Kronik Karaciğer Hastalığı Nedeniyle Karaciğer Nakli Yapılan Çocuklarda Malnütrisyonun Değerlendirilmesinde Antropometrik Ölçümler ve Büyüme Faktörleri

Öz

Amaç: Kronik karaciğer hastalığı, özellikle insülin benzeri büyüme faktörü-1 (IGF-1) ve insülin benzeri büyüme faktörü bağlayıcı protein-3 (IGF-BP3) başta olmak üzere büyüme faktörü proteinlerinin yapı ve işlevindeki değişikliklerle birlikte çocuklarda büyüme geriliğine neden olur. Bu çalışmanın amacı, antropometrik parametreler (AP) ve büyüme faktörü proteinlerini kullanarak karaciğer nakli (LT) yapılan kronik karaciğer hastalığı olan çocuklarında beslenme durumunu değerlendirmektir.
Yöntem: Karaciğer nakli uygulanan 33 hasta ve 54 sağlıklı çocuk değerlendirildi. Hastaların AP'leri karaciğer nakli öncesi ve nakilden 1, 3, 6 ve 12 ay sonra değerlendirildi. Antropometrik parametreler, IGF-1/IGFBP-3 düzeyleri ve Child-Pugh skorları arasındaki ilişki analiz edildi.
Bulgular: Kronik karaciğer hastalığı olan çocuklarda, nakil öncesi boya göre ağırlık (WFH) dışındaki tüm antropometrik ölçümler kontrol grubuna göre daha düşüktü (p<0.05). Child-Pugh skoru ile triseps deri kıvrım kalınlığı (TSF) (r=-0.387, p=0.026) ve orta-üst kol çevresi (MUAC) Z-skoru (r=-0.448, p=0.009) arasında negatif bir ilişki vardı. IGF-I ve IGFBP-3 düzeyleri, nakil öncesi hasta grubunda ortalama 35.24±14.68 ng/ml ve 1.31±0.9 µg/ml olup, kontrol grubundan daha düşüktü (69.88±67.45 ng/ml ve 3.2±1µg/ml) (sırası ile p=0.001 ve p=0.000). 12 ay sonra, hasta grubunun yaşa göre boy Z skoru (HFA) (-0.7±1.46) kontrol grubundan daha düşük (0.08±0.9) (p=0.01) iken, TSF Z skoru (0.24±0.8) ve orta kol kas alanı (MAMA) (20.67±20.28) kontrol grubundan daha yüksekti (p=0.009, p=0.004). IGF-1 ve IGFBP-3 düzeyleri nakil öncesi dönemden daha yüksekti (p=0.000). IGF-1 ve IGFBP-3 seviyeleri ile AP arasında ilişki saptanmadı.
Sonuç: Kronik karaciğer hastalığı nedeniyle karaciğer nakli yapılan hastalarda malnütrisyon takibinde antropometrik parametreler IGF-1 ve IGFBP-3'e göre daha güvenilirdir.

Anahtar Kelimeler

• Kronik karaciğer hastalığı
• malnutrisyon
• insülin benzeri büyüme faktörü-1
• insülin benzeri büyüme faktörü bağlayıcı protein-3
• karaciğer nakli

Anthropometric Measurements and Growth Factors in the Evaluation of Malnutrition in Children with Liver Transplantation due to Chronic Liver Disease

Öz

Objective: Chronic liver disease (CLD) causes growth retardation in children, together with the changes in the structure and function of growth factor proteins, especially the insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGF-BP3). The aim of this study was to evaluate nutritional status of children with CLD undergone liver transplantation (LT) by using anthropometric parameters (AP), and growth factor proteins.
Method: Thirty-three patients undergone LT and 54 healthy children were evaluated. The AP of the patients were determined before and 1, 3, 6, and 12 months after LT. Relationship between AP, IGF-1/IGFBP-3 levels and Child-Pugh scores were analyzed.
Results: In children with CLD, all anthropometric measurements except weight for height (WFH) before transplantation were lower than the control group (p<0.05). There was a negative correlation between Child-Pugh score and triceps skinfold thickness (TSF) (r=-0.387, p=0.026) and mid-upper arm circumference (MUAC) Z-score (r=-0.448, p=0.009). IGF-I and IGFBP-3 levels were 35.24±14.68 ng/ml and 1.31±0.9 µg/ml in the pre-transplant patient group and were lower than the control group (69.88±67.45 ng/ml and 3.2±1 µg/ml) (respectively p=0.001 and p=0.000). After 12 months, the patient group's height-for-age (HFA) Z score (-0.7±1.46) was lower than the control group (0.08±0.9) (p=0.01), while TSF Z score (0.24±0.8) and mid- arm muscle area (MAMA) (20.67±20.28) was higher than the control group (p=0.009, p=0.004). IGF-1 and IGFBP-3 levels were higher than before transplantation (p=0.000). No correlation was found between IGF-1 and IGFBP-3 levels and AP.
Conclusion: AP are more reliable for the follow-up of malnutrition in patients undergone LT due to CLD, when compared to IGF-1 and IGFBP-3.

Anahtar Kelimeler

• Chronic liver disease
• Malnutrition
• Insulin-like growth factor-1
• Insulin-like growth factor binding protein-3
• liver transplantation

Kaynakça

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