Endocrine Abstracts

Bile acids (BA) regulate glucose and lipid metabolism, provide bile flow, increase lipase activity by 10–15 times. With the development of inflammation, violations occur in the membrane proteins of glucose transporters.

Aim

Determine the total pool of bile acids in NAFLD with diabetes mellitus (DM) and impaired glucose tolerance (IGT). Determine the content of inflammation markers lipoprotein-associated phospholipase (Lp-PLA2), endotoxin (ET) in the blood serum of NAFLD patients.

Material and methods

On a biochemical analyzer ’Olympus’ using test systems * Randox * (England), the total content of BA was determined by the enzymatic method. 80 patients with NAFLD with type 2 diabetes and ITG were examined. BMI 36–40 kg/m². During ultrasound, fatty hepatosis or diffuse liver damage was detected. Analysis of biochemical parameters showed a significant increase in aminotransferases in 90% of cases. Lp-PLA2 was determined by the enzyme immunoassay using the PLAC TEST diagnostic kits (USA), and the LAL test (USA) was used to determine ET.

Research results

In 59 NAFLD patients with diabetes, there was a significant decrease in the fatty acid content by 45% compared to the control, the level of bile acids in the blood serum was 2.97 ± 1.02 µmol/l, and with ITG 8.88 ± 4.94 µmol/l and a high content of PLA2 median 605 (504–826) ng/ml. In patients with NTG, PLA2 was significantly lower and amounted to a median of 430 (324–497) ng/ml. The content of Et in patients with diabetes is increased 12-fold. This activates Ca2 + channels on the membrane of smooth muscle cells, which leads to the activation of PLA2.

Conclusions

In NAFLD patients with diabetes, biliary insufficiency develops, the PLA2 and ET indices are significantly increased, which indicates the presence of inflammation and a high risk of cardiovascular complications, including coronary atherosclerosis, myocardial infarction and stroke. An increase in the content of inflammatory markers leads to a decrease in the activity of nuclear receptors for the synthesis and conjugation of BA.