| Objective:Nonalcoholic fatty liver disease (NAFLD), which is a liver cell diffuse fatty degeneration and fatty accumulation as the pathological features, related with genetic-environment-metabolic stress related, but there was not clinical history of excessive alcohol syndrome. Ranging from simple steatosis to steatohepatitis, fatty liver cirrhosis and hepatocellular carcinoma. Fat storage is a less process of disease, steatohepatitis is a recognized cause of fatty liver cirrhosis and hepatocellular carcinoma. Most of NAFLD did not accompanied by symptoms. People often found some defects of the liver by physical examination or medical check-up of other diseases, then he had to go to the hospital. A great number of studies have shown that insulin resistance (IR) was the center of the pathogenesis of NAFLD, and type 2 diabetes (T2DM) was one of the most common causes of NAFLD. In recent years, along with the increasing incidence of T2DM, as well as improving awareness of fatty liver year by year, detection rate of T2DM complicated with NAFLD is getting higher and higher.Serum amyloid A (SAA), as a new inflammatory adipocytokine, which can trigger human adipose tissue localized inflammatory response, and cause chronic low-grade systemic inflammation, result in IR of liver, skeletal muscle and vascular endothelial tissue. At present, it is confirmed that the level of SAA in T2DM patients is significantly increased, and is closely related to IR. As regards the relationship between SAA and NAFLD, there is no relevant reports in the domestic. we investigate the relationship between the level of SAA and IR in patients of T2DM, NAFLD and T2DM complicated with NAFLD, to explore the meaning and role in pathogenesis of T2DM combined NAFLD.Methods:The patients were selected from in-patients of department of endocrinology in our hospital from january 2008 to september 2008. A total of 30 (14 males and 16 females, age 51.13±9.49) patients of T2DM combined with NAFLD group (T2DMN group), and 32 (17 males and 15 females, age 51.81±11.03) patients of T2DM not merged with NAFLD group (T2DM group) were entered into study. Collecting 32 cases of NAFLD (18 males and 14 females, age 49.63±8.81) whose blood glucose were normal (NAFLD group), and 30 cases of healthy people as a normal control group (NGT group) in the medical examination center of our hospital. T2DM was in line with the 1999 WHO diagnostic criteria for diabetes, NAFLD diagnosis based on 2006 Chinese Medical Association Society for the development of liver disease at the "non-alcoholic fatty liver disease clinics Guide". NAFLD group and normal control group were given oral glucose tolerance test to exclude glucose abnormality. All subjects were excluded viral liver disease, alcoholic liver disease, drug-induced liver disease, autoimmune diseases, acute infections, acute coronary syndrome, severe acute and chronic complications of diabetes; meanwhile, those objects were ruled out the possibility of long-term oral Thiazolidinediones drugs, statins and fibrates drug. SAA was examined by enzyme linked immunosorbent assay (ELISA), tumor necrosis factor-alpha (TNF-α) was examined by radiation immunology, at the same time, we detect the clinical indicators in each group too.Results:1 There were no difference in age and sex in the four group (P>0.05); Compared with control group, the body mass index (BMI), waistline (WAL) and waist-hip ratio (WHR) values in patients of T2DMN group and NAFLD group were higher, the differences have statistical significance (P<0.01), in patients of T2DM group, WAL and WHR values were higher too, but the differences of BMI value have not statistical significance. Compared with NGT group, the SBP value was increased significantly in patients of T2DM group, T2DMN group and NAFLD group, the DBP value of T2DMN group and NAFLD group was higher than NGT group, the differences have statistical significance (P<0.01).2 The alanine aminotransferase (ALT) level and the aspartate amino transferase (AST) level in patients of T2DMN group and NAFLD group were significantly higher than NGT T2DM, T2DMN and NAFLD group was significantly higher than NGT group (P<0.01), the TG level in patients of T2DMN was significantly higher than T2DM group (P<0.05); Compared with NGT group, there was no difference in total cholesterol (CHOL) level in the four group (P>0.05), the high-density lipoprotein cholesterol (HDL-C) level in patients of T2DM, T2DMN and NAFLD groups was decreased significantly than NGT group (P<0.05 or P<0.01); Compared with NGT group, the low-density lipoprotein cholesterol (LDL-C) level in patients of NAFLD was increased significantly (P<0.01), but the difference of LDL-C level between T2DMN and T2DM groups was not statistical significance. The fasting insulin (FIns) level in patients of T2DMN and NAFLD groups was increased significantly (P<0.01).3 The SAA and TNF-αlevels in patients of T2DM, T2DMN and NAFLD group were significantly higher than NGT group (P<0.01); Compared with T2DM group, the TNF-αlevel were significantly increased in patients of T2DMN group (P<0.05).Compared with NGT group, HOMA-IR value increased significantly, and insulin sensitivity index (ISI) value decreased significantly in patients of T2DM, T2DMN and NAFLD groups, and the differences were significantly (P<0.01). Compared with T2DM group, HOMA-IR value increased significantly, and ISI value decreased significantly in patients of T2DMN group too (P<0.05), but there was no difference between T2DM group and NAFLD group.4 Correlation and regression analysis of showed that HOMA-IR (r=0.397, P<0.01), TNF-α(r=0.480, P<0.01), BMI (r=0.231, P<0.05), WAL (r=0.389, P<0.01), WHR (r=0.332, P<0.01), ALT (r=0.203, P<0.05), TG (r=0.366, P<0.01), fasting plasma glucose (FPG) (r=0.328, P<0.01), postprandial plasma glucose (2hPG) (r=0.331, P<0.01) and FIns (r=0.223, P<0.05) were positively correlated with SAA, in addition, HDL-C (r=-0.330, P<0.01) and ISI (r=-0.397, P<0.01) were negatively correlated with SAA. Multiple regression analysis showed that TNF-α, TG and HOMA-IR were the independent related factors of SAA .The level of TNF-αwas positively correlated with HOMA-IR (r=0.524, P<0.01), BMI (r=0.289, P<0.01), WAL (r=0.410, P<0.01), WHR (r=0.344,P<0.01), ALT (r=0.307, P<0.01), AST (r=0.281, P<0.01), TG (r=0.383, P<0.01), FPG (r=0.572, P<0.01), 2hPG (r=0.578, P<0.01) and FIns (r=0.197, P<0.05), but the level of TNF-αwas inversely associated with HDL-C (r=-0.334, P<0.01) and ISI (r=-0.524, P<0.01). Multiple regression analysis showed that HOMA-IR, SAA and TG were the independent related factors of TNF-α.Conclusion:SAA and HOMA-IR are increased in patients of T2DM, T2DMN and NAFLD. SAA has a great of relationship with IR, and SAA probably plays a role in the development of T2DM complicated with NAFLD. Furthermore, the patients of NAFLD often accompanied by abnormal body fat distribution, lipid metabolism disorders, liver enzyme abnormalities, insulin resistance and high level of SAA. In the meanwhile, the asymptomatic fatty liver is often ignored. It is necessary and importance to reduce the body mass, lower blood lipid and improve insulin resistance, which could reverse liver steatosis and reduce cryptogenic cirrhosis. |
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