Predictors of fibrosis formation in patients with combined course of non-alcoholic fatty liver disease and type 2 diabetes mellitu

Abstract

The aim of the investigation was to study the predictors of metabolic disturbances and their effect on liver steatosis and fibrosis formation in patients with non- alcoholic fatty liver disease (NAFLD) combined with type 2 diabetes mellitus (DM). 125 patients  with NAFLD and DM type 2 were examined: 61 patients with  NAFLD and  64 patients with combined course of NAFLD and subcompensated type 2 DM. The control group consisted of 20 persons comparable by age and sex. The  results of the investigation testify that the increases of MMP-1 and TIMP-1 levels in patients with combined course of diseases may occur on early stages of metabolic  disturbances in liver and appear to be the prognostic predictors of liver fibrosis development and progression. The presence of correlation relationship between the  content and the activity of transaminases indicates that intensity of fibrotic reactions in patients with combined course of NAFLD and type 2 DM depends on the   ctivity  of cytolysis enzymes. Reliable correlation between the content of MMP-1 and HOMA-IR index and inverse relationship between the content of adiponectin and  HOMA-IR demonstrates insulinresistance as the predictor of formation and the risk factor of liver fibrosis progression in patients with combined course of NAFLD and  type 2 DM. Positive correlation between the content of MMP-1 and the level of CRP and inverse correlation between the content of TIMP-1 and CRP confirm the role of  CRP in liver fibrosis progression, and the correlation between the content of MMP-1 and triglycerides shows the influence of hypertriglyceridemia on the development  of liver fibrosis in patients with combined courseof NAFLD and type 2 DM. The presence of different stages of liver fibrosis on the results of FibroMax test in patients  with isolated NAFLD and with combined course of the diseases testifies that formation and progression of fibrotic changes in liver depends not only on inflammatory  reaction of liver parenchyma and severity of fatty liver but also on the disturbances of carbohydrate metabolism. The combined course of NAFLD and type 2 DM is  characterized by exacerbation of fatty liver infiltration and processes of fibrogenesis. These findings indicate that the age of patients greater than 45 years old, the  presence of arterial hypertension, dyslipidemia, the increase of fasting plasma glucose level are the factors that affect the processes of liver fibrosis and correlate with  insulinresistance and inflammatory changes in fatty liver tissue.