Department of Endocrinology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, Chongqing, China.
Department of Endocrinology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, Chongqing, China
BMJ Open Diabetes Res Care. 2024 Sep 25;12(5):e004514. doi: 10.1136/bmjdrc-2024-004514.
Metabolic dysfunction associated fatty liver disease (MAFLD) is a prevalent condition in patients with type 2 diabetes mellitus (T2DM). Isthmin-1 (ISM1) is an adipokine that promotes glucose uptake and improves glucose tolerance and hepatic steatosis. Although ISM1 has been shown to be associated with T2DM, its role in patients with MAFLD and metabolic syndrome (MetS) remains insufficiently examined. This study aimed to investigate the relationship between serum ISM1 and MAFLD in patients with T2DM and the potential involvement of MetS in this association.
A total of 250 participants were divided into four groups: 60 patients with T2DM and MAFLD, 60 with newly diagnosed T2DM, 60 with MAFLD, and 70 healthy controls. Serum ISM1 levels were measured using ELISA. The distribution of ISM1 concentration in the combined data was divided into quartiles, and the Cochran-Armitage trend test was performed to estimate the significant trends across increasing quartiles.
Compared with the controls, patients with coexisting MAFLD, MetS, and T2DM exhibited significantly elevated serum ISM1 concentrations. Serum ISM1 levels in the overweight/obese group were also higher than those in the lean group. Serum ISM1 levels were positively correlated with body mass index (BMI), uric acid, alanine aminotransferase, aspartate aminotransferase, total cholesterol (TC), low-density lipoprotein cholesterol, fasting insulin, and homeostasis model assessment of insulin resistance and negatively associated with age and high-density lipoprotein cholesterol (HDL-C). BMI, TC, and HDL-C were independently associated with serum ISM1 concentration. The relative risks for MAFLD, T2DM, and T2DM with MAFLD increased significantly with higher ISM1 quartiles. Furthermore, a positive correlation was observed between serum ISM1 levels and the number of MetS components, with the elevated plasma levels of ISM1 escalating the risk of developing MetS to some extent.
The combination of ISM1 with TG and UA was identified as the best predictive factor for diagnosing MAFLD and MetS, potentially due to their contribution to aggravating the metabolic state.
代谢相关脂肪性肝病（MAFLD）是 2 型糖尿病（T2DM）患者中常见的病症。胰岛素抑素-1（ISM1）是一种脂肪因子，可促进葡萄糖摄取，改善葡萄糖耐量和肝脂肪变性。尽管已经表明 ISM1 与 T2DM 有关，但它在 MAFLD 和代谢综合征（MetS）患者中的作用仍未得到充分研究。本研究旨在探讨 T2DM 患者血清 ISM1 与 MAFLD 之间的关系，以及 MetS 在这种关联中的潜在作用。
共纳入 250 名参与者，分为四组：60 名 T2DM 合并 MAFLD 患者、60 名新诊断的 T2DM 患者、60 名 MAFLD 患者和 70 名健康对照者。采用 ELISA 法检测血清 ISM1 水平。将合并数据中的 ISM1 浓度分布分为四等份，采用 Cochran-Armitage 趋势检验估计递增四分位数的显著趋势。
与对照组相比，同时患有 MAFLD、MetS 和 T2DM 的患者血清 ISM1 浓度显著升高。超重/肥胖组的血清 ISM1 水平也高于非超重/肥胖组。血清 ISM1 水平与体重指数（BMI）、尿酸、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、总胆固醇（TC）、低密度脂蛋白胆固醇、空腹胰岛素、稳态模型评估的胰岛素抵抗呈正相关，与年龄和高密度脂蛋白胆固醇（HDL-C）呈负相关。BMI、TC 和 HDL-C 与血清 ISM1 浓度独立相关。MAFLD、T2DM 和 T2DM 合并 MAFLD 的相对风险随着 ISM1 四分位的升高而显著增加。此外，血清 ISM1 水平与 MetS 成分数量之间存在正相关，ISMI 水平的升高在一定程度上增加了发生 MetS 的风险。
ISM1 与 TG 和 UA 联合可作为诊断 MAFLD 和 MetS 的最佳预测因子，这可能是由于它们加剧了代谢状态。
