Potential Relations Of Serum GIP Level And Chinese Medicinal Pattern Characteristic Based On Factor And Cluster Statistical Analysis In Patients With NAFLD (GAN PI)

Background:NAFLD (GANPI) is the most common liver disorder in western industrialized countries, and recent studies indicate it is also an emerging problem in Asia-Pacific region. While there have been lack of safe and efficacious pharmacologic treatments for NAFLD (GANPI) in western medicine, so the therapies of Chinese medicine show great advantages. What the questions of NAFLD (GAN PI) in Chinese medicine are lacking of criteria of Chinese medicinal patterns on dialectic and diagnosis as well as a bridge to integrate Chinese medicine and western medicine. Gastric inhibitory polypeptide (GIP), also designated as glucose-dependent insulintropic polypeptide (GIP), is an emerging key modulator of lipid metabolism and is linked to metabolic disease, such as obesity, diabetes, and hyperlipidemia. However, study on relation of GIP to another important metabolic disease, non-alcoholic fatty liver disease (NAFLD), is rare all over the world, and there is few research report on association of GIP with NAFLD (GAN PI) in China up to present.Objective:To establish the primary research paper model and apply the model to research papers of GIP. Also to study the distribution characteristics and quantify the dialectic and diagnosis criterion of Chinese medicinal patterns in eligible NAFLD (GANPI) patients. Furthermore, to clarify whether fasting serum GIP level alters in patients with NAFLD (GAN PI) compared to healthy subjects, and to analyze whether altered GIP level is relative to Chinese medicinal patterns in patients with NAFLD (GAN PI)Methods:We established the primary research paper model by standard method of searching, including and excluding research papers. At the same time, We designed a questionnaire containing information of symptoms and signs gathered from the Four Examination, and we analyzed questionnaire data in 306 eligible patients with NAFLD (GAN PI) using statistical methods of factor analysis, cluster analysis, and frequency normalization to calculate variables weight to establish and quantify criterion of Chinese medicinal patterns of NAFLD(GAN PI). We also measured fasting serum GIP level with ELISA in 61 patients with NAFLD(GAN PI) and 22 healthy controls to assess concentration difference between NAFLD(GANPI) patients and healthy subjects. The relation of GIP level to different Chinese medicinal patterns of NAFLD (GAN PI) which determined by statistical analysis was analyzed. Also, we identified correlations of GIP level among non-obese and non-diabetic patients with NAFLD (GAN PI), obese patients with NAFLD (GAN PI) and diabetic patients with NAFLD(GAN PI). Correlations of GIP level to other blood variables related to NAFLD(GAN PI) were analyzed by Pearson correlation test.Results:(1) The primary research paper model was established and applied successfully to GIP. (2) By analyzing questionnaires data of 306 eligible patients with NAFLD(GAN PI), We found 13 public factors exhibiting basic pathologic mechanisms of Chinese medicine for NAFLD (GAN PI):the main pathogenic factors included accumulation of pathogenic Mucus, Dampness, Heat, congealed Blood, stagnant Qi, and deficiency of Organs, and the main disharmony Organs of NAFLD(GAN PI) referred to Liver, Spleen, and Kidneys. We found five Chinese medicinal patterns of NAFLD(GAN PI) by cluster analysis and a group of specialists named the five patterns according to Chinese medicinal logic. The five patterns listed as follows:Pattern of Damp Heat Collecting (n=101), Pattern of Constrained Liver Qi and Deficient Spleen Qi(n=89), Pattern of Mucus Damp Collecting (n=47), Pattern of Stagnant Qi and Congealed Blood (n=41), Pattern of Deficient Spleen and Kidney Yang (n=28). We also established quantified diagnosis criterion and classification standards of patterns severity for Chinese medicinal patterns in patients with NAFLD(GAN PI). (3) Patients with NAFLD(GAN PI) showed significantly elevation of fasting serum GIP level compared to healthy controls (P< 0.01). Fasting GIP level was similar in different Chinese medicinal patterns of NAFLD(GAN PI)(P>0.05). Altered GIP level correlated to altered AST and TG level positively and to LDL-C level negatively(P<0.05). Furthermore, There was no observed difference in GIP level among non-obese and non-diabetic patients with NAFLD (GAN PI), obese patients with NAFLD(GAN PI) and diabetic patients with NAFLD(GAN PI) (P>0.05).Conclusion:(1) Establishment of the study model to primary research paper makes preliminary method foundation to study research papers scientifically and systematically. (2) We conclude that our study established a systematic model to understand Chinese medicinal logic of NAFLD(GAN PI) from pathogenesis, Organs location, quantified diagnosis to patterns distinguishing, and the model may play some role for clinical diagnosis and evaluation to efficacy of Chinese medicine therapies. (3) Altered fasting GIP level was neither specific for Chinese medicinal patterns of NAFLD(GAN PI), nor for NAFLD (GAN PI) complicated with obesity and diabetes. It needs to be prospectively confirmed in large cohort studies. (4) Elevation of fasting GIP level may be relative to the pathogenesis of NAFLD (GAN PI).The result of Pearson correlation test suggests elevated fasting GIP level may correlate with injury of liver cell and deregulated fat metabolism.