Endocrine Abstracts

Pathogenesis of Non-alcoholic fatty liver disease in 90% combined with diabetes mellitus (DM) of the second type. Factors cutting: abdominal obesity, excessive content of free fatty acids. Development of insulin resistance through protein kinase. Violation of the transmission of insulin signal leads to damage to the endothelium. Glycation of nitric oxide synthase leads to the development of diabetic complications and violates the sensitivity of the insulin receptors.

Purpose of the study: To determine the level of insulin, metabolites of nitric oxide, malonic dialdehyde, activity of lipoprotein-associated phospholipase A2 (PLA2), in the serum of patients with NAFLD and type 2 diabetes and impaired glucose tolerance.

Material and methods: 74 patients with NAFLD and type 2 diabetes were examined; 30 with NAFLD and impaired glucose tolerance. The age of patients is 55.6±2.2 years. The body mass index is 34.85±1.79 kg/m². Phospholipase A2 was determined by the method of chemiluminescent immunological analysis on a Siemens device. Fatty acids were determined by the enzyme method using test systems (England). Nitric oxide metabolites were determined by the method of Metelskoy VA, Malondiy aldehyde was determined by the Andreeva method.

Results: Insulin was determined in 74 patients. Hyperinsulinemia was observed in 30 patients with low glucose tolerance. 34.65±4.16 μIU/ml. Control group: 8.3±1 μIU/ml. In patients with diabetes, insulin content: 6.28±0.4 (P=0.001), which caused the expression of phospholipase A2 3 times in diabetes and twice in violation of glucose tolerance. With NAFLD, the content of nitric oxide is increased: the level of metabolites increased in parallel with the activity of hepatic enzymes. The content of malondialdehyde in diabetes in patients with diabetes increased and amounted to 24.12±1.64 μmol/l. In case of violation of glucose tolerance: amounted to 16.91±3.87. (the norm is 9.94±1.62 μmol/l). P=0.001. A negative correlation between insulin and malonic dialdehyde was detected. (R=−0.31). The interrelation of the peroxide and phospholipase mechanism of lipid damage to the membranes of hepatocytes FLA2 and MDA r=−0.53; P=0.001; between NO and FLA2=0.625. P=0.001.

Conclusions: High activity of inflammatory markers in patients with NAFD with diabetes mellitus is an early diagnostic criterion for the activity of non-alcoholic steatohepatitis (NASH).