Correlation Between Adiponectin,Tumor Necrosis Factor-a,Insulin Resistance And Traditional Chinese Medicine Syndrome Differentiation Typing In Patients With Nonalcoholic Fatty Liver

Objective: To assay the serum of adiponectin (APN),TNF-a levels inpatients with nonalcoholic fatty liver diseases (NAFLD), and to explore therelationship between them and insulin resistance (IR), analyse their correlationwith traditional Chinese Medicine (TCM) syndrome differentiation typing(SDT).Methods: 42 normal controls and 120 patients with NAFLD subjects arerecruited, according to fasting serum glucose, the NAFLD patients are dividedinto NAFLD with type 2 diabetes group (DFL) and simple NAFLD group (FL).All patients with NAFLD are divided into three tpyes: phlegm-dampness due todeficiency of the spleen,dampness-heat internally retaining,expectorant phlegmand gore by TCM SDT and are divied into mild,moderate,severe three groupsby B type ultrasound. Measured the level of body mass index (BMI),waist-to-hipratio (WHR),serum alanine aminotransferase(ALT),aspartateaminotransferase (AST),γ-glutamyl transpeptidase (GGT), total cholesterol(TC), triglyeride (TG), high density lipoprotein (HDL), low density lipoprotein(LDL), apolipoprotein A (ApoA), apolipoprotein B (ApoB),parameters of fasting serum glucose (FPG), fasting insulin level in serum(FINS), serum adiponectin (APN) and tumor necrosis factor-a(TNF-a).Homeostasis model assessment(HOMA), Insulin sensitive index (ISI) andinsulin secretion(HOMA-IS) are applied for the status insulin resistance(IR).The correlation among these factors are analyzed.Results: 1. The serum alanine aminotransferase (ALT), aspartateaminotransferase (AST),γ-glutamyl transpeptidase (GGT) are increased in DFLgroup and FL group,but still within normal extent(P＜0.01).2.The morbidiry ofNAFLD merging with type 2 diabets is 26.67％(32/120),with obesity is55％(66/120),with high triglyceride(TG) is 46.67％(56/120),with high lowdensity lipoprotein(LDL) is 43.33％(52/120).3.Compared with the normalcontrol group, the FINS,HOMA-IR levels in DFL group and FL group aresignificantly increased, the ISI numerical data are significantly decreased(allP＜0.01);Compared with the FL group,the FINS,HOMA-IR levels in DFL groupare significantly increased, the ISI,HOMA-IS numerical data are significantlydecreased(all P＜0.01);The difference of HOMA-IR is no statistical significancein mild,moderate two groups of NAFLD(P＞0.05),which both lower than thesevere group(all P＜0.01).4.The level of TNF-a in DFL and FL groups issignificantly higher and the concentration of serum APN is significantly lowercompared with those of NC group (P＜0.01).Correlation analysis showed: APNis marked correlated negative with HOMA-IR,TNF-a and positive with ApoA,ISI; TNF-a is marked correlated negative with APN,ISI and positive withTG, LDL-C,FPG,FINS,IR. Multiple stepwise regression analysis showed thatBMI,FPG,FINS,TG,TC,TNF-a are the mainly risk factors for IR; ISI,TG,APN are the mainly risk factors for TNF-a; ApoA,TNF-a are the mainlyrisk factors for APN.5.The severity degree of fatty liver are gradually increasedfrom phlegm-dampness due to deficiency of the spleen type to dampness-heatinternally retaining type and expectorant phlegm and gore type of TCM SDT inNAFLD patients.The levels of TG,TC,LDL-C in the three TCM types aresignificantly higher than those in NC group and the levels of HDL-C,ApoA arelower compared with NC group (P＜0.05,P＜0.01), TG,TC,HDL-C,ApoA,ApoB are no difference among the three groups(P＞0.05); The concentration ofserum TNF-a is gradually increased and serum APN is graduallydecreasedbetween the three groups(P＜0.05,P＜0.01); The level of FPG,HOMA-IR aresignificantly higher and ISI is significantly lower in the three group than those inNC group(P＜0.01);The level of FPG,HOMA-IR in dampness-heat internallyretaining type and expectorant phlegm and gore typeare are significantly higherwhile ISI significantly lower compared with those in phlegm-dampness due todeficiency of the spleen type (P＜0.01).Conclusions: 1.Obesity,hyperglycemia,hyperlipemia and the lowconcentration of APN are the main risk factors for forming NAFLD.2.Insulinresistance is uniformly present in subjects with NAFLD and is more obvious ingroup with type 2 diabetes; IR may initially result in fatty liver, but mayintensify with advancement of the severity degree of fatty liver.3.The level ofserum TNF-a are increased and APN decreased in patients with NAFLD;There are significantly negative correlation between APN and TNF-a,which both haveclose correlation with IR. Serum APN is a role of protection and TNF-a is a roleof impairment in the pathogenesis of NAFLD patients, they play an importantrole in pathogensis and progression of NAFLD.4.The severity degree of fattyliver,level of serum APN and TNF-a are closely correlated with TCM SDT ofNAFLD patients,thus they could become one of objective indexs for diagnosingTCM SDT.