| Objective:With a high incidence of Nonalcoholic Fatty Liver Disease (NAFLD), adipose tissue has been re-recognized as an important endocrine organ, which can promote pro-inflammatory adipocytokine release and decrease anti-inflammatory adipocytokine release. The functions of adipocytokines have played an important role in the pathogenesis of insulin resistance, type 2 diabetes and NAFLD.It has already been confirmed that Tumor necrosis factorα(TNFα) can cause NAFLD.Retinol-binding protein 4 (RBP4) is a newly discovered adipocytokine which aslo can lead to NAFLD, but the study about the relationship of RBP4 and NAFLD has not been much reported in the word. The aim of study was to investigate(1)Pathogenesis of NAFLD was induced by RBP4.(2)The relationship between RBP4 and NAFLD.(3)The relationship between RBP4 andβ-cell function (HOMAβ).Methods:(1)Based on the Chinese Medical association for the Study of Liver Diseases in 2006《Guidelines for diagnosis and treatment of nonalcoholic fatty liver disease》,the patients were divided into not complicated with NAFLD (NO-NAFLD) and complicated with NAFLD(NAFLD).Then according to WHO type 2 diabetes diagnosis standard in 1999,the patients were divided into 4 groups: 34 not complicated with nonalcoholic fatty liver disease and normal glucose regulation(NONAFLD-NGR),32 not complicated with nonalcoholic fatty liver disease and type 2 diabetes(NONAFLD -T2DM), 32 complicated with nonalcoholic fatty liver disease and normal glucose regulation(NAFLD-NGR), 31 complicated with nonalcoholic fatty liver diseases and type 2 diabetes(NAFLD-T2DM).(2)Venous blood samples were collected in the moring,serum were frozen and stored at -70℃, RBP4 was determined by ELISA method and TNFαwas determined by radioimmunity.(3)All the patients detected: height,weight,body mass index(BMI),waist circumference(W),systolic blood pressure(SBP),diastolic blood pressure(DBP),triglyceride(TG),cholesterol(TC),low density lipoprotein(LDL),high density lipoprotein(HDL),aspartate aminotransferase(AST),alanine aminotransferase(ALT),renal function.(4)75g oral glucose tolerance test (OGTT) was performed in all the patients,which can detect Fasting blood glucose(FPG),Fasting insulin(FIns),insulin resistance index(HOMA-IR),HOMAβand Glucose disposition index(DI).(5)Abdominal ultrasonography was measured by one chief physician using the same color doppler ultrasonography.(6) SPSS 13.0 was used to do the statistical analysis,data was expressed by mean number±standard deviation( x±S) , non-normal data can be analyzed after logarithmic conversion. Variance analysis was applied in the comparison among many groups. Simple correlation and multiple stepwise dygression analysis was used in my study.Results:1 There was no significant differences in the constituent ratio of age and sex among the four groups(P>0.05).2 RBP4 was higher in NAFLD-NGR group and NAFLD- T2DM group than in NO NAFLD-NGR group and NO NAFLD -T2DM group(P<0.01 or P<0.05). There was no difference between NAFLD-NGR group and NAFLD-T2DM group, and was no difference between NO NAFLD-NGR group and NO- T2DM group(P>0.05).3 BMI and W were the lowest in NONAFLD-NGR group among the four groups.And they were higher in NAFLD-T2DM group than in NONAFLD-T2DM group(P<0.01).4 TNFαwas the lowest in NONAFLD-NGR group among the four groups, NAFLD-T2DM group was the highest(P<0.01), There was no difference between NONAFLD-T2DM group and NAFLD-NGR group(P>0.05).5 FIns was the highest in NAFLD-NGR group among four groups(P<0.01). There was no difference among other three groups(P>0.05).6 HOMA-IR was the lowest in NONAFLD-NGR group among the four groups(P<0.01), it was higher in NAFLD-T2DM group than in NONAFLD-T2DM group(P<0.01).7 HOMAβwas the highest in NAFLD-NGR group among four groups(P<0.01), and it was the highest in NONAFLD-NGR group among NONAFLD-NGR group,NAFLD-T2DM group and NONAFLD-T2DM group(P<0.01). But there was no difference between NAFLD-T2DM group and NONAFLD-T2DM group(P>0.05).8 DI was higher in NAFLD-NGR group and NONAFLD-NGR group than in NAFLD-T2DM group and NONAFLD-T2DM group(P<0.01),There was no difference between NAFLD-NGR group and NONAFLD-NGR group(P>0.05), DI was higher in NONAFLD-T2DM than in NAFLD-T2DM group(P<0.01).9 TG was the lowest in NONAFLD-NGR group among the four groups, NAFLD-T2DM group was the highest(P<0.05 or P<0.01). There was no difference between NONAFLD -T2DM group and NAFLD-NGR group(P>0.05).10 SBP was the lowest in NONAFLD-NGR group among the four groups(P<0.01), There was no difference among NAFLD-NGR group,NAFLD-T2DM group and NONAFLD-T2DM group(P>0.05).11 Simple correlation: RBP4 was positively correlated with BMI,W,FIns,lnHOMA-IR,AST,TG,SBP(r=0.311,0.410,0.213,0.307,0.301,0.331,0.313). lnHOMAβwas positively correlated with Fins(r=0.685),but lnHOMAβwas negatively correlated with FPG,TG,TNFα(r=-0.815,-0.292,-0.440). 12 RBP4 was positively correlated with TNFα(r=0.295).13 The results of multiple stepwise dygression analysis: W,TG,SBP were the independent risk factors of RBP4(r2=0.168,0.217,0.252). FIns,FPG,age,lnHOMA-IR and TNFαwere the independent risk factors of HOMAβ. (r2=0.664,0.934,0.936,0.939,0.943).conclusions:1 RBP4 was higher in NAFLD-NGR group and NAFLD- T2DM group than in NO NAFLD-NGR group and NO NAFLD -T2DM group.2 RBP4 was positively correlated with TNFα.They may play cooperative role with each other in the development and progression of NAFLD.3 Obesity,Hyperinsulinemia,Lipid metabolic disorder,Hypertension,HOMA-IR and TNFαare the pathogenesis of NAFLD,which can be induced by RBP4.4 RBP4 was not correlated with glucose metabolism. Lipid metabolic disorder may be deteriorated by glucose metabolism,which has an indirect effect on the development of NAFLD.5 RBP4 was not directly affect HOMAβ, FIns,FPG,age,lnHOMA-IR and TNFαwere the independent risk factors of HOMAβ. |
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