Study On The Level Of SCD36 In Patients With Type 2 Diabetes Mellitus Complicated With Nonalcoholic Fatty Liver Disease

ObjectiveWith the prevalence of obesity and diabetes(DM),non-alcoholic fatty liver disease(NAFLD)has become a common metabolic disorder,and it is the most common chronic liver disease in China.NAFLD is a metabolic stress-induced liver injury associated with genetic susceptibility and insulin resistance(IR).NAFLD not only causes liver damage,but also is closely related to T2DM and atherosclerosis(AS).CD36 is one of the B-type scavenger receptors,which binds to ligands to exert tissue-specific effects and is involved in the evolution of clinical processes such as glycolipid metabolism,atherosclerosis,and diabetes.Serum secretory CD36(sCD36)can reflect the expression of CD36 in the body and can be detected by ELISA.The aim of this study was to analyze the levels of sCD36 in T2DM patients with NAFLD and T2DM alone and its related influencing factors,and to analyze the risk factors of liver fibrosis.MethodFrom November 2017 to June 2018,100 patients with T2DM diagnosed at the Department of Endocrinology,Affiliated Central Hospital of Shenyang Medical College,including 50 patients with NAFLD(group A)and 50 patients with T2DM alone(group B);Male and female are not limited;diabetic patients are in line with the diagnostic criteria for diabetes established by the WHO in 1999;NAFLD meets the diagnostic criteria for the revised guidelines for the diagnosis and treatment of nonalcoholic fatty liver disease in 2010;Exclude T1DM,acute complications of diabetes,chronic heart failure and liver and kidney dysfunction,history of cancer,pregnant and lactating women,history of drinking and drinking alcohol equivalent to men>140g/w or women>70g/w,alcoholic liver disease,Liver diseases caused by viral hepatitis and drugs(amiodarone,methotrexate,glucocorticoid,sodium valproate,etc.),poisons,etc.The patient's age,gender,family history,smoking status were recorded.The height,body mass,waist circumference(WC),hip circumference,arterial blood pressure(systolic blood pressure and diastolic blood pressure)of each patient were measured.Blood was collected from the elbow vein after fasting for 12 hours.Blood routine,fasting plasma glucose(FPG),fasting insulin(Fins),C-peptide,glycosylated hemoglobin(HbA1c),total cholesterol(TC),triglyceride(TG),High density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),uric acid(UA),glutamic acid aminotransferase(ALT),Asperate aminotransferase(AST),?-glutamyl.transpeptidase(?-GT),albumin(Alb)and high sensitive C-reactive protein(hs-CRP).Calculate body mass index(BMI)=weight/height(kg/m2),homeostasis model of assessment for insulin resistance index(HOMA-IR)=fasting insulin(mU/L)×fasting plasma glucose(mmol/L)/22.5,liver fibrosis score(NFS)=-1.675+0.037 ×age(years)+0.094 ×BMI(kg/m2)+1.13×impaired fasting glucose/Diabetes(yes=1,no=0)+0.99×AST/A LT-0.013 ×platelet count(×109/L)-0.66×albumin(g/dL),sCD36 levels were determined by ELISA.The expression levels of sCD36 in each group were compared,and the related influencing factors were analyzed,and the risk factors of liver fibrosis were analyzed.Result1.Comparison of clinical data between groups:There were no significant differences in gender,smoking history,family history,SBP,DBP between the two groups(P>0.05).The WC and BMI of group A were higher than those of group B,and the differences were statistically significant.The difference was statistically significant(P<0.05).2.T2DM combined with NAFLD group sCD36(6.25±1.94ng/dl),HOMA-IR(5.90±2.66),FINS(14.65±5.73mU/L),TG(3.21±1.48mmol/L),LDL-C(3.22)±0.95mmol/L),ALT(24.56±7.44 mmol/L),AST(19.02±8.58 mmol/L),?-GT(34.68±22.36mmol/L),hs-CRP(2.92±1.40mmol/L),UA(279±68.19mmol/L)was lower than T2DM group(4.18±2.19ng/dl),(4.89±1.84),(10.41±6.36 mU/L),(2.29±0.84 mmol/L),(2.88±0.66 mmol/L),(19.76±5.69 mmol/L),(16.84±5.92 mmol/L),(29.12±16.11 mmol/L),(2.42±0.94 mmol/L),(248±70.98 mmol/L)was high,and the difference was statistically significant(P<0.05);group A HDL-C(1.14±0.35 mmol/L)was lower than group B(1.25±0.41 mmol/L),and the difference was statistically significant(P<0.05);no statistical difference was found in other indicators.3.Correlation analysis showed that sCD36 was positively correlated with BMI,WC,HbA1c,HOMA-R,UA,ALT,TG and hs-CRP.Multiple linear regression analysis showed that UA,hs-CRP,HOMA-IR and TG were the influencing factors of sCD36.4.Multivariate logistic regression analysis showed that BMI,TG,HOMA-IR,UA,sCD36 were risk factors for the fibrosis.Conclusion1.Serum sCD36 levels in patients with T2DM and NAFLD were significantly higher than those in patients with T2DM alone.2.UA,hs-CRP,HOMA-IR,TG are the influencing factors of sCD36 in patients with T2DM and NAFLD.3.BMI,TG,HOMA-IR,UA,sCD36 are risk factors for liver fibrosis in patients with T2DM combined with nonalcoholic fatty liver disease.