Association Between Serum 25(OH)D Levels And Hepatic Advanced Fibrosis In T2DM Patients Complicated With NAFLD

Objective: The purpose of this study is to analyze the association between serum25-hydroxyvitamin D [25(OH)D] and NAFLD Fibrosis Score(NFS),anthropometric parameters and biochemical parameters,and to investigate the relationships between serum25(OH)D and type 2 diabetes mellitus(T2DM)complicated with nonalcoholic fatty liver disease(NAFLD)and hepatic advanced fibrosis.Methods: A cross-sectional survey was performed in hospitalized T2 DM complicated with NAFLD(group NAFLD,380 cases)and hospitalized T2 DM without NAFLD(group DM,130 cases),affiliated hospital of Zunyi medical college,between October 2014 and March 2016.According to the results of NFS,group NAFLD were divided into three groups,group NFS>0.676 was diagnosed with hepatic advanced fibrosis,group NFS<-1.455 was used to exclude hepatic advanced fibrosis,and group NFS=-1.4555 ~ 0.676 is not clear whether there is progress of hepatic fibrosis.In addition,healthy people who underwent physical examination in our hospital physical examination center were taken as normal control group(group NC,130 cases).The demographic information,history of present illness,past history,anthropometric parameters,abdominal color Doppler ultrasonography,25(OH)D,blood routine,liver and kidney function,glycolipid metabolism and other related biochemical parameters was collected in all subjects to calculate body mass index(BMI),and in group NAFLD to calculate NFS.Results:(1)Comparison of clinical characteristics of group NAFLD,group DM and group NC: AST/ALT and SCr were lower than those in group DM(P<0.05).FC-P and2 h C-P were higher than thoese in group DM(P<0.05).BMI,WC,HC,ALT,AST,SUA,Hb A1 c,TG were higher than group NC and group DM(P<0.05),while Apo A1 was lower than group NC and group DM(P<0.05).In group DM and group NAFLD,WC,SBP,Hb A1 c,FPG and 2h PG were higher than those in group NC(P<0.05),while PLT,ALB,HDL-C and Apo A1 were lower than those in group NC(P < 0.05).In group NAFLD,25(OH)D levels were significantly lower than that in group DM and group NC(P<0.05).(2)There were 106 patients(27.89%)in group NFS>0.676,240 patients(63.16%)in group NFS=-1.4555 ~ 0.676,and 34 patients(8.95%)in group NFS <-1.455;(3)Comparison of clinical characteristics of group NAFLD which was grouped according to NFS: diabetes duration,age,BMI,AST/ALT,SCr and SCys-C in the other two groups were lower than those in group NFS> 0.676(P<0.05),while DBP,RBC,HGB,ALT,ALB and 25(OH)D were higher(P<0.05).A/G in group NFS>0.676 was lower than that in group NFS=-1.455 ~ 0.676(P<0.05),while SUA was higher(P<0.05).In group NFS<-1.455,age,diabetes duration,BMI,and Apo A1 were lower than those of the other two groups,while PLT was higher(P<0.05).HC and HDL-C were lower than those in group NFS>0.676(P<0.05).(4)In group NAFLD,25(OH)D was positively correlated with ALB and Ur(P<0.05),and negatively with 24 h MAU,AST/ALT and Apo A1(P<0.05);(5)NFS was positively correlated with SCr,SCys-C,24 h MAU(P<0.05),and negatively with 25(OH)D,ALT,A/G(P<0.05);(6)Linear regression analysis for the influencing factors of 25(OH)D in group NAFLD showed that,Y=-1.244-1.385X1 +0.386X2-0.01X3(Y:25(OH)D;X1:AST/ALT:X2:Ur;X3:24h MAU),(R2)=0.114,(F=9.588,P<0.01).25(OH)D was positively correlated with Ur,and negatively correlated with AST/ALT and24 h MAU.(7)Logistic regression analysis for influencing factors of NFS in group NAFLD showed that,25(OH)D and ALT were the independent protective factors of hepatic advanced fibrosis,while SCr was its independent risk factors.Conclusion: The detection rate of hepatic advanced fibrosis in T2 DM patient with NAFLD was approximately 27.89%,by applying NAFLD Fibrosis Score.The proportion of subjects who can be excluded from advanced fibrosis was only 8.95%.Serum vitamin D levels were lower in T2 DM patients complicated with NAFLD.Vitamin D deficiency may increase the risk that hepatic advanced fibrosis occured.