Non-Alkolik Yağlı Karaciğer (NAYK) Hastalığının Derecelerinin ve Olası Biyobelirteçlerinin İncelenmesi

Yıl 2018, Cilt: 23 Sayı: 2, 73 - 78, 09.04.2018

Abdulhalim Şenyiğit , Bülent Yaprak Timur Orhanoğlu

https://doi.org/10.21673/anadoluklin.370144

Cited By: 1

Öz

Amaç: Çalışmamızda non-alkolik yağlı karaciğer (NAYK) hastalığında ilgili biyokimyasal belirteçleri ve bunlar arasındaki ilişkileri incelemeyi amaçladık.

Gereç ve Yöntemler: Herhangi bir yakınması olmayıp hastanemize kontrol amacıyla başvurmuş olan bireylerin dosyaları retrospektif olarak incelendi. Ultrasonografide (USG) karaciğerde değişik derecelerdeNAYK tespit edilen 148 (94 kadın, 54 erkek) birey vaka grubu olarak, USG’de NAYK tespit edilmeyen 149 (76 kadın, 73 erkek) birey ise sağlıklı kontrol grubu olarak çalışmaya dahil edildi. Toplamda 297 hastanın açlık kan glukozu, insülin, HOMA-IR, ürik asit, C-reaktif protein (CRP), trigliserit, LDL, HDL, TSH, D vitamini, AST, ALT, GGT, ALP değerleri ve USG ile belirlenmiş olan NAYK dereceleri incelendi.

Bulgular: Cinsiyet karşılaştırılmasında erkeklerde, NAYK prevalansı vaka grubunda sağlıklı gruptakine göre anlamlı biçimde daha yüksek bulundu (p=0,029). Benzer şekilde serum açlık kan glukozu, insülin, HOMA-IR, ürik asit, trigliserit, HDL, ALT, AST, GGT, CRP değerleri de vaka grubunda anlamlı biçimde daha yüksekti. HDL, D vitamini düşüklüklerinin NAYK derecesine etkisi saptanmadı. Vaka grubunda NAYK derecesine göre yapılan analizler açlık kan şekeri (AKŞ), HOMA-IR, ALT, AST ve GGT ortalamaları açısından NAYK dereceleri arasında istatistiksel olarak anlamlı fark olduğunu gösterdi. NAYK derecesi 2 ve 3 olan gruplar birleştirilerek analizler tekrarlandığında NAYK derecesi 1 ve 2 olan iki yeni grup arasında AKŞ, insülin, HOMA-IR, ALT, GGT ortalamaları açısından istatistiksel olarak anlamlı bir fark bulundu. Bu kez AST’deki farklılık azalırken, insülin değeri ortalaması açısından da istatistiksel olarak anlamlı fark olduğu gözlendi.

Tartışma ve Sonuç: Çalışmamız görünürde sağlıklı olan bireylerde de NAYK’nin araştırılması gerektiğini, erken tanı ve uygun yönetim ile siroz ve hepatoselüler karsinom gibi komplikasyonların önüne geçilebileceğini düşündürmektedir.

Anahtar Kelimeler

Non-alkolik yağlı karaciğer, Ultrasonografi, HOMA-IR

An Investigation of Degrees and Possible Biomarkers of Non-Alcoholic Fatty Liver (NAFL) Disease

Öz

Aim: In this study, we aimed to investigate the related biochemical markers and their correlations in non-alcoholic fatty liver (NAFL) disease.

Materials and Methods: Patient files of individuals who came to our hospital for routine controls without any complaints were reviewed retrospectively. One hundred and forty-eight individuals (94 females; 54 males) whose ultrasonographic examination revealed varying degrees of NAFL disease constituted the patients group and 149 individuals (76 females; 73 males) whose results were clear the healthy controls group. We reviewed the ultrasonographically determined NAFL disease grades and fasting blood glucose, insulin, HOMA-IR, uric acid, C-reactive protein (CRP), triglyceride, LDL, HDL, TSH, vitamin D, AST, ALT, GGT and ALP values of a total of 297 patients.

Results: With respect to sex, NAFL prevalence was significantly higher in the patients group than in the healthy controls for males (p=0.029). Similarly, fasting blood glucose, insulin, HOMA-IR, uric acid, triglyceride, HDL, ALT, AST, GGT and CRP levels were also significantly higher in the patients group. No effect of low HDL and vitamin D levels on NAFL disease grade was observed. Analyses based on NAFL disease grade showed statistically significant difference between the subgroups of disease grade of the patients group in terms of fasting blood glucose, HOMA-IR, ALT, AST and GGT mean values. When the analyses were repeated after the grade 2 and 3 subgroups were combined, there was statistically significant difference between the new grade 1 and 2 subgroups in terms of fasting blood glucose, insulin, HOMA-IR, ALT and GGT mean values. This time there was statistically significant difference in terms of mean insulin levels also, while the difference between the AST levels decreased.

Discussion and Conclusion: Our study suggests that apparently healthy individuals also be examined for presence of NAFL disease because timely diagnosis and appropriate management could significantly help prevent complications such as cirrhosis and hepatocellular carcinoma.

Anahtar Kelimeler

Non-alcoholic fatty liver, Ultrasonography, HOMA-IR

Kaynakça

• 1. Brunt EM. Nonalcoholic steatohepatitis: definition and pathology. Semin Liver Dis. 2001;21:3-16 2. Sanyal AJ; American Gastroenterological Association. AGA technical review on nonalcoholic fatty liver disease. Gastroenterology. 2002;123:1705-25. 3. Browning JD, Szczepaniak LS, Dobbins R, et al. Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology. 2004 ;40:1387-1395. 4. Bellentani S, Tiribelli C, Saccoccio G, et al. Prevalence of chronic liver disease in the general population of northern Italy: the Dionysos Study. Hepatology. 1994 ;20:1442-9. 5. Angulo P. GI epidemiology: nonalcoholic fatty liver disease. Aliment Pharmacol Ther. 2007;25:883-9. 6. Musso G, Gambino R, Bo S, et al. Should nonalcoholic fatty liver disease be included in the definition of metabolic syndrome? A cross-sectional comparison with Adult Treatment Panel III criteria in nonobese nondiabetic subjects. Diabetes Care. 2008 ;31:562-8. 7. Marchesini G, Brizi M, Bianchi G, et al. Nonalcoholic fatty liver disease: a feature of the metabolic syndrome. Diabetes. 2001;50:1844-50. 8. 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. 9. Bugianesi E, Leone N, Vanni E, et al. Expanding the natural history of nonalcoholic steatohepatitis: from cryptogenic cirrhosis to hepatocellular carcinoma. Gastroenterology. 2002;123:134-40. 10. Caldwell SH, Oelsner DH, Iezzoni JC, et al. Cryptogenic cirrhosis: clinical characterization and risk factors for underlying disease. Hepatology. 1999;29:664-9. 11. Washington K, Wright K, Shyr Y, et al. Hepatic stellate cell activation in nonalcoholic steatohepatitis and fatty liver. Hum Pathol. 2000 ;31:822-8. 12. Falck-Ytter Y, Younossi ZM, Marchesini G, McCullough AJ. Clinical features and natural history of nonalcoholic steatosis syndromes. Semin Liver Dis. 2001;21:17-26. 13. 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. 14. Angulo P, Keach JC, Batts KP, Lindor KD. Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis. Hepatology. 1999;30:1356-62. 15. Teli MR, James OF, Burt Adet al. The natural history of nonalcoholic fatty liver: a follow-up study. Hepatology. 1995;22:1714-9. 16. Matteoni CA, Younossi ZM, Gramlich T, et al. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology. 1999 ;116:1413-9 17. Cosar S. Alkol Bağımlılarında Biyokimyasal Parametrelerın incelemesı ve Karaciğer Hemodinamisinin Doppler Us ile Değerlendirilmesi Gazi Üniversitesi Radyoloji Abd , Uzmanlık Tezi , Ankara 2001. 18. Bayard M, Holt J, Boroughs E. Nonalcoholic fatty liver disease. Am Fam Physician. 2006;73:1961-8. 19. Nigam P, Bhatt SP, Misra A, et al. Non-alcoholic fatty liver disease is closely associated with sub-clinical inflammation: a case-control study on Asian Indians in North India. PLoS One. 2013;8:e49286. 20. Kucukazman M, Ata N, Yavuz B, et al. Evaluation of early atherosclerosis markers in patients with nonalcoholic fatty liver disease. Eur J Gastroenterol Hepatol. 2013;25:147-51. 21. Ozhan H, Aydin M, Yazici M, et al. Mean platelet volume in patients with non-alcoholic fatty liver disease. Platelets. 2010;21:29-32. 22. Toledo FG, Sniderman AD, Kelley DE. Influence of hepatic steatosis (fatty liver) on severity and composition of dyslipidemia in type 2 diabetes. Diabetes Care. 2006 ;29:1845-50. 23. Fenkci S, Rota S, Sabir N, Akdag B. Ultrasonographic and biochemical evaluation of visceral obesity in obese women with non-alcoholic fatty liver disease. Eur J Med Res. 2007 26;12:68-73.