Abstract: Objective The aim of this study was to explore the changes and clinical implications of serum fibroblast growth factor-21 (FGF21) and secreted frizzled related protein 5 (SFRP5) in patients with non-alcoholic fatty liver disease (NAFLD) and diabetes mellitus type 2(T2DM). Methods 101 patients with NAFLD, including nonalcoholic fatter liver(NAFL) in 64 cases, nonalcoholic steatohepatitis (NASH) in 25 cases and liver cirrhosis (LC) in 12 cases, and 81 patients with NAFLD and T2DM, including NAFL in 58 cases, NASH in 16 cases and LC in 7 cases, were enrolled in this study between May 2020 and March 2023, and the fasting blood glucose (FBG) and fasting insulin (FINS) levels were detected, and the homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. Serum FGF21 and SFRP5 levels were detected by ELISA. Results The FBG, serum FINS, the HOMA-IR and serum FGF21 levels in patients with NAFLD and concomitant T2DM were (8.7±1.4)mmol/L, (28.9±5.8)μIU/mL, (11.1±2.7) and (304.8±36.0)pg/mL, all significantly higher than [(5.5±1.2)mmol/L,(20.8±4.1)μIU/mL, (5.1±1.5) and (267.6±34.5)pg/mL, respectively, P＜0.05], while serum SFRP5 level was (6.8±1.2)pg/mL, much lower than [(10.3±2.2)pg/mL, P＜0.05] in patients with NAFLD; serum total cholesterol, triglyceride,high-density lipoprotein cholesterol and low-density lipoprotein cholesterol levels in patients with NAFLD and T2DM were(6.7±1.0)mmol/L,(3.7±0.6)mmol/L,(1.3±0.2)mmol/L and (3.4±0.8)mmol/L, all not significantly different as compared to [(6.2±0.9)mmol/L, (4.1±0.5)mmol/L, (1.3±0.3)mmol/L and (3.2±0.7)mmol/L, respectively] in patients with NAFLD (P>0.05); serum SFRP5 levels in patients with T2DM and underlying NAFL, NASH and LC were (7.8±1.1)pg/mL, (6.4±0.8)pg/mL and (5.1±0.7)pg/mL, all significantly lower than [(11.9±2.1)pg/mL, (9.8±1.6)pg/mL and (8.4±1.1)pg/mL, respectively, P＜0.05], while serum FGF21 levels were (295.6±31.2)pg/mL, (316.8±32.9)pg/mL and (353.6±36.7)pg/mL, all significantly higher than [(255.1±32.5)pg/mL, (279.5±33.4)pg/mL and (309.7±35.8)pg/mL, respectively, P＜0.05] in patients with NAFL, with NASH or with LC. Conclusion Serum FGF21 level significantly increases, while serum SFRP5 level significantly decreases in patients with NAFLD and concomitant T2DM, which might be applied to predict the severity of the entity in clinical practice.

Key words: Non-alcoholic fatty liver diseases, Type 2 diabetes mellitus, Fibroblast growth factor-21, Secreted frizzled related protein 5