)(P> 0.05); in the aspect of the level of insulin resistance between the two groups,here was significant insulin resistance between the group of abnormal liver enzyme and normal liver enzymes, insulin resistance of the adnormal one was significantly increased by comparation with the normal one, but there was no significant difference showed between the two groups(P> 0.05).(See in Table 4) 6.correlated analysis of the liver enzymes indexes The index of ALT、AST and GGT in the liver enzymes were sapatarely did with all of the clinical index which contained duration of diabetes(DD)、Systolic blood pressure(SBP), diastolic blood pressure(DBP)、 Waist(WR), weight, and body mass index(BMI) 、glycated hemoglobin(Hb A1c),、insulin resistance index(HOMA-IR) 、uric acid(UA)、blood glucose、blood fat and so on by Pearson correlation analysis,which showed: The relationship of ALT with Hb A1c、DD、HDL-C、LDL-C、TG、TC、HOMA-IRI was positively correlated,and with age、Waist(WR)、BMI、Systolic blood pressure(SBP), diastolic blood pressure(DBP)、Fasting blood glucose(FBG)、 and 2-hour postprandial blood glucose(PBG) 、 fasting insulin(FINS) was negatively correlated, only the positive correlation between ALT and HOMA-IRI was statistically significant(P<0.05);The relationship of AST with Hb A1c、age、WR、BMI、DBP、HDL-C、LDL-C、PBG、TG、TC was positively correlated,with DD、SBP、FBG、FINS、HOMA-IRI was negatively correlated,only the positive correlation between AST with TG was statistically significant(P<0.05);The relationship of GGTwith Hb A1c、WR、BMI、SBP、DBP、FBG、LDL-C、FINS、HOMA-IRI、TG、TC was positively correlated,With age、DD、HDL-C、PBG was negatively correlated,Only e positive correlationwith GGT and Hb A1c、SBP、DBP、FINS was statistically significant(P<0.05)。(see in Table 5)Conclusions: 1.Type 2 diabetes in this group had comparitivly high detection rate of abnormal liver function, liver enzyme abnormalities was also had highe detection rate(28.6%). 2.The course of diabetes、glycosylated hemoglobin,waist circumference,body weight, body mass index,lipid and insulin levels of the disease in the group of newly diagnosedin type 2 in patients with hepatic enzyme abnormalities showed no significant difference between the normal one of liver enzymes.In the aspect of Triglyceride levels,the abnormal liver were higher than the normal group,the difference was not statistically significant.As to blood uric acid levels,liver enzyme abnormalities were significantly higher than normal liver enzymes group,there was a significant difference. 3.The two groups had no significant differences between insulin resistance,insulin resistance was an obvious phenomenon,but in some ages, degrees of insulin resistance were different, the insulin resistance most severe. 4.In the newly diagnosed type 2 diabetes,ALT and homeostasis model HOMA-IRI was positively correlated;AST and TG were positively correlated;GGT and Hb A1 c,SBP,DBP, FINS were positively correlated.Through this study,we should pay close attention to indicators of liver enzymes in newly diagnosed type 2 diabetes and keep abreast of insulin resistance, as well as blood uric acid level, so that,we can obtain timely guidance tand adjust clinical treatments stratgies.