الفهرس 
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Abstract
Serum sex hormone-binding globulin (SHBG) has been proposed to act as a hepatokine that contributes to the extrahepatic complications observed in non-alcoholic fatty liver disease (NAFLD). However, it remains uncertain whether serum SHBG mediates the association between intrahepatic lipids (IHL) and type 2 diabetes. Therefore, we studied whether, and to what extent, serum SHBG mediates the association between IHL content and type 2 diabetes.
This prospective case control study involved 82 patients 48 of them have Non-Alcoholic Fatty Liver Disease (NAFLD) and 34 healthy control subjects matched for age and sex. These patients were selected from attendants to outpatient clinic of Internal Medicine, in partnership with the clinical pathology department and the radiology department of Minia University hospital from March 2023 to October 2023.
Classification of these patients:
•group I: involved 24 NAFLD only patients.
•group II: involved 24 NAFLD patients with type II diabetes.
•group III: involved 34 apparently healthy individuals.
All participates had conventional assessments including thorough history taking, physical examination, and abdominal ultrasonography and MRI. They underwent routine hematologic and biochemistry tests and special tests including: SHBG, Serum Adiponectin, Insulin level.
Subjects had any one of the following criteria were excluded from study:
Viral hepatitis e.g.: HCV and HBV. Wilson`s disease, autoimmune hepatitis disorders, hemochromatosis , hepatic decompensation, hepatocellular carcinoma, renal failure, hypothyroidism, daily alcohol consumption, drug induced liver injury (corticosteroids, tamoxifen, antipsychotics, antidepressants, amiodarone, and Methotrexate), any advanced systemic disease, Pregnancy, IBD, females using oral contraceptive pills, Patients on any hormonal therapy.
Blood sampling and biochemical assays:
Venous blood samples were withdrawn from each participant fasting 10 hours by sterile venipuncture. This sample was divided as follow:
•Two ml used for CBC
•Two ml on Na citrate containing tube for platelet concentration (PC), INR.
•Fasting blood glucose (FBG), liver function tests (LFTS) including AST and ALT.
•Fasting insulin levels are measured using the expressed serum for estimate HOMA-IR.
•Three ml blood on plane tube was left to clot in the incubator then centrifuged. Expressed serum is used for determination of thyroid function.
•HBs Ag, HCV Ab.
•Triglyceride and cholesterol.
•Three ml of blood on plane tube was left to clot for 10-20 minutes at room temperature then centrifuged. Expressed samples used for determination of Adiponectin levels, and Human sex- hormone binding globulin level by ELISA.
Results
We found that:
•The current study confirmed that Sex hormone binding globulin (SHBG) in NAFLD patients was lower than non NAFLD group which is found statistically significant (P=<0.0001*).
•The lowest level of SHBG was in group II (NAFLD with T2DM), then in group I (NAFLD only), where the highest level was in group III (control group).
•Also we found that serum Adiponectin was more decreased in NAFLD group than non NAFLD group which is found statistically significant (P=<0.0001).
•The lowest level of Adiponectin was in group II (NAFLD with T2DM), then in group I (NAFLD only), where the highest level was in group III (control group).
•There was a statistically significant increase in TSH (P 0.001).At the same time, participants with MAFLD have significantly higher values of cholesterol, triglyceride, fasting blood glucose, and HOMA-IR (P< 0.001) than healthy individuals.
• There is diagnostic performance of SHBG for NAFLD association with T2DM with a cutoff point of 23.5ng/ml.
• Sex hormone shows a significant negative correlation with Mdixon MRI imaging of fatty liver (r = -0.453, p = 0.026), suggesting that higher levels of sex hormone are associated with decreased MRI fat content measurements of fat content.
• Insulin exhibits a significant positive correlation with the MRI imaging of fatty liver (r =0.361, p = 0.083), implying that higher insulin levels are associated with increased MRI measurements of fat content .
Conclusion
• In conclusion, our investigation shown that in T2D patients, low serum SHBG levels were independently linked to NAFLD. In order to ascertain whether SHBG could function as a novel fatty liver producer or contribute to the development of liver steatosis, more research is necessary given the strong correlation.
• NAFLD in middle-aged and older subjects can be predicted by a lower serum adiponectin level.
• Subclinical or low-normal thyroid function is associated with NAFLD to a large degree.
•Role of MRI in detecting percentage of lipid content is useful in detection ofseverity and management plan, for further research to be done.