الفهرس 
Introduction & Aim of the workOnly 14 pages are availabe for public view
 |  | from | 168 |  |  |
| | | from | 168 | | |
Abstract
Diabetes mellitus (DM) is a chronic condition that is linked with an elevated risk for a number of long-term consequences, both macro- and microvascular, as well as a large number of additional comorbidities. It has been shown beyond a reasonable doubt that male patients with type 2 diabetes have a substantially elevated risk of developing hypogonadism.
Insulin resistance is significantly associated with NAFLD, which stands for non-alcoholic fatty liver disease. NAFLD is another prevalent comorbidity. Numerous studies have shown that a low blood testosterone level is an independent risk for nonalcoholic fatty liver disease (NAFLD). Unresolved questions remain about the pathophysiological processes underlying each of these comorbid conditions.
The state of chronic sterile inflammation that is frequently observed in obese diabetics, namely metabolic inflammation or meta-inflammation, is strongly suggested as a pathophysiologic mechanism. One of the key players of metabolic inflammation is monocytes with their different subsets.
Aim of the study:
- To evaluate and study NAFLD in diabetic male patients and the relation of NAFLD to hypogonadotrophic hypogonadism.
- To study the possible role of total monocytes fraction and their proinflammatory subset in NAFLD and their relation to hypogonadotrophic hypogonadism.
Patients and methods:
The endocrinology outpatient clinic at Minia university hospital served as the setting for the present investigation, which was carried out there. One hundred male patients with diabetes were enrolled in the study, along with fifty healthy people.
The patients were divided into three groups based on their ADAM scores and testosterone levels: group I (the hypogonadal group), group II (the eugonadal group), and the control group (III), which consisted of fifty healthy guys. group I was the hypogonadal group.
Everyone had their complete medical histories taken, filled out an ADAM score questionnaire, and had a comprehensive physical examination that included anthropometric measures and a check of their systems. The following tests were carried out: total testosterone, SHBG, FSH, and LH levels, as well as fasting blood sugar, urea levels, creatinine levels, ALT levels, AST levels, albumin levels, and bilirubin levels. The vermeulene equation was used in order to determine the free testosterone level.
The measurements of the lipid profile and the calculations of the homeostasis model evaluation index were used to analyze the statuses of both the lipid and carbohydrate metabolisms (HOMA IR). Flowcytometry was used in order to measure the percentages of monocytes as well as the subgroups of monocytes based on their expression of CD 14, 16.
Two expert radiologists carried out an ultrasonographic examination of the liver in order to establish the severity of the patient’s fatty liver. The NAFLD fibrosis score, often known as the NFS, was determined.
Results:
The hypogonadal group had significantly lower anthropometric values compared to both the eugonadal group and the control group. Fasting insulin and HOMA IR were both greater in the hypogonadal group, which may help to explain why insulin resistance was more pronounced in this population. The same kind of conclusion was made about the TG levels. Those with hypogonadal hypothyroidism had a fatty liver at a rate of 88%, while patients with eugonadal hypothyroidism had a fatty liver at a rate of 54%. NFS was computed, and the results showed that it was considerably greater in hypogonadal patients (p = 0.026).
There were statistically significant differences between groups I and II, as well as between all of the groups, and the hypogonadal group had significantly higher percentages of total and proinflammatory (CD16+) monocytes than the other groups did. There was an inverse relationship between total monocyte percentage and both TT and CfT levels. The total monocyte percentage and NFS were shown to have a robustly positive and significantly correlating relationship.
It was possible to predict hypogonadism in diabetic males by looking at either their total monocyte % or their proinflammatory monocyte percentage. It was shown that larger percentages were related with a greater risk of hypogonadism. In addition, the presence of fatty liver — to whatever degree — was associated with an increased risk of hypogonadism. For the purpose of hypogonadism prediction, the ideal cutoff thresholds of total and proinflammatory monocytes were found to be >6 percent for total monocytes and >13 percent for the proinflammatory (CD16+) group.