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Nonalkolik yağlı karaciğer hastalığında histolojik progresyon ile klinik ve laboratuvar parametrelerin ilişkisi

Yıl 2020, Cilt: 19 Sayı: 2, 63 - 74, 04.10.2020
https://doi.org/10.17941/agd.799535

Öz

Giriş ve Amaç: Nonalkolik steatohepatit nonalkolik yağlı karaciğer hastalığının ilerleyici bir formudur. Nonalkolik steatohepatit, zamanla siroz ve hepatosellüler karsinomaya sebep olabilir. Bu çalışmada nonalkolik yağlı karaciğer hastalığı tanılı olgularda zamanla karaciğer histolojisindeki değişikliklerin araştırılması ve histolojik progresyonla ilişkli klinik ve laboratuvar değişkenlerin saptanması amaçlanmıştır. Gereç ve Yöntem: Bu çalışmada 1994-2009 yılları arasında hepatoloji veri tabanına kayıtlı toplam 783 nonalkolik yağlı karaciğer hastalıklı olgu retrospektif olarak tarandı. En az 2 yıl arayla yapılan 2 karaciğer biyopsisi olan 29 hasta çalışmaya alındı. Vücut kitle indeksi, glukoz intoleransı veya diyabetes mellitus varlığı, karaciğer fonksiyon testi dahil biyokimyasal parametreler kaydedildi. Nonalkolik yağlı karaciğer hastalığı aktivite skoru steatoz, lobüler inflamasyon ve hepatosellüler balonlaşma skorlarının toplamı ile hesaplandı. Fibroz skorları ayrı rapor edildi. Bulgular: Ortalama yaş 45.2±11 yıl, olguların 17’si (%58.6) erkekti. Başvuruda ortalama vücut kitle indeksi 29.5±4 kg/m2, 15'i (%51.7) fazla kilolu, 12'si (%41.4) obezdi. Toplam 11’inde (%37.9) diyabetes mellitus, 6’sında (%20.7) glukoz intoleransı vardı. Aspartat aminotransferaz düzeyi ortalama 51±36 IU/ml, alanin aminotransferaz düzeyi ortalama 79±50 IU/ml, albümin ortalama 4.5±0.4 gr/dL, trigliserit ortalama 197±106 mg/dL saptandı. Hastaların 14'ünde (%48.3) “nonalkolik steatohepatit” ve 6’sında (%20.6) basit steatoz vardı. Egzersiz ve diyet önerisiyle kontrol biyopsi için medyan takip aralığı 4.8 yıl (2-9 yıl) saptandı. Kontrol biyopsi anında vücut kitle indeksi ortalama 29.6±4 kg/m2, aspartat aminotransferaz ortalama 38.8±14 IU/ml, alanin aminotransferaz ortalama 59.2±32 IU/ml, 13’ünde (%44.8) diyabetes mellitus ve 7’sinde (%24.1) glukoz intoleransı saptandı. İkinci karaciğer biyopsilerinde nonalkolik yağlı karaciğer hastalığı aktivite skoru; 9 (%31) hastada ilerlemiş, 17’sinde (%58.6) gerilemiş, 3’ünde (%10.3) aynı bulundu. Fibrozis skorunda ise 6 (%20.1) hastada ilerleme, 3 (%10.3) hastada ise iyileşme görüldü. Nonalkolik yağlı karaciğer hastalığı aktivite skoru ilerlemesiyle başlangıç yaşı arasında negatif, başlangıç vücut kitle indeksi ile pozitif korelasyon saptandı, sırasıyla (r=-0.370, p=0.047 ve r=0.485, p=0.007). Fibrozis skoru ilerlemesiyle, başlangıç yaşı arasında negatif, başlangıç vücut kitle indeksi ile pozitif ve kontrol biyopsileri anındaki aspartat aminotransferaz düzeyiyle pozitif korelasyon saptandı, sırasıyla (r=-0.503 p=0.005; r=0.382 p=0.04 ve r=0.546 p=0.007). Sonuç: Basit yağlanma yaşla ve yüksek vücut kitle indeksi ile ilişkili olarak nonalkolik steatohepatite progrese olabilir. Genç yaştakiler, yüksek vücut kitle indeksi ve aspartat aminotransferaz düzeyinde yükseklik olanlar fibrozis progresyonu açısından daha riskli bulunmuştur.

Kaynakça

  • 1. Schaffner F, Thaler H. Nonalcoholic fatty liver disease. Prog Liver Dis 1986:8:283-98.
  • 2. Sheth SG, Gordon FD, Chopra S. Nonalcoholic steatohepatitis. Ann Intern Med 1997;126:137-45.
  • 3. Matteoni CA, Younossi ZM, Gramlich T, et al. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology 1999;116:1413-9.
  • 4. Reid AE. Nonalcoholic steatohepatitis. Gastroenterology 2001;121:710-23.
  • 5. Becker U, Deis A, Sorenson TL, et al. Prediction of risk of liver disease by alcohol intake, sex and age: a prospective population study. Hepatology 1996;23:1025-9.
  • 6. Maxwell JD, Sanderson I, Butler WH, Gazet JC, Pilkington TR. Hepatic structure and function after modified jejunoileal bypass surgery for obesity. Br Med J 1977;2:726-9.
  • 7. Ludwig J, Viggiano TR, McGill DB, Oh BJ. Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease. Mayo Clin Proc 1980;55:434-8.
  • 8. Teli MR, James OF, Burt AD, Bennett MK, Day CP. The natural history of nonalcoholic fatty liver: a follow-up study. Hepatology 1995;22:1714-9.
  • 9. Powell EE, Cooksley WG, Hanson R, et al. The natural history of nonalcoholic steatohepatitis: a follow-up study of forty-two patients for up to 21 years. Hepatology 1990;11:74-80.
  • 10. Harrison SA, Torgerson S, Hayashi P. The natural history of non-alcoholic fatty liver disease: a clinical histopathological study. Am J Gastroenterol 2003;98:2042-7.
  • 11. Marrero JA, Fontana RJ, Su GL, et al. NAFLD may be a common underlying liver disease in patients with hepatocellular carcinoma in the United States. Hepatology 2002;36:1349-54.
  • 12. Propst A, Propst T, Judmaier G, Vogel W. Prognosis in nonalcoholic steatohepatitis. Gastroenterology 1995;108:1607.
  • 13. Angulo P, Keach J, Batts K, Lindor K. Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis. Hepatology 1999;30:1356-62.
  • 14. Adams LA, Sanderson S, Lindor KD, Angulo P. The histological course of nonalcoholic fatty liver disease: a longitudinal study of 103 patients with sequential liver biopsies. J Hepatol 2005;42:132-8.
  • 15. Dixon JB, Bhathal PS, O’Brien PE. Nonalcoholic fatty liver disease: predictors of nonalcoholic steatohepatitis and liver fibrosis in the severely obese. Gastroenterology 2001;121:91-100.
  • 16. Colicchio P, Tarantino G, del Genio F, et al. Non-alcoholic fatty liver disease in young adult severely obese non-diabetic patients in south Italy. Ann Nutr Metab 2005;49:289-95.
  • 17. Angulo P. NAFLD, obesity, and bariatric surgery. Gastroenterology 2006;130:1848-52.
  • 18. Stranges S, Dorn JM, Muti P, et al. Body fat distribution, relative weight, and liver enzyme levels: a population-based study. Hepatology 2004;39:754-63.
  • 19. American Diabetic Association. Clinical practice recommendations 2000. Diabetes Care 2000;23(Suppl 1):4-19.
  • 20. Health NIH: Clinical guidelines on the identification, evaluation and treatment of overweight and obesity in adults: The evidence report. Obes Res Obes Res 1998;6(Suppl 2):51S-209S.
  • 21. Harold E. Lebovitz. Clinician’s Manual on Insulin Resistance 2002;p:5.
  • 22. Kleiner DE, Brunt EM, Van Natta M, et al; Nonalcoholic Steatohepatitis Clinical Research Network. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology 2005;41:1313-21.
  • 23. Argo CK, Northup PG, Al-Osaimi AM, Caldwell SH. Systematic review of risk factors for fibrosis progression in non-alcoholic steatohepatitis. J Hepatol 2009;51:371-9.
  • 24. Merriman RB, Ferrell LD, Pati MG, et al. Correlation of paired liver biopsies in morbidly obese patients with suspected nonalcoholic fatty liver disease. Hepatology 2006;44:874-80.
  • 25. Fassio E, Alvarez E, Dominguez N, Landeira G, Longo C. Natural history of nonalcoholic steatohepatitis: a longitudinal study of repeat liver biopsies. Hepatology 2004;40:820-6.
  • 26. Das K, Das K, Mukherjee PS, et al. Nonobese population in a developing country has a high prevalence of nonalcoholic fatty liver and significant liver disease. Hepatology 2010;51:1593-602.

The relationship between clinical and laboratory parameters and histological progression in nonalcoholic fatty liver disease

Yıl 2020, Cilt: 19 Sayı: 2, 63 - 74, 04.10.2020
https://doi.org/10.17941/agd.799535

Öz

Background and Aims: Nonalcoholic steatohepatitis is the progressive form of nonalcoholic fatty liver disease and can cause cirrhosis and hepatocellular carcinoma. We aimed to investigate the changes in liver histology and determined the relationship between histologic progression and clinical and laboratory parameters in patients with nonalcoholic fatty liver disease. Materials and Methods: We retrospectively screened 783 patients with nonalcoholic fatty liver disease who had enrolled in the hepatology database between 1994 and 2009. Among the 783, there were 29 patients with two liver biopsies performed at least two years apart. Body mass index, presence of glucose intolerance or diabetes, and biochemical parameters including liver function test were noted. Nonalcoholic fatty liver disease activity score was the sum of steatosis, lobular inflammation, and hepatocellular ballooning scores. The fibrosis scores were reported separately. Results: Mean patient age was 45.2±11years, and 17 (58.6%) patients were men. Mean body mass index was 29±4 kg/m2, and 15 (51.7%) patients were overweight and 12 (41.4%) were obese. Twelve (41.4%) patients had diabetes mellitus and five (17.2%) patients had glucose intolerance. Mean aspartate aminotransferase level was 51±36 IU/ml, mean alanine aminotransferase level was 79±50 IU/ml, mean albumin level was 4.5±0.4 g/dL, and mean triglyceride level was 197±106 mg/dL at baseline. Fourteen (48.3%) patients had nonalcoholic steatohepatitis and six (20.6%) patients had simple steatosis. The patients followed the recommended exercises and diet for therapy, and control liver biopsies were performed. The median follow-up duration was 4.8 years (2–9). Mean body mass index was 29.6±4 kg/m2, mean aspartate aminotransferase level was 38.8±14 IU/ml, and mean alanine aminotransferase was 59.2±32 IU/ml. Thirteen (44.8%) patients had diabetes mellitus and seven (24.1%) had glucose intolerance at the time when their control biopsies were collected. According to nonalcoholic fatty liver disease activity score, nonalcoholic steatohepatitis progression was detected in 9 (31%) patients, while improvement was detected in 17 (58.6%) patients. In control liver biopsies, nonalcoholic fatty liver disease activity score remained the same in three (10.3%) patients. Six (20.1%) patients experienced progression and three (10.3%) patients showed improvement in fibrosis scores in the control biopsies. Regarding the basal parameters, age was negatively correlated and body mass index was positively correlated with the nonalcoholic steatohepatitis progression (r=−0.370, p=0.047 and r=0.485, p=0.007, respectively). The progression of fibrosis scores was negatively correlated with baseline age and positively correlated with baseline body mass index and aspartate aminotransferase levels when control biopsies were taken (r=−0.503, p=0.005; r=0.382, p=0.04; and r=0.546, p=0.007, respectively). Conclusion: Simple steatosis may progress to nonalcoholic steatohepatitis in patients with younger age and high body mass index. Patients with younger age and higher body mass index at baseline and higher aspartate aminotransferase at the time of collecting the control biopsies were more likely to experience progression of liver fibrosis.

Kaynakça

  • 1. Schaffner F, Thaler H. Nonalcoholic fatty liver disease. Prog Liver Dis 1986:8:283-98.
  • 2. Sheth SG, Gordon FD, Chopra S. Nonalcoholic steatohepatitis. Ann Intern Med 1997;126:137-45.
  • 3. Matteoni CA, Younossi ZM, Gramlich T, et al. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology 1999;116:1413-9.
  • 4. Reid AE. Nonalcoholic steatohepatitis. Gastroenterology 2001;121:710-23.
  • 5. Becker U, Deis A, Sorenson TL, et al. Prediction of risk of liver disease by alcohol intake, sex and age: a prospective population study. Hepatology 1996;23:1025-9.
  • 6. Maxwell JD, Sanderson I, Butler WH, Gazet JC, Pilkington TR. Hepatic structure and function after modified jejunoileal bypass surgery for obesity. Br Med J 1977;2:726-9.
  • 7. Ludwig J, Viggiano TR, McGill DB, Oh BJ. Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease. Mayo Clin Proc 1980;55:434-8.
  • 8. Teli MR, James OF, Burt AD, Bennett MK, Day CP. The natural history of nonalcoholic fatty liver: a follow-up study. Hepatology 1995;22:1714-9.
  • 9. Powell EE, Cooksley WG, Hanson R, et al. The natural history of nonalcoholic steatohepatitis: a follow-up study of forty-two patients for up to 21 years. Hepatology 1990;11:74-80.
  • 10. Harrison SA, Torgerson S, Hayashi P. The natural history of non-alcoholic fatty liver disease: a clinical histopathological study. Am J Gastroenterol 2003;98:2042-7.
  • 11. Marrero JA, Fontana RJ, Su GL, et al. NAFLD may be a common underlying liver disease in patients with hepatocellular carcinoma in the United States. Hepatology 2002;36:1349-54.
  • 12. Propst A, Propst T, Judmaier G, Vogel W. Prognosis in nonalcoholic steatohepatitis. Gastroenterology 1995;108:1607.
  • 13. Angulo P, Keach J, Batts K, Lindor K. Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis. Hepatology 1999;30:1356-62.
  • 14. Adams LA, Sanderson S, Lindor KD, Angulo P. The histological course of nonalcoholic fatty liver disease: a longitudinal study of 103 patients with sequential liver biopsies. J Hepatol 2005;42:132-8.
  • 15. Dixon JB, Bhathal PS, O’Brien PE. Nonalcoholic fatty liver disease: predictors of nonalcoholic steatohepatitis and liver fibrosis in the severely obese. Gastroenterology 2001;121:91-100.
  • 16. Colicchio P, Tarantino G, del Genio F, et al. Non-alcoholic fatty liver disease in young adult severely obese non-diabetic patients in south Italy. Ann Nutr Metab 2005;49:289-95.
  • 17. Angulo P. NAFLD, obesity, and bariatric surgery. Gastroenterology 2006;130:1848-52.
  • 18. Stranges S, Dorn JM, Muti P, et al. Body fat distribution, relative weight, and liver enzyme levels: a population-based study. Hepatology 2004;39:754-63.
  • 19. American Diabetic Association. Clinical practice recommendations 2000. Diabetes Care 2000;23(Suppl 1):4-19.
  • 20. Health NIH: Clinical guidelines on the identification, evaluation and treatment of overweight and obesity in adults: The evidence report. Obes Res Obes Res 1998;6(Suppl 2):51S-209S.
  • 21. Harold E. Lebovitz. Clinician’s Manual on Insulin Resistance 2002;p:5.
  • 22. Kleiner DE, Brunt EM, Van Natta M, et al; Nonalcoholic Steatohepatitis Clinical Research Network. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology 2005;41:1313-21.
  • 23. Argo CK, Northup PG, Al-Osaimi AM, Caldwell SH. Systematic review of risk factors for fibrosis progression in non-alcoholic steatohepatitis. J Hepatol 2009;51:371-9.
  • 24. Merriman RB, Ferrell LD, Pati MG, et al. Correlation of paired liver biopsies in morbidly obese patients with suspected nonalcoholic fatty liver disease. Hepatology 2006;44:874-80.
  • 25. Fassio E, Alvarez E, Dominguez N, Landeira G, Longo C. Natural history of nonalcoholic steatohepatitis: a longitudinal study of repeat liver biopsies. Hepatology 2004;40:820-6.
  • 26. Das K, Das K, Mukherjee PS, et al. Nonobese population in a developing country has a high prevalence of nonalcoholic fatty liver and significant liver disease. Hepatology 2010;51:1593-602.
Toplam 26 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Makaleler
Yazarlar

Nalan Ünal Bu kişi benim 0000-0001-8870-2450

Funda Yılmaz Bu kişi benim 0000-0003-1837-6498

Ulus Akarca Bu kişi benim 0000-0002-7020-5816

Deniz Nart Bu kişi benim 0000-0002-8100-6978

Galip Ersöz Bu kişi benim 0000-0002-2040-7524

Zeki Karasu Bu kişi benim 0000-0002-4974-7944

Ömer Özütemiz Bu kişi benim 0000-0002-6960-4043

Fulya Günşar Bu kişi benim 0000-0002-6002-4819

Yayımlanma Tarihi 4 Ekim 2020
Yayımlandığı Sayı Yıl 2020 Cilt: 19 Sayı: 2

Kaynak Göster

APA Ünal, N., Yılmaz, F., Akarca, U., Nart, D., vd. (2020). Nonalkolik yağlı karaciğer hastalığında histolojik progresyon ile klinik ve laboratuvar parametrelerin ilişkisi. Akademik Gastroenteroloji Dergisi, 19(2), 63-74. https://doi.org/10.17941/agd.799535

test-5