Relavant Research Of Type 2 Diabetes Mellitus With Non-alcoholic Fatty Liver Fibrosis

[Object] To analyze the risk factors of type 2 diabetes mellitus(T2DM) with non-alcoholic fatty liver disease(NAFLD), and to explore the possible relative risk factors correlated with non-alcoholic fatty liver fibrosis.[Methods] Referring to the 1999 WHO diagnostic criteria of T2 DM, We selected 140 patients with T2 DM in the in-patient department, carefully recording their age, gender, duration of diabetes. We enquired their drinking history, measured their height, weight, waist circumference(WC), calculating their Body Max Index(BMI), BMI = weight(kg) / height2(m2). Referring to the Chinese revised edition of non-alcoholic fatty liver disease diagnosis and treatment guidelines in 2010, we chose liver ultrasound to diagnose NAFLD. All the patients were divided into two groups,the T2 DM with NAFLD(group A,77patients) and the T2 DM without NAFLD(group B,63 patients). We used SPSS 20.0 to make a statistical analysis,comparing the age, WC, course of diabetes, hemoglobin A1C(Hb A1C), fasting blood glucose(FBG), blood fat, blood pressure, liver enzyme, uric acid(UA), cystatin C(C ys C) of the two groups. Independent-samples t test was used to analyze data according with normal distribution, non-parametric test was used to analyze data that didn't complied with normal distribution. We selected Logistic regression to analyze the risk factors of NAFLD, which P<0.05 indicated a significant difference. N FS =-1.675 + 0.037*age(years) + 0.094*BMI(kg/m2) + 1.13*IFG / diabetes(yes:+ 1, no:+ 0) + 0.99*AST /ALT?0.013*PLT(*10^9) ?0.66*albumin(g/dl). We calculated Non-alcoholic liver Fibrosis Score(NFS) of every patients with N AFLD, NFS > 0.676 indicatedprogressive hepatic fibrosis, NFS<?1.455 excluded progressive hepatic fibrosis. We subdivided patients of group A into two groups,T2 DM with light grade NAFLD(group C, 52 patients) and T2 DM with middle grade NAFLD(gro up D, 25patients). Age, waist, BMI, course of diabetes, FBG, Hb A1 C, liver enzyme, blood fat, blood pressure, UA, C ys C, NFS were compared of the two groups. We use Spearman correlation analysis to explore the correlation between NFS and FBG, Hb A1 C, TC, TG, LDLC, HDLC, UA, WC, BMI, course of diabetes, systolic pressure, diastolic pressure,also with Cys C level.[Results](1)Compared with group B(T2DM without NAFLD),group A(T2DM without NAFLD) had higher level of TC, TG, LDLC, ALT, AST, GGT, UA, WC, BMI, diastolic pressure,lower level of age. FBG, Hb A1 C, Cys C, HDLC, course of diabetes, systolic level showed no statistical difference of the two groups.(2)Logistic regression results indicated that TG(OR 1.853,95%C L 1.032-3.328), BMI(OR 1.398, 95%CL 1.054-1.854), WC(O R 1.114, 95%C L 1.002-1.238) were the independent risks factors of T2 DM with NAFLD.(3)Compared with patients with light grade NAFLD, patients with middle grade NAFLD had higher level of ALT, AST, BMI, WC, diastolic pressure, lower level of age and duration of diabetes,while NFS, Cys C level and other va riables showed no difference.(4)According to the NFS,9.1% enrolled patients developed progressive fibrosis,26% excluded progressive fibrosis,while 64.9% patients felled in between.(5)Spearman correlation analysis showed NFS demonstrated remarkable positive correlation with course of diabetes(r=0.352), WC(r=0.258), diastolic pressure(r=0.242), Cys C(r=0.389).[Conclusion](1)TG, waist, BMI were the independent risk factors of type2 diabetes with N AFLD.(2)ALT, AST, waist, BMI and diastolic pressure were closely related with liver steatosis progress. Patients with more serious liver steatosis showed younger age and shorter duration of diabetes, maybe because they had not implement adequate lifestyle and medicine intervention to change the poor condition of their liver.(3)The NFS showed no difference between light grade NAFLD and middle grade NAFLD, it indicated that liver fibrosis maybe not in parallel with liver fat content.(4)Course of diabetes, WC, diastolic pressure, Cys C level showed significant positive correlation with NFS, maybe they were promoting factors of progressive hepatic fibrosis of NAFLD.