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

Yıl 2020, Cilt: 20 Sayı: 3, 143 - 149, 11.01.2022

Bahadır Köylü Yunus Günegül Cenk Sökmensüer Taylan Kav Erkan Parlak Bülent Sivri Onur Keskin

https://doi.org/10.17941/agd.1055288

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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