Correlation Between Plasma Lactate Level And Severity Of Fatty Liver And Related Clinical Indicators In Patients With NAFL

Objective: Lactic acid,as an emerging metabolic marker,plays an important role in the occurrence and development of metabolic syndrome,while non-alcoholic fatty liver disease(NAFLD),as an important component of metabolic syndrome,has not been clearly correlated with lactic acid.This study will explore the relationship between plasma resting lactic acid level and the severity of NAFLD,explore the correlation between lactic acid and many clinical treatments,and discuss the causes of elevated lactic acid,so as to provide new ideas for the clinical diagnosis and treatment of NAFLD.Methods: This study was based on the NAFLD patients who visited the clinic of Metabolic Disease Center,Affiliated Hospital of Hangzhou Normal University from June 2021 to December 2022.A total of 272 patients who met the inclusion criteria were included in the study.Demographic information,smoking history,drinking history,past history and madicationgs of the subjects were collected based on the unified inquiry criteria.Height,weight,waist circumference and hip circumference were measured by international standardized methods,and waist-to-hip ratio and body mass index(BMI)were calculated.Body composition analyzer was used to determine the visceral fat area,body fat percentage,muscle content and other related human body indicators.Fatty liver severity was evaluated by Fibroscan detection and noninvasive fibrosis scoring model.CAP and E values indicated liver steatosis and liver hardness,respectively.The fasting resting plasma lactate level(Lac)of patients in the early morning resting state was determined by UV enzyme dynamic method.At the same time,fasting blood glucose(FBG),glycated hemoglobin(Hb A1c),uric acid(UA),total cholesterol(TG),triglyceride(TC),high density lipoprotein(HDL),low density lipoprotein(LDL),C-reactive protein,alanine aminotransferase(ALT),asthenic aminotransferase(AST)and other biochemical indexes were measured.The resting lactate plasma levels of the subjects were divided into four groups,Q1-Q4,according to the quartile score method,and the differences of their clinically related indicators were compared respectively.At the same time,the non-invasive fibrosis scoring model and the proportion of patients with hepatic fibrosis diagnosed by CAP were compared.The correlation between lactate and clinical indicators was calculated,and the data were statistically analyzed by SPSS 23.0 software.P < 0.05 was considered to be statistically significant.Results:(1)A total of 272 effective subjects were included in this study,with an average age of 40.92 years,including 209 males and 63 females.The overall number of males was more than females.(2)The body weight,BMI,waist circumference,waist-to-hip ratio,body fat percentage,skeletal muscle,visceral fat area and subcutaneous fat area in Q4 group were increased compared with those in Q1-Q3group;(3)The prevalence rates of impaired fasting blood glucose,insulin resistance,hyperinsulinemia and dyslipidemia in group Q4 were generally higher than those in group Q1-Q3,and the levels of FINS,IRI,TG,free fatty acids,uric acid and retinol-binding protein in groups with different lactic acid levels were increased step by step.(4)The incidence of liver fibrosis in NAFLD patients with E value and non-invasive model increased with the increase of lactic acid grade,and the scores of CAP,E,ALT,AST,ALB,GGT and NLR also increased step by step.(5)The lactate level in overweight and obese group was higher than that in normal group,and there was a gradient difference.The plasma lactate level was higher in patients with impaired fasting blood glucose,insulin resistance,hyperinsulinemia,dyslipidemia,smoking and drinking.(6)Lactic acid was correlated with BMI and FBG(P < 0.05).It was highly correlated with body weight,waist circumference,waist-to-hip ratio,diastolic blood pressure,body fat percentage,skeletal muscle,visceral fat area,subcutaneous fat area,Hb A1 c,Hb A1,FINS,C-peptide,IRI,TG,HDL,APO-A,free fatty acids,ALT,AST,ALB,GGT,CAP and E(P < 0.01).Conclusions:(1)The level of liver enzymes in NAFLD patients in the high lactic acid group was significantly higher than that in the low lactic acid group,and the CAP and E indexes were also higher;(2)The prevalence of some components of metabolic syndrome increased with the increase of lactate level,including impaired fasting glucose,insulin resistance,hyperinsulinemia,dyslipidemia;(3)The plasma lactate level of normal body weight group,superrecombinant group and obese group showed a gradient increase,and lactate concentration was positively correlated with BMI,waist circumference,waist-to-hip ratio,visceral fat area,subcutaneous fat area and body fat percentage.(4)The lactate level of smoking and drinking patients was higher than that of control group;(5)Lactate level in male patients was higher than that in female patients,and there was no significant difference in lactate level in age.