Year 2012, Volume 11, Issue 1, Pages 18 - 23 2012-04-01

Four-year evaluation and association between chronic liver disease and diabetes mellitus in a patient
4 yıllık kronik karaciğer hastalıklı olgularımızda diyabetes mellitus ile birlikteliğin değerlendirilmesi

Özgür YILMAZ [1] , Elmas KASAP [2] , Hakan YÜCEYAR [3]

178 859

Background and Aims: Diabetes mellitus increases morbidity and mortality in patients with liver cirrhosis. The aim of this study was to investigate the rate of diabetes mellitus in chronic liver diseases (chronic hepatitis, liver cirrhosis and hepatocellular cancer) and to evaluate the correlation of diabetes mellituswith the etiology and severity of liver disease. Materials and Methods: One hundred and eighty-six patients withchronic liver disease (90 chronic hepatitis, 80 cirrhosis and 16 hepatocellular carcinoma) were recruited retrospectively from January 2007 to July 2010. Based on fasting blood glucose levels, normoglycemia, impaired fasting glucose, and diabetes mellitusstates among patients were determined. Patients were evaluated by classification in terms of age, gender, and etiology, and with a diagnosis of cirrhosis and hepatocellular cancer, were additionally classified in terms of Child-Pugh and MELD (Model for End-Stage Liver Disease) scores. Results: Rates of diabetes mellitusand impaired fasting glucose among chronic liver disease patients were determined as 28% and 20.4%, respectively. Normoglycemia was significantly higher in HBV patients than in HCV, alcohol-induced chronic liver disease and cryptogenic patients (p
Amaç: Kronik karaciğer hastalıklarında glikoz metabolizma bozuklukları ve diyabetes mellitus sıklığı artmıştır. Diyabet, karaciğer sirozu olan hastaların morbidite ve mortalitesini artırmaktadır. Çalışmamızın amacı, kronik karaciğer hastalığında (kronik hepatit, karaciğer sirozu ve hepatosellüler kanser) diyabetes mellitus görülme sıklığı ile karaciğer hastalığı etiyolojisi ve şiddeti arasındaki ilişkinin değerlendirilmesidir. Gereç ve Yöntem: Yüz seksen altı kronik karaciğer hastası (90 kronik hepatit, 80 siroz ve 16 hepatosellüler kanser) retrospektif olarak çalışmaya dahil edilmiştir. Hastaların açlık kan şekerleri değerlendirilerek, normoglisemi, bozulmuş açlık glikozu ve diyabetes mellitus durumları saptanmıştır. Hastalar yaş, cinsiyet, etyoloji (HBV, HCV, alkol ve kriptojenik) ve hastalık grubuna (kronik hepatit, karaciğer sirozu, hepatosellüler kanser) göre, sirozu ve hepatosellüler kanser tanısı olan olgular ise ayrıca Child-Pugh ve MELD (Model for End-Stage Liver Disease) skoruna göre gruplandırılarak değerlendirilmiştir. Sonuçlar: Kronik karaciğer hastalarında diyabet ve bozulmuş açlık glikozu sıklıkları sırasıyla %28 ve %20.4 olduğu görüldü. Sirozlu olgularda diyabetes mellitus ve bozulmuş açlık glikozu sıklığı kronik hepatitlilere göre anlamlı olarak yüksek bulundu (p=0.004). Child A, B, C ve MELD skorunun 14 ve altı ile 15 ve üstü şeklinde gruplandırılan olguların normoglisemi, bozulmuş açlık glikozu ve diyabetes mellitus dağılımlarında istatistiksel bir fark saptanmadı (p:0.781, p=0.423). Kriptojenik (%67.7), HCV (%56.8) ve alkole bağlı karaciğer hastalarında (%60), HBV'li (%38.9) olgulara göre daha yüksek oranda bozulmuş açlık glikozu ve diyabetes mellitus saptandı (p=0.017). Tartışma: Kronik karaciğer hastalarında diyabetin erken tanı ve tedavisiyle morbidite ve mortalitenin azalması beklenebilir.
  • Spolarics Z, Ottlakan A, Lang CH, Spitzer JJ. Kupffer cells play a
  • major role in insulin-mediated hepatic glucose uptake in vivo. Bioc- hem Biophys Res Commun 1992;186:455-60.
  • Kolaczynski JW, Carter R, Soprano KJ, et al. Insulin binding and
  • degradation by rat liver Kupffer and endothelial cells. Metabolism 1993;42:477-81.
  • Casteleijn E, Kuiper J, van Rooij HCJ, et al. Hormonal control of
  • glycogenolysis in parenchymal liver cells by Kupffer and endotheli- al liver cells. J Biol Chem 1988;263:2699-703.
  • El-Serag HB, Tran T, Everhart JE. Diabetes increases the risk of chro
  • nic liver disease and hepatocellular carcinoma. Gastroenterology 2004;126:460-8.
  • El-Serag HB, Everhart JE. Diabetes increases the risk of acute hepa
  • tic failure. Gastroenterology 2002;122:1822-8.
  • Tolman KG, Fonseca V, Dalpiaz A, et al. Spectrum of liver disease
  • longterm course after liver transplantation. Liver Transpl 2004;10: 1030-40.
  • Del Vecchio Blanco C, Gentile S, Marmo R, et al. Alterations of glu- cose metabolism in chronic liver disease. Diabetes Res Clin Pract 1990;8:29-36.
  • Garcia-Compean D, Jaquez-Quintana JO, Gonzalez-Gonzalez JA, Maldonado-Garza H. Liver cirrhosis and diabetes: Risk factors, pat- hophysiology, clinical implications and management. World J Gas- troenterol. 2009;15:280-8.
  • Niederau C, Fischer R, Purschel A, et al. Long-term survival in pati- ents with hereditary hemochromatosis. Gastroenterology 1996; 110:1107-19.
  • Buzzelli G, Chiarantini E, Cotrozzi G, et al. Estimate of prevalence of glucose intolerance in chronic liver disease. Degree of agree- ment among some diagnostic criteria. Liver 1988;8:354-9.
  • Harrison SA. Liver disease in patients with diabetes mellitus. J Clin Gastroenterol 2006;40:68-76.
  • De Marco R, Locatelli F, Zoppini G, et al. Cause-specific mortality in type 2 diabetes. The Verona Diabetes Study. Diabetes Care 1999; 22:756-61.
  • Bianchi G, Marchesini G, Zoli M et al. Prognostic significance of di- abetes in patients with cirrhosis. Hepatology 1994;20:119-25.
  • Moreau R, Delegue P, Pessione F, et al. Clinical characteristics and outcome of patients with cirrhosis and refractory ascites. Liver Int 2004;24:457-64.
  • Hickman IJ, Macdonald GA. Impact of diabetes on the severity of liver disease. Am J Med 2007;120:829-34.
  • Amarapurkar DN, Patel ND, Kamani PM. Impact of diabetes melli- tus on outcome of HCC. Ann Hepatol 2008;7:148-51.
  • Satman I, Yılmaz MT, Şengül A, et al. The TURDEP Group: Popula- tion based study of diabetes and risk characteristics in Turkey: Re- sult of the Turkish diabetes epidemiology study (TURDEP). Diabe- tes Care 2002;25:1551-6.
  • Balbi M, Donadon V, Ghersetti M, et al. Alcohol and HCV Chronic Infection Are Risk Cofactors of Type 2 Diabetes Mellitus for Hepa- tocellular Carcinoma in Italy. Int J Environ Res Public Health. 2010; 7:1366-78.
  • Flores-Rendon AR, Gonzalez-Gonzalez JA, Garcia-Compean D, et al. Model for end stage of liver disease (MELD) is better than the Child-Pugh score for predicting in-hospital mortality related to esophageal variceal bleeding. Ann Hepatol 2008;7:230-4.
  • Durand F, Valla D. Assessment of the prognosis of cirrhosis: Child- Pugh versus MELD. J Hepatol 2005;42 Suppl:S100-7.
  • Custro N, Carroccio A, Ganci A, et al. Glycemic homeostasis in chronic viral hepatitis and liver cirrhosis. Diabetes Metab 2001;27: 476-81.
  • Lecube A, Hernandez C, Genesca J, et al. High prevalence of glu- cose abnormalities in patients with hepatitis C virus infection: a multivariate analysis considering the liver injury. Diabetes Care 2004;27:1171-5.
  • Angulo P. GI epidemiology: nonalcoholic fatty liver disease. Ali- ment Pharmacol Ther 2007;25:883-9.
  • Caldwell SH, Oelsner DH, Iezzoni JC, et al. Cryptogenic cirrhosis: clinical characterization and risk factors for underlying disease. He- patology 1999;29:664-9.
  • Tellez-Avila FI, Sanchez-Avila F, Garcia-Saenz-de-Sicilia M, et al. Pre- valence of metabolic syndrome, obesity and diabetes type 2 in cryptogenic cirrhosis. World J Gastroenterol 2008;14:4771-5.
  • Fraser GM, Harman I, Meller N, et al. Diabetes mellitus is associa- ted with chronic hepatitis C but not chronic hepatitis B infection. Isr J Med Sci 1996;32:526-30.
  • Lecube A, Hernández C, Genescà J, Simó R. Proinflammatory cyto- kines, insulin resistance, and insulin secretion in chronic hepatitis C patients: A case-control study. Diabetes Care 2006;29:1096-101.
  • Moucari R, Asselah T, Cazals-Hatem D, et al. Insulin resistance in chronic hepatitis C: association with genotypes 1 and 4, serum HCV RNA level, and liver fibrosis. Gastroenterology 2008;134:416- 23.
  • Hui JM, Sud A, Farrell GC, et al. Insulin resistance is associated with chronic hepatitis C virus infection and fibrosis progression [correc- ted]. Gastroenterology 2003;125:1695-1704.
  • Anty R, Gelsi E, Giudicelli J,et al. Glucose intolerance and hypoadi- ponectinemia are already present in lean patients with chronic he- patitis C infected with genotype non-3 viruses. Eur J Gastroenterol Hepatol 2007;19:671-7.
  • Mehta SH, Brancati FL, Sulkowski MS, et al. Prevalence of type 2 diabetes mellitus among persons with hepatitis C virus infection in the United States. Ann Intern Med 2000;133:592-9.
  • Zein NN, Abdulkarim AS, Wiesner RH, et al. Prevalence of diabetes mellitus in patients with endstage liver cirrhosis due to hepatitis C, alcohol, or cholestatic disease. J Hepatol 2000;32:209-17.
  • Patel BC, D'Arville C, Iwahashi M, Simon FR. Impairment of hepa- tic insulin receptors during chronic ethanol administration. Am J Physiol 1991;261:199-205.
  • Onishi Y, Honda M, Ogihara T, et al. Ethanol feeding induces insu- lin resistance with enhanced PI 3-kinase activation. Biochem Bi- ophys Res Commun 2003;303:788-94.
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Authors

Author: Özgür YILMAZ

Author: Elmas KASAP

Author: Hakan YÜCEYAR

Bibtex @ { agd17540, journal = {Akademik Gastroenteroloji Dergisi}, issn = {1303-6629}, eissn = {2149-0600}, address = {Türk Gastroenteroloji Vakfı}, year = {2012}, volume = {11}, pages = {18 - 23}, doi = {}, title = {4 yıllık kronik karaciğer hastalıklı olgularımızda diyabetes mellitus ile birlikteliğin değerlendirilmesi}, key = {cite}, author = {YILMAZ, Özgür and KASAP, Elmas and YÜCEYAR, Hakan} }
APA YILMAZ, Ö , KASAP, E , YÜCEYAR, H . (2012). 4 yıllık kronik karaciğer hastalıklı olgularımızda diyabetes mellitus ile birlikteliğin değerlendirilmesi. Akademik Gastroenteroloji Dergisi, 11 (1), 18-23. Retrieved from http://dergipark.org.tr/agd/issue/1455/17540
MLA YILMAZ, Ö , KASAP, E , YÜCEYAR, H . "4 yıllık kronik karaciğer hastalıklı olgularımızda diyabetes mellitus ile birlikteliğin değerlendirilmesi". Akademik Gastroenteroloji Dergisi 11 (2012): 18-23 <http://dergipark.org.tr/agd/issue/1455/17540>
Chicago YILMAZ, Ö , KASAP, E , YÜCEYAR, H . "4 yıllık kronik karaciğer hastalıklı olgularımızda diyabetes mellitus ile birlikteliğin değerlendirilmesi". Akademik Gastroenteroloji Dergisi 11 (2012): 18-23
RIS TY - JOUR T1 - 4 yıllık kronik karaciğer hastalıklı olgularımızda diyabetes mellitus ile birlikteliğin değerlendirilmesi AU - Özgür YILMAZ , Elmas KASAP , Hakan YÜCEYAR Y1 - 2012 PY - 2012 N1 - DO - T2 - Akademik Gastroenteroloji Dergisi JF - Journal JO - JOR SP - 18 EP - 23 VL - 11 IS - 1 SN - 1303-6629-2149-0600 M3 - UR - Y2 - 2019 ER -
EndNote %0 The Turkish Journal of Academic Gastroenterology 4 yıllık kronik karaciğer hastalıklı olgularımızda diyabetes mellitus ile birlikteliğin değerlendirilmesi %A Özgür YILMAZ , Elmas KASAP , Hakan YÜCEYAR %T 4 yıllık kronik karaciğer hastalıklı olgularımızda diyabetes mellitus ile birlikteliğin değerlendirilmesi %D 2012 %J Akademik Gastroenteroloji Dergisi %P 1303-6629-2149-0600 %V 11 %N 1 %R %U
ISNAD YILMAZ, Özgür , KASAP, Elmas , YÜCEYAR, Hakan . "4 yıllık kronik karaciğer hastalıklı olgularımızda diyabetes mellitus ile birlikteliğin değerlendirilmesi". Akademik Gastroenteroloji Dergisi 11 / 1 (April 2012): 18-23.