The Clinical Characteristics And Risk Factors Research Of LADA With NAFLD

BackgroundsDiabetes is one of the most common metabolic disorders,and with the improvement of living standards and the change of life style,the prevalence of diabetes has been increasing.The diabetes patients are 415 million in the world,which will be estimated about 642 million in 2040.In 1977,Irvine et al reported that islet autoantibodies were detected in patients with type 2 diabetes,and Tuomi named this type of diabetes as latent autoimmune diabetes in adults(LADA).The main feature of the LADA is that glutamic acid decarboxylase antibody(GADA)was positive.The pathogeny of LADA classified as type 1 diabetes is related to autoimmunity.But compared with typical type 1 diabetes,the age of onset was older and the process of insulin-dependent was slow in LADA.Diabetes and nonalcoholic fatty liver disease are both components of the metabolic syndrome,and insulin resistance is the common pathological basis.Nonalcoholic fatty liver disease(NAFLD)covers a range of conditions from simple steatosis to non-alcoholic steatohepatitis(NASH)and cirrhosisand,even hepatocellular carcinoma.NAFLD is a common cause of chronic liver disease worldwide.Recently,a large number of studies showed that NAFLD was a multisystem disease which not olny damaged liver tissue,but affects the extrahepatic system,such as heart and blood vessels."Two hit" theory plays a dominant role in the pathogenesis of NAFLD.Recently studies showed that insulin resistance was associated with NAFLD.A large number of clinical observation showed that the prevalence of NAFLD in patients with type 2 diabetes was 55-70%,and the initial stage of LADA was easily misdiagnosed as type 2 diabetes mellitus,so some type 2 diabetes with NAFLD might be LADA with NAFLD.The relation between type 2 diabetes and nonalcoholic fatty liver disease was supported by a large number of basic and clinical studies,but clinical research on LADA with NAFLD is rarely reported.ObjectiveTo explore clinical features and related factors of LADA with NAFLD and T2 DM with NAFLD;to analyze clinical features and risk factors of LADA with NAFLD and simple LADA.Methods109 patients with LADA were collected in the hospitalized patients of the First Affiliated Hospital of Zhengzhou University from June 2013 to June 2016,62 of which were LADA with NAFLD,and 47 were simple LADA.144 type 2 diabetes with NAFLD were selected in the same period.General informations of all patients were recorded,including duration of disease,height and weight,then calculating body mass index(BMI);the levels of indicators such as alanine aminotransfera(ALT),aspartate aminotransferase(AST),cholesterol(T-CHO),high density lipoprotein(HDL),low density lipoprotein(LDL),glycosylated hemoglobin(HbAlc),fasting C-pepitide(FC-P),2 hours C-pepitide(2hC-P),glutamic acid decarboxylase antibody(GADA),islet cell antibody(ICA),insulin autoantibody(IAA)were measured.The data of complications of diabetes patients were collected.Statistical analysis of the data used in this research are carried out using SPSS21.0 software package,and p<0.05 was considered statistically significant difference.Results1.Of 109 patients with LADA,62 were LADA with NAFLD(56.88%)and 47 were simple LADA(43.12%).2.The duration of disease,BMI and systolic blood pressure in LADA with NAFLD were lower than T2 DM with NAFLD(P < 0.05);TG,TC and LDL in LADA with NAFLD was lower than T2 DM with NAFLD,but the differences were not statisticantly significant(P > 0.05);the differences of FC-P,Homa-IR and Homa-islet between T2 DM with NAFLD group and LADA with NAFLD group have no statistical significance(P > 0.05);the incidence of peripheral vascular disease in LADA with NAFLD group were lower than that of T2 DM with NAFLD group(P < 0.05).3.Compared with simple LADA group,BMI,diastolic pressure,ALT,TG,FC-P,2hPG,Homa-IR and Homa-islet of LADA with NAFLD group were higher(P<0.05),tthe incidence of hypertension,peripheral vascular disease and retinopathy in LADA with NAFLD group were higher than that of simple LADA group(P < 0.05).4.in patiens with LADA,NAFLD as the dependent variable,age,gender,disease duration,BMI,TC,TG,LDL,HDL and FC-P as independent variables,multiple regression analysis based on logistic,high TG,high FC-P are the risk factors of LADA with NAFLD.Conclusions1.The prevalence of NAFLD in LADA was higher;the BMI of LADA with NAFLD was lower than that of T2 DM with NAFLD,but there were similar insulin resistance and lipid metabolism.2.Compared with simple LADA,the levels of C peptide was higher in LADA with NAFLD whoes insulin resistance and dyslipidemia were more severe.3.High TG and high C peptide were risk factors for LADA with NAFLD.