Peculiarities of insulin resistance syndrome in non-alcoholic steatogepatitis on the background of type 2 diabetes mellitus depending on the stage of diabetic kidney disease

Abstract

To study the interaction of changes in glucose and insulin homeostasis, the degree of IR and insulin sensitivity, the degree of glycosylation of hemoglobin on the clinical course of NASH on the background of diabetes mellitus depending on the presence of DKD and its stage.Material and methods. 108 patients with NASH with comorbid diabetes were examined. The average age of patients was (58.2 ± 6.1) years. There were 63 women (58.3%) and 45 men (41.7%). Depending on the presence of DKD, 4 groups of patients were formed, which were randomized by age, sex, activity of cytolytic syndrome of NASH depending on the stage of DKD. The comparison group consisted of 30 healthy individuals (PHP) of the appropriate age and sex. The degree of hepatic steatosis and its nature were determined using a ratified kit "SteatoTest", "ASH" and "NASH-Test" (BioPredictive, France) in the laboratory Sinevo. The stage of liver fibrosis was determined by using a set of markers for quantitative biochemical evaluation of fibrosis "FibroTest" (BioPredictive, France) in the laboratory Sinevo. Calculation of the glomerular filtration rate (GFR) was performed using a GFR calculator of the Institute of Nephrology of the National Academy of Medical Sciences of Ukraine on the average of three calculated indicators: creatinine clearance according to the Cockcroft-Golt formula, MDRD and CKD EPI. Determination of the stages of DKD was carried out according to the classification of C.E. Mogensen (1983).Results. In patients with NASH, diabetes mellitus and DKD I-II st. found a probable decrease in the content of albumin in the blood by 9.0% (p <0.05), GFR and the content of albumin in the urine, on the contrary, probably increased 1.5 times (p <0.05) compared with the indicator in PHP, which indicates the phenomenon of hyperfiltration and inherent in the initial stage of DKD. In patients with NASH, diabetes mellitus and DKD III found a probable decrease in the content of albumin in the blood by 1.2 times (p <0.05), GFR and albuminuria were significantly increased by 1.4 times and 11.7 times (p <0.05), respectively, compared with PHP. In patients with NASH, diabetes mellitus and DKD IV found a significant decrease in the content of albumin in the blood by 1.4 times (p <0.05), the content of albumin in the blood was probably increased by 30.2 times (p <0.05) compared with the indicator in the PHP, and the GFR - on the contrary, it was significantly reduced - 1.7 times (p <0.05), which indicates the progression of CKD and DKD.Conclusions. Metabolic prerequisites for the development of nonalcoholic steatohepatitis on the background of type 2 diabetes mellitus are probable fasting and postprandial hyperglycemia, hyperinsulinemia, increased hemoglobin glycosylation, tissue insulin resistance compared to healthy individuals. Disorders of glucose homeostasis due to insulin resistance are one of the probable risk factors for the progression of nonalcoholic steatohepatitis and type 2 diabetes mellitus in the presence of stage I-IV diabetic kidney disease, as carbohydrate metabolism disorders and the degree of insulin resistance type 2 diabetes in the absence of diabetic kidney disease.