Correlation Between Serum FGF-21 And Risk Of Liver Fibrosis In Patients With Type 2 Diabetes Mellitus And Nonalcoholic Fatty Liver Disease

With the change of lifestyle,the incidence of Type 2 diabetes mellitus(T2DM)and Nonalcoholic fatty liver disease(NAFLD)have been rising.NAFLD combined with T2DM are more likely to promote the progress of NAFLD,lead to steatohepatitis,liver fibrosis and etc,except for the abnormal glucose metabolism and chronic complications of diabetes.Fibroblast growth factor 21(FGF-21)is an endocrine factor related to glucose and lipid metabolism.FGF-21 has the effect of reducing blood glucose,regulating lipid metabolism,improving insulin resistance,inhibiting inflammatory cytokines production,antifibrosis and etc.We used Nonalcoholic fatty liver fibrosis score(NFS)to assess the risk of liver fibrosis in T2DM patients with NAFLD.Our research aim to analysis the relationship between serum FGF21 and the risk of liver fibrosis in patients with T2DM and NAFLD.The propose of this study was hope to provide theoretical basis for the diagnosis and treatment of T2DM and NAFLD.Objective:To investigate the relationship between serum FGF-21 and risk of liver fibrosis in patients with type 2 diabetes mellitus and nonalcoholic fatty liver disease.Methods:Using the methods of cross-sectional study,422 patients with T2DM who attended to Cangzhou People’s hospital from December 2018 to January2020.Clinical and biochemical indexes such as age,height,weight,glucolipid metabolism,and so on were collected.Serum FGF-21 levels were detected by Enzyme-Linked Immuno Sorbent Assay.All of them were selected and divided into T2DM group(n=121 cases)and T2DM with NAFLD group(n=301 cases)according to abdominal color ultrasound diagnosis.NFS was used to assess the risk of liver fibrosis.Patients with T2DM and NAFLD were divided into the Low risk fibrosis group(LF group,125 cases),the Intermediate risk fibrosis group(IF group,136 cases)and the High risk fibrosis group(HF group,40 cases).The differences of clinical biochemical indexes were compared between the groups.Pearson or Spearman were used to analyze the correlation between FGF-21 and each biochemical indexes.Logistic regressions were used to explore related influencing factors of NAFLD and liver fibrosis.Scatter plots were drawn to explore the relationship between FGF-21 and NFS.Results:1 The levels of BMI,WC,GGT,AST,AST/ALT,SUA,HOMA-IR,Hb A1c,TG,FIns and FGF-21 in T2DM with NAFLD group were higher than those in T2DM group(P<0.05),the differences were statistically significant.There were no significant statistical differences in age,sex composition,duration of diabetes mellitus and A/G(P>0.05).2 The levels of age,BMI,duration of diabetes mellitus,WC,AST/ALT,GGT,TG,TC,LDL-C,SUA,Hb A1c,HOMA-IR in HF group were higher than those in LF group and IF group(P<0.05).The levels of PLT,A/G,FGF-21 in HF group were lower than those in LF group and IF group(P<0.05).The levels of FGF-21 in IF group were higher than those in LF group and HF group(P<0.05).3 The correlation analysis showed that the levels of FGF-21 was positively correlated with WC,TG,FPG,BMI,FIns,HOMA-IR and Hb A1c(r=0.132,0.160,0.156,0.125,0.210,0.105,0.104,0.105,P<0.05).4 The logistic regression analysis showed that WC(OR=1.036,P<0.001),Hb A1c(OR=1.094,P=0.019),SUA(OR=1.095,P<0.001),TG(OR=1.206,P=0.021),HOMA-IR(OR=1.061,P=0.010),FGF-21(OR=1.139,P<0.001)had the statistically significant difference in the incidence of NAFLD in T2DM patients.The duration of diabetes(OR=1.120,P=0.002),Hb A1c(OR=1.501,P<0.001),SUA(OR=1.125,P<0.001),TG(OR=1.019,P=0.041),HOMA-IR(OR=1.076,P=0.017),FGF-21(OR=0.890,P=0.012)had statistically significant difference in the incidence of liver fibrosis in T2DM patients with NAFLD.5 Scatter plots were drawn with FGF-21 and NFS.The linear model,NFS was negatively correlated with FGF-21(β=-0.162,R~2=0.026,P=0.005).The nonlinear model,NFS squared was negatively correlated with FGF-21(β=-0.167,R~2=0.057,P<0.001).There was an inverted U-shaped relationship between serum FGF-21 level and NFS.Conclusion:1 The level of serum FGF-21 in T2DM patients with NAFLD was significantly higher than that in T2DM patients2 There was an inverted U-shaped relationship between serum FGF-21level and the risk of liver fibrosis in patients with T2DM and NAFLD.