The value of the triglyceride-glucose index in the diagnosis of insulin resistance in early forms of non-alcoholic fatty liver disease
The goal. To determine the value of the triglyceride glucose index (TGI) for the diagnosis of insulin resistance (IR) in early forms of non-alcoholic fatty liver disease (NAFLD). Materials and methods. 99 patients with NAFLD were examined: 38 (38.4%) with liver steatosis (LS) and 61 (61.6%) with steatohepatitis (SH). TGI was determined by the formula - ln [fasting TG (mg / dl) × fasting glucose (mg / dl) / 2], patients with LS and SH were divided into quartiles (Q<sub class="Subscript CharOverride-17" lang="en-US">1</sub>-Q<sub class="Subscript CharOverride-17" lang="en-US">4</sub>) by increasing TGI levels with an assessment of liver tests, insulin levels (“Insulin TEST System”, Monobind Inc., USA), HOMA-IR, fragments of cytokeratin-18 (FCK-18) (“TPS ELISA, Biotech”, Sweden) and TNF-α (“Human TNFα Platinum” ELISA, eBioscience, Austria). Results. In patients with LS with a TGI increase from Q<sub class="Subscript CharOverride-17" lang="en-US">1</sub> to Q<sub class="Subscript CharOverride-17" lang="en-US">4</sub>, HOMA-IR increased from 1.12 ± 0.48 to 6.02 ± 3.15 (p <0.05), a direct relationship was found between these indicators - r = 0.52 (p = 0.03). TGI also correlated with waist circumference - r = 0.81 (p = 0.01), cholesterol - r = 0.51 (p = 0.002), alkaline phosphatase - r = 0.41 (p = 0.02). In patients with SH, from Q<sub class="Subscript CharOverride-17" lang="en-US">1</sub> to Q<sub class="Subscript CharOverride-17" lang="en-US">4</sub>, HOMA-IR increased from 3.15 ± 1.8 to 6.2 ± 3.04 (p <0.05), but there was no significant correlation between HOMA-IR and TGI. The levels of FCK-18 increased from Q<sub class="Subscript CharOverride-17" lang="en-US">1</sub> to Q<sub class="Subscript CharOverride-17" lang="en-US">4</sub>-139.82 ± 72.45 to 359.75 ± 189.03 U / L (p <0.05) and TNF-α - from 6.38 ± 1.25 pg / ml up to 7.75 ± 1.09 pg / ml (p <0.05). There was a connection between TGI and the level of a marker of hepatocyte apoptosis - FCK-18 - r = 0.43 (p = 0.004). Conclusion. In liver steatosis, TGI has demonstrated its diagnostic role as a surrogate marker of insulin resistance, correlating with HOMA-IR. In steatohepatitis, TGI reflected the degree of hepatocytic apoptosis, correlating with fragments of cytokeratin-18.