Biblioteca Virtual en Salud

Objective:

To observe the expression of fibroblast growth factor 21 (FGF-21) in serum of patients with type 2 diabetes mellitus (T2DM) and nonalcoholic fatty liver disease (NAFLD) and its relationship with nonalcoholic fatty liver fibrosis score (NFS).

Methods:

Using the methods of cross-sectional study, 422 patients with T2DM who attended to Cangzhou People's Hospital from December 2018 to January 2020, were selected and divided into T2DM group(121 cases) and T2DM with NAFLD group(301 cases) according to abdominal color ultrasound diagnosis.Serum FGF-21 level was detected by Enzyme-Linked Immuno Sorbent Assay(ELISA). Age-adjusted NFS was used to assess the risk of NAFLD liver fibrosis.Patients with T2DM and NAFLD were divided into the non NAFLD fibrosis group (NNF group, 125 cases ), the suspected NAFLD fibrosis group (SNF group, 136 cases)and the definited NAFLD fibrosis group (DNF group, 40 cases). A one-way analysis of variance or the Kruskal-Wallis H was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical date between groups.Pearson method was used to analyze and compare the correlation of biochemical indexes in each group.Logistic regressions were used to explore related influencing factors.

Results:

Compared with the T2DM group, FGF-21 level was increased in T2DM with NAFLD group( P<0.05). The serum FGF-21 levels of NNF, SNF and DNF groups were significantly different ((297.03±52.71) ng/L, (321.52±69.42) ng/L, (274.08±30.82) ng/L; F=12.03, P<0.001). The level of FGF-21 in SNF group was higher than that in NNF group and DNF group, DNF group was lower than NNF group(all P<0.05). (2)Pearson correlation analysis showed NFS was negatively correlated with FGF-21( r=-0.162, P<0.01). (3)Logistic regressions analysis showed that the compensatory increase of FGF-21 level was the independent risk factor for NAFLD in T2DM patients ( OR 1.139, 95% CI 1.023-1.380, P<0.001). And the progressive decrease of FGF-21 level was the independent related factor of liver fibrosis in patients with T2DM combined with NAFLD ( OR 0.89, 95% CI 0.83-0.98, P=0.012).

Conclusion:

The inverted U-shaped relationship was found between serum FGF-21 level and nonalcoholic fatty liver fibrosis score in patients with type 2 diabetes mellitus and nonalcoholic fatty liver disease.The level of serum FGF-21 compensatory increase in nonalcoholic fatty liver disease at early stages, With the progression of liver fibrosis, the secretion of FGF-21 was progressively deficient.This suggests that FGF-21 may be a new target for liver fibrosis in patients with type 2 diabetes mellitus and nonalcoholic fatty liver disease.