Biyopsi tanılı nonalkolik steatohepatit hastalarında fibrozis evrelerine göre metabolik sendrom komponentlerinin sıklıklarının karşılaştırılması: Metabolik bozukluk sayısındaki artış fibrozis progresyonunda etkili mi?

Öz

Giriş ve Amaç: Fibrozis evresi, nonalkolik steatohepatitte karaciğer ilişkili komplikasyonlar ve mortalite ile ilişkisi en kuvvetli olan histolojik parametredir. Nonalkolik steatohepatit hastalarında fibrozisin patogenezi halen tam olarak ortaya konulamamıştır ve eşlik eden tip 2 diyabet, obezite, hipertansiyon ve dislipideminin fibrozis progresyonundaki rolleri net değildir. Bununla beraber, eşlik eden metabolik bozuklukların sayısıyla fibrozis evresi arasında bir ilişki olması mümkündür. Gereç ve Yöntem: Bu çalışma tek merkezli, kesitsel bir çalışma olup bu çalışmada Ocak 2020-Ocak 2021 tarihleri arasında karaciğer biyopsisi yapılarak nonalkolik steatohepatit tanısı konulan 56 hastanın metabolik özellikleri, Ulusal Kolesterol Eğitim Programı/3. Erişkin Tedavi Paneli metabolik sendrom kriterleri temel alınarak değerlendirilmiştir. Nonalkolik Steatohepatit-Klinik Araştırma ağına göre yapılan fibrozis evrelemesi sonrasında, hastalar evre 2 ve üzeri fibrozisi ( ≥ F2) olanlar ve ≤ F1 fibrozisi olanlar şeklinde iki gruba ayrılmıştır. Bu iki grup arasında tip 2 diyabet, hipertansiyon, dislipidemi ve metabolik sendrom varlığı, vücut kitle indeksi, bel çevresi, kalça çevresi, bel çevresi/kalça çevresi oranı ve oluşturulan toplam metabolik sendromu puanı açısından karşılaştırma yapılmıştır. Bulgular: Fibrozis evrelemesi sonucunda ≤ F1 grubunda 23 hasta, ≥ F2 grubunda 33 hasta mevcuttur. Gruplar arasında tip 2 diyabet, hipertansiyon ve dislipidemi varlığı ile vücut kitle indeksi, bel çevresi, kalça çevresi, bel çevresi/kalça çevresi oranı açısından anlamlı bir fark saptanmazken, metabolik sendrom varlığı açısından anlamlı bir fark mevcuttur ( ≥ F2 grubunda %84.8 ve ≤ F1 grubunda %47.8; p = 0.001). Toplam metabolik sendrom puanı ≥ F2 grubunda anlamlı olarak daha yüksek olup bu gruptaki hastaların %60.6’sında 4 puan ve üzerindedir (p < 0.001). Korelasyon analizinde fibrozis evresi ile toplam metabolik sendrom puanı arasında istatistiksel açıdan anlamlı, orta derecede korelasyon saptanmıştır (r = 0.48, p < 0.001). Sonuç: Toplam metabolik sendrom puanı kolay hesaplanabilir bir yöntem olup nonalkolik steatohepatit hastalarında fibrozis progresyonu riskinin değerlendirilmesinde kullanılabilir.

Anahtar Kelimeler

• Steatohepatit
• karaciğer fibrozisi
• metabolik sendrom

Comparison of the frequencies of metabolic syndrome components according to fibrosis stages in biopsy-proven nonalcoholic steatohepatitis patients: Does increased number of metabolic dysregulation have an effect on fibrosis progression?

Öz

Background and Aims: Fibrosis stage is the histologic parameter that has the strongest association with liver-related complications and mortality in nonalcoholic steatohepatitis. The pathogenesis of fibrosis in nonalcoholic steatohepatitis patients has still not been fully elucidated, and the roles of concomitant type 2 diabetes, obesity, hypertension and dyslipidemia in the progression of fibrosis are unclear. However, there may be an association between the number of accompanying metabolic dysregulations and fibrosis stage in a number-dependent manner. Materials and Methods: In this single-center, cross-sectional study, 56 patients with the diagnosis of biopsy-proven nonalcoholic steatohepatitis were enrolled between January 2020 and January 2021, and the metabolic characteristics of these patients were evaluated on the basis of National Cholesterol Education Program/Adult Treatment Panel III metabolic syndrome criteria. After fibrosis staging according to Nonalcoholic Steatohepatitis Clinical Research Network, patients were divided into two groups as those with fibrosis stage ≥ F2, and those with fibrosis stage ≤ F1. Comparison between these two groups in terms of the presence of type 2 diabetes, hypertension, dyslipidemia and metabolic syndrome, total metabolic syndrome score, body mass index, waist circumference, hip circumference and waist circumference/hip circumference ratio has been made. Results: After grouping of patients according to fibrosis stages, there were 23 patients in ≤ F1 group and 33 patients in ≥ F2 group. While there was no significant difference between the groups in terms of presence of type 2 diabetes, hypertension and dyslipidemia, body mass index, waist circumference, hip circumference and waist circumference/hip circumference ratio, there was a significant difference for the presence of metabolic syndrome (84.8% in ≥ F2 group and 47.8% in ≤ F1 group; p = 0.001). The total metabolic syndrome score was significantly higher in ≥ F2 group and it was 4 points or more in 60.6% of the patients in this group. In the correlation analysis, a statistically significant and moderate correlation was found between the fibrosis stage and total metabolic syndrome score (r = 0.48, p < 0.001). Conclusion: Total metabolic syndrome score is an easily calculated method and can be used to evaluate the risk of fibrosis progression in nonalcoholic steatohepatitis patients.

Anahtar Kelimeler

• Steatohepatitis
• liver fibrosis
• metabolic syndrome

Kaynakça

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