| Objective:To investigate the correlation between the severity of liver fibrosis and UACR in T2 DM patients with NAFLD.Methods: The data of 171 patients with T2 DM who were hospitalized in the Second Department of Endocrinology,the First Affiliated Hospital of Kunming Medical University from June 2021 to November 2022 were collected.According to the results of abdominal ultrasound,they were divided into 56 patients with T2 DM and 115 patients with T2 DM combined with NAFLD.In the T2 DM combined with NAFLD group,the liver fibrosis subgroup was further analyzed according to the fibrosis 4 score(FIB-4).FIB-4<1.3 was the low-risk group(80 cases),and FIB-4 ≥1.3 was the medium-high risk group(35 cases).Compare the differences of clinical and biochemical indexes between the groups,and logistic regression analysis was used to evaluate the relationship between the severity of liver fibrosis and UACR in T2 DM patients with NAFLD.Results:(1)In T2 DM combined with NAFLD group,WHR [0.95 ± 0.05 vs 0.90± 0.06],BMI [25.20(23.57,27.10)vs 21.97(20.31,23.31)],fasting C-peptide [1.38(0.99,1.77)vs 0.97(0.62,1.31)](ng/ml),HOMA2-IR [1.13(0.76,1.94)vs 0.76(0.52,1.19)],ALT [20.50(14.60,30.35)vs 14.00(10.50,20.85)](IU/L),GGT [26.00(18.00,43.50)vs 16.00(12.00,20.00)](IU/L),TG [1.74(1.40,2.67)vs 1.15(0.86,1.73)](mmol/L)levels were significantly higher than that of T2 DM group,and the level of HOMA2-%S [89.00(67.00,130.90)vs 131.70(83.90,193.50)] was significantly lower than that of T2 DM group(P<0.001).The levels of Hb A1 c [8.60(7.30,10.20)vs7.30(6.50,9.40)](%),FPG [7.43(5.86,10.11)vs 5.99(4.95,7.52)](mmol/L),2h PBG[13.11(10.94,15.65)vs 11.97(8.55,14.90)](mmol/L),and postprandial 2h C peptide[2.79(1.97,3.96)vs 2.14(1.13,3.04)](ng/ml)in T2 DM combined with NAFLD group were higher than T2 DM group(P<0.05).Age,gender,course of diabetes,SBP,DBP,HOMA2-%B,e GFR,UACR,BUN,UA,Scr,AST,CHE,TBIL,TBA,TC,HDL-C,LDL-C were no significant difference between the two groups(P>0.05).(2)Among patients with T2 DM combined with NAFLD,the risk of liver fibrosis was stratified based on FIB-4,in which FIB-4<1.3 was divided into low-risk group,and ≥ 1.3was divided into medium-high risk group.The results showed that the age [61.49 ±9.04 vs 52.61 ± 8.63](years old),UACR [17.56(6.81,79.56)vs 8.40(5.04,22.95)](mg/g),TBA [4.80(2.80,7.50)vs 2.90(1.73,4.08)](umol/L)levels in the medium-high risk group were higher than low-risk group,and the GGT [22.00(14.00,30.70)vs 29.50(18.00,49.75)] level was lower than low-risk group,the difference was statistically significant(P<0.05).(3)Indicators with statistical differences between the low-risk group and the medium-high risk group of liver fibrosis: age,UACR,GGT,TBA were included in the multivariate logistic regression analysis.The results showed that the increase of age and TBA level were independent risk factors for increased risk of liver fibrosis(P<0.05),and no correlation between liver fibrosis and UACR was found(P>0.05).(4)After comparing the incidence of microalbuminuria/macroalbuminuria in the low-risk group and the medium-high risk group,it was found that the incidence of microalbuminuria/macroalbuminuria in patients increased with the progression of liver fibrosis [low-risk group vs medium-high risk group: 24% vs 46%],and the difference was statistically significant(P<0.05).Conclusions :(1)With the progression of liver fibrosis,the incidence of microalbuminuria/macroalbuminuria increased.(2)Age and TBA levels are independent risk factors for the progression of liver fibrosis in patients with T2 DM and NAFLD.Objective:To explore the correlation between the changes of plasma Maresin-1,CK-18,FABP-1 levels and early DKD in T2 DM patients with NAFLD.Methods: 64 Han patients with T2 DM complicated with NAFLD admitted to the Second Department of Endocrinology,the First Affiliated Hospital of Kunming Medical University from June 2021 to November 2022 were included.According to the UACR level of the patients,they were divided into two groups: those with UACR< 30mg/g were included in the NDKD group(41 cases);The patients with 30 ≤UACR < 300 mg/g were included in the early DKD group(23 cases),and 36 healthy Han people were included in the NC control group.Gender,age,glucose metabolism indexes(FPG,2h PBG,Hb A1c)、 islet function related indexes(Cps 、 IRI 、HOMA2-IR、HOMA2-%B、HOMA2-%S)、lipid metabolism indexes(TC,F-TC,TG,HDL-C,LDL-C)、renal function indexes(BUN,Scr,UA,e GFR)、 liver function indexes(AST,ALT,FIB-4)were compared among the three groups.The concentrations of plasma Maresin-1,FABP-1 and CK-18 were determined by double-antibody one-step sandwich enzyme-linked immunosorbent assay(ELISA),and the correlation between the three biomarkers and clinical indicators was analyzed by Spearman correlation analysis.Logistic regression analysis was used to explore the risk factors of early DKD in patients with T2 DM and NAFLD,and to evaluate whether the changes in plasma Maresin-1,FABP-1 and CK-18 levels had diagnostic value for early DKD in patients with T2 DM and NAFLD.If it was meaningful,ROC curves were further drawn.Results:(1)The plasma Maresin-1 level showed a decreasing trend among the three groups of NC group,NDKD group and early DKD group [73.29(45.95,93.62);44.45(24.10,95.47);34.06(16.12,51.31)](pg/ml),NDKD group [44.45(24.10,95.47)vs 73.29(45.95,93.62)](pg/ml)and early DKD group [34.06(16.12,51.31)vs 73.29 (45.95,93.62)](pg/ml)lower than NC group(P<0.05),but there was no significant difference between NDKD group and early DKD group[44.45(24.10,95.47)vs 34.06(16.12,51.31)](pg/ml)(P>0.05).The levels of CK-18 in NDKD group [22.82 ± 9.145 vs 30.92 ± 14.56](ng/ml)and early DKD group [22.96 ± 11.93 vs 30.92 ± 14.56](ng/ml)were significantly lower than NC group(P<0.05).FABP-1 level showed an increasing trend among NC group,NDKD group and early DKD group [210.61(149.30,343.45);218.10(149.45,281.46);234.54(113.60,316.11)](pg/ml),but there was no significant difference among the three groups(P>0.05).In addition,the age,Hb A1 c and FPG levels in NDKD group and early DKD group were higher than NC group [54.85 ± 8.80/54.35 ± 9.70 vs 46.42 ± 12.56(years old);8.72 ± 1.94/8.77 ±1.80 vs 5.79 ± 1.32(%);8.05 ± 2.93/8.26 ± 3.10 vs 5.61 ± 3.61(mmol/L),P<0.05];The levels of F-TC and HDL-C were lower than NC group [1.48 ± 0.37/1.53 ± 0.34 vs1.80 ± 0.27(mmol/L),P<0.05];the level of TC in NDKD group was lower than NC group [4.38 ± 1.01 vs 5.04 ± 1.15(mmol/L),P<0.05].The level of UACR in NDKD group was significantly lower than early DKD group [7.97(6.18,11.07)vs 55.29(36.80,201.54)(mg/g),P<0.001].There was no significant difference in other indicators among the three groups(P>0.05).(2)There was no significant difference in islet function and liver function between NDKD group and early DKD group(P>0.05).(3)In the plasma of T2 DM patients with NAFLD,Maresin-1 was positively correlated with FABP-1(rs=0.371,P<0.05).There was no significant correlation between Maresin-1 and CK-18,CK-18 and FABP-1(P>0.05).Maresin-1 was positively correlated with AST(rs=0.286,P=0.022)and negatively correlated with Scr(rs=-0.265,P=0.034).With the increase of AST level,the level of Maresin-1gradually increased;with the increase of Scr level,the level of Maresin-1 gradually decreased.The level of CK-18 was positively correlated with postprandial C-peptide(rs=0.421,P<0.001),HOMA2-%B(rs=0.306,P=0.016),UA(rs=0.253,P=0.044),TC(rs=0.286,P=0.022),LDL-C(rs=0.284,P=0.023),and negatively correlated with FPG(rs=-0.272,P=0.030).There was no statistical difference between FABP-1 level and each index(P>0.05).(4)Taking the presence or absence of DKD as the dependent variable and sex,age,BMI,SBP,DBP,Hb A1 c,FPG,FIB-4,Maresin-1,CK-18,FABP-1 as the independent variable,no risk or protective factor for early DKD was found after single factor logistic regression analysis(P>0.05).Conclusions:With the occurrence of DKD in T2 DM patients with NAFLD,the plasma Maresin-1 level gradually decreased,the FABP-1 level gradually increased,and the CK-18 level did not change significantly.Maresin-1,FABP-1 and CK-18 have low value in early diagnosis of DKD. |
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