Study On Related Factors Of Hospitalized Type 2 Diabetics With Nonalcoholic Fatty Liver Disease In Adults

Objective:To investigate related factors of hospitalized type 2 diabetic patients with nonalcoholic fatty liver disease(NAFLD) in adults, and analyze the risk factors and vascular lesions of type 2 diabetic patients with NAFLD, so as to provide theoretical evidence for prevention,diagnosis and treatment of NAFLD. Methods:To collect clinical datas of adults with type 2 diabetic patients who were in endocrinology department of Shaanxi provincial People's Hospital from December 2013 to May 2014. Based on the diagnosis and treatment guidelines of nonalcoholic fatty liver disease in 2010, a total of 302 subjects fulfilled the diagnostic criteria. According to the results of abdominal ultrasound diagnosis, patients were divided into two groups: T2 DM without NAFLD group(group A,n=135) and T2 DM with NAFLD group(group B,n=167). The contents of analysis included patient's general conditions, physical examination and laboratory tests, the general conditions included age and sex. The physical examinations included height, weight, waist circumference, hip circumference and blood pressure. The laboratory tests included blood glucose, insulin lever, glycosylated hemoglobin, hepatic transaminase, blood lipid, uric acid, cystatin C, retinol binding protein, homocysteine, fibrinogen, hypersensitive C-reactive protein, white blood count, microalbuminuria, thyroid function and other indicators. The incidence of vascular complications of the two groups were compared. Body mass index was calculated, insulin resistance index was obtained by using Homeostasis model assessment. All the datas were counted and analyzed with SPSS18.0 statistics software, the obvious test level ? is 0.05. Results:1. Comparison of the general situation and physical examination of two groups:Body mass index and waistline circumference of group B were significantly higher than group A, the difference was statistically significant(P<0.05). There was no significant difference between the two groups in gender, hip circumference, systolic blood pressure and diastolic blood pressure(P>0.05).2. Comparison of blood glucose, insulin level and insulin resistance of two groups:Fasting insulin, 2h insulin and insulin resistance index of group B were significantly higher than group A, the difference was statistically significant(P<0.05). There was no significant difference between the two groups in fasting plasma glucose, 2h plasma glucose and glycosylated hemoglobin(P>0.05).3. Comparison of liver enzymes and blood lipid of two groups:Alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transpeptidase and triglyceride of group B were significantly higher than group A, high density lipoprotein cholesterol and lipoprotein(a) of group B were significantly lower than group A, the difference was statistically significant(P<0.05). There was no significant difference between the two groups in alkaline phosphatase, total cholesterol, lower density lipoprotein cholesterol, apolipoprotein A and apolipoprotein B(P>0.05).4. Comparison of the other biochemical indicators of two groups:Uric acid, microalbuminuria, homocysteine, fibrinogen and high-sensitivity C-reactive protein of group B were significantly higher than group A, the difference was statistically significant(P<0.05). There was no significant difference between the two groups in cystatin C, retinol binding protein, microalbuminuria/Creatinine ratio, white blood count, triiodothyronine, thyroxine and thyroid stimulating hormone(P>0.05).5. Logistic regression analysis of risk factors of NAFLD:Logistic regression analysis showed that BMI, WC, ALT, TG, UA, Fg, HCY were risk factors for NAFLD.6. Comparison of vascular complications of two groups:The incidence of diabetic nephropathy, diabetic retinopathy, carotid atherosclerosis of group B was significantly higher than group A, the difference was statistically significant(P<0.05). There was no significant difference between the two groups in the incidence of diabetes peripheral neuropathy(P>0.05). Conclusion:1. The FINS?2hINS?HOMA-IR was higher in T2 DM patients with NAFLD, it suggests that insulin resistance is more obvious in T2 DM patients with NAFLD.2. The BMI and WC was higher in T2 DM patients with NAFLD, it suggests that obesity, especially abdominal obesity is risk factor for NAFLD.3. Compared with patients who were not combined with NAFLD, the levels of ALT, TG, UA, HCY, Fg were higher in the T2 DM patients with NAFLD, and those indexes were risk factors of patients with NAFLD, T2 DM patients should be tested the transaminase, blood cholesterol, uric acid, homocysteine, fibrinogen and other indexes periodically, early intervention and treatment of these indicators can prevent the occurrence and progress of NAFLD.4. The incidence of nephropathy, diabetic retinopathy and carotid artery atherosclerosis of diabetic patients with NAFLD was obviously higher than the diabetics without NAFLD, the meaning of the prevention and treatment of NAFLD is far greater than protecting the liver itself, the more important is to reduce the incidence of vascular complications.