| Objective: Recently, diabetes mellitus (DM) is the focus of human because of its increasing worldwide morbidity. Macroangiopathy is the leading cause of mortality and disability in diabetic patients whose pathophysiological base is atherosclerosis. Visfatin is a newly identified adipocytokine with a potential insulin-mimetic effect that may improve insulin sensitivity. Recent research has shown that plasma visfatin levels were significantly elevated in diabetic patients compared with healthy controls. It may play a role in inflammation. More attentions have been paid to the relationship between visfatin and vascular complications in patients with type 2 diabetes mellitus. Meanwhile, the carotid intima-media thickness (cIMT) is being used as a marker of early atherosclerosis. Increased IMT of carotid artery in ultrasonography has significantly related to the presence of chronic coronary artery disease (CAD). Determine of IMT with ultrasonography is an effective, noninvasive peripheral marker for atherosclerosis assessment. Several findings support the view that visceral fat thickness (VFT) might be a direct, reliable, and practical index for assessing the amount of visceral fat. VFT measured by ultrasonography is closely associated with metabolic syndrome(MS) and cardiovascular risks. It can be one of noninvasive ways in the collaborative diagnosis for MS. To date, the exact role of visfatin in humans remains largely unknown. The relationship between visfatin, IMT and VFT in patients with type 2 diabetes mellitus is not fully revealed. The aim of this study was to evaluate the plasma visfatin levels and investigate the relationships between visfatin, IMT and VFT, in order to evaluate the predictive value of visfatin for predicting the development of atherogenesis.Methods: Plasma visfatin level was measured by enzyme immunoassay and IMT of the carotid artery and VFT were determined by high resolution ultrasonography in 73 diabetic and 30 normal subjects. According to the IMT level, the diabetic patients were divided into two subgroups: atherosclerosis(AS) group(IMT>0.9 mm, 37cases) and non-AS group(IMT≤0.9 mm, 36cases). The course of disease, age, body mass index(BMI), glycosylated hemoglobin(HbA1c), systolic blood pressure(SBP), diastolic blood pressure(DBP), total cholesterol(TC), triglycerides(TG), high-density lipoprotein -cholesterol(HDL-C), low-density lipoprotein-cholesterol (LDL-C), fasting serum insulin(FINS), homeostasis model assessment for insulin resistance(HOMA-IR), waist circumference(WC), waist hip ratio(WHR), VFT, fasting blood glucose(FBG) and plasma levels of visfatin were measured respectively. The correlations between each variable and carotid IMT were analyzed. Also, the relationship between visfatin and IMT and other variables were investigated.Results:1. Comparison of clinical data among various groups. Compared with normal controls, VFT, FBG, TG, HDL-C, HOMA-IR, WC were markedly increased in the diabetic patients(P<0.05), HOMA-IR in AS group was significantly higher than that in non-AS group(P<0.05). The other variables did not differ significantly between the two groups.2. Comparison of plasma visfatin levels among various groups. The plasma visfatin levels were significantly increased in patients with type 2 diabetes compared with normal control subjects(39.81±10.91 ng/mL vs 24.46±7.18 ng/mL), P<0.01. The diabetic patients in AS group showed higher visfatin levels than that in non-AS group(44.95±10.14 ng/mL vs 34.52±9.08 ng/mL), P<0.01.3. Linear regression analysis between visfatin, IMT and various variables. Visfatin level was positively correlated with IMT(r=0.311, P=0.007), WC(r=0.233, P=0.047), WHR(r=0.289, P=0.013), VFT(r=0.336, P=0.004), FINS(r=0.369, P=0.001), HOMA-IR(r=0.322, P=0.005). IMT, VFT, FINS were the major influencing factors for the elevated plasma visfatin levels. IMT of the carotid artery was positively correlated with Age(r=0.246, P=0.036), course of disease(r=0.383, P=0.001), HbA1c (r=0.265, P=0.023) and visfatin level(r=0.311, P=0.007). Age, course of disease, HbA1c and visfatin level were the major risk factors for increased carotid artery intima-media thickness.Conclusion:1. High plasma visfatin may be involved to the type 2 diabetes development.2. The present data showed that plasma level of visfatin, markedly increased in diabetic patients with AS, was positively correlated with carotid IMT. Our results indicated that visfatin may play a role in the pathogenesis of AS. It may be one of possible risk factors of early atherosclerosis in the patients with type 2 diabetes mellitus.3. The plasma level of visfatin was correlated positively with VFT and HOMA-IR, suggesting the close relationship between visfatin and cardiovascular disease associated with insulin resistance and obesity.4. Plasma visfatin level, age, course of disease and HbA1c may be the independent risk factors for atherosclerosis in type 2 diabetes. |
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