TRİGLİSERİD-YÜKSEK YOĞUNLUKLU LİPOPROTEİN KOLESTEROL ORANI (TG/HDL) VE TRİGLİSERİD-GLUKOZ (TyG) İNDEKSİNİN HEPATOSTEATOZDAKİ YERİ

Öz

Amaç: Bu çalışmanın amacı Trigliserid/HDL değeri ve Trigliserid-glukoz indeksinin hepatosteatoz varlığı tahmininde kullanılıp kullanılmayacağının değerlendirilmesidir. Araçlar ve Yöntem: Etik Kuruldan 02.08.2021 tarihli 294 sayılı olur alınarak çalışmaya başlandı. Tek merkezde retrospektif olarak yapılan bu vaka-kontrol çalışmasında, 3. basamak hastanemiz veri tabanından hastalar tarandı. Ultrasonografi ile hepatosteatoz tanısı konulmuş 18 yaşından büyük hastalar çalışmaya alındı. Dışlama kriterleri; 18 yaşından küçük bireyler, kronik böbrek yetersizliği ve kronik karaciğer hastalığı olanlar (viral hepatitler, Wilson hastalığı, hemokromatozis), diyabet hastaları, gebeler, emzirenler, malignitesi veya tiroid hastalığı olanlar, alkol ve/veya ilaç bağımlılığı olanlar idi. Hastaların veri tabanlarından vücut kitle indeksi (VKİ), glukoz, insülin, HDL, trigliserid, Alanin Aminotransferaz (ALT) ve kreatinin değerleri kayıt edildi. Çalışmadan elde edilen veriler SPSS 21 versiyon program ile değerlendirildi. P<0.05 anlamlılık düzeyi kabul edildi. Bulgular: Çalışmaya 70 kadın, 32 erkek toplam 102 hasta alındı. Vakaların ortalama yaşları 41,33±13,84 yıl idi. TG/HDL değeri hepatosteatozlu hastalarımızda hepatosteatozu olmayanlara göre daha yüksekti (p:0.001). TG/HDL ve TyG indeksi, İnsülin Direncinin Homeostatik Model Değerlendirmesi olan HOMA-IR ile korelasyon gösteriyordu (p:0.001). TG/HDL 2.09 cut-off değerinde %85 duyarlılık ile hepatosteatoz varlığını tespit ediyordu (p:0.001). Sonuç: Trigliserid/HDL değeri poliklinik şartlarında daha ileri tetkikler yapılmadan önce hepatosteatoz varlığının değerlendirilmesinde güvenle kullanılabilecek, ucuz ve kolay hesaplanabilir bir parametredir.

Anahtar Kelimeler

• Hepatosteatoz
• Trigliserid
• HDL
• Glukoz

The Role of Triglyceride- High-Density Lipoprotein Cholesterol Ratio (TG/ HDL-C) and Triglyceride-Glucose (TyG) Index in Hepatosteatosis

Öz

Objective: The aim of this study is to evaluate whether the Triglyceride/HDL value and the Triglyceride-glucose index can be used in the estimation of the presence of hepatosteatosis. Materials and Methods: The study was initiated after obtaining the approval dated 02.08.2021 and numbered 294 from the Ethics Committee. In this retrospective case-control study conducted in a single center, patients were searched from the database of our 3rd level hospital. All patients older than 18 years of age who were diagnosed with hepatosteatosis by USG for any reason were included in the study. Exclusion criteria; Those under 18 years of age, those with chronic kidney failure and chronic liver disease (viral hepatitis, Wilson's disease, hemochromatosis), diabetes, pregnancy, breastfeeding, malignancy, thyroid disease, alcohol and/or drug addiction. Body mass index (BMI), glucose, insulin, HDL, triglyceride, ALT, and creatinine values were recorded from the databases of the patients. The data obtained from the study were evaluated with the SPSS 21 version program. P<0.05 significance level was accepted. Results: A total of 102 patients, 70 females and 32 males, were included in the study. The mean age of the cases was 41.33±13,84 years. TG/HDL value was higher in our patients with hepatosteatosis than in patients without hepatosteatosis (p:0.001). TG/HDL and TyG index showed a correlation with Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) (p:0.001). TG/HDL at a cut-off value of 2.09 with 85% sensitivity indicated the presence of hepatosteatosis (p:0.001). Conclusion: Triglyceride/HDL value is an inexpensive, easily calculated parameter that can be safely used in the evaluation of the presence of hepatosteatosis before further investigations are performed in outpatient settings.

Anahtar Kelimeler

• Hepatosteatosis
• Triglyceride
• HDL
• Glucose

Kaynakça

1. Zheng S, Shi S, Ren X et al. Triglyceride glucose-waist circumference, a novel and effective predictor of diabetes in first-degree relatives of type 2 diabetes patients: cross-sectional and prospective cohort study. J Transl Med. 2016;14(1):260.
2. Cohen DE, Fisher EA. Lipoprotein metabolism, dyslipidemia, and nonalcoholic fatty liver disease. Semin Liver Dis. 2013;33(4);380-388.
3. García AS, Gutiérrez RR, Adame LM et al. Diagnostic Accuracy of the Triglyceride and Glucose Index for Insulin Resistance: A Systematic Review. Int J Endocrinol. 2020; e4678526.
4. Quispe R, Martin SS, Jones SR. Triglycerides to high-density lipoprotein-cholesterol ratio, glycemic control and cardiovascular risk in obese patients with type 2 diabetes. Curr Opin Endocrinol Diabetes Obes. 2016;23(2):150-156.
5. Zhou M, Zhu L, Cui X et al. The triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio as a predictor of insulin resistance but not of β cell function in a Chinese population with different glucose tolerance status. Lipids Health Dis. 2016; 15:104.
6. Ren X, Chen Z, Zheng S et al. Association between Triglyceride to HDL-C Ratio (TG/HDL-C) and Insulin Resistance in Chinese Patients with Newly Diagnosed Type 2 Diabetes Mellitus. PLoS One. 2016;11(4): e0154345.
7. Er LK, Wu S, Chou HH et al. Triglyceride Glucose-Body Mass Index Is a Simple and Clinically Useful Surrogate Marker for Insulin Resistance in Nondiabetic Individuals. PLoS One. 2016;11(3): e0149731.
8. Li X, Li G, Cheng T et al. Association between triglyceride-glucose index and risk of incident diabetes: a secondary analysis based on a Chinese cohort study : TyG index and incident diabetes. Lipids Health Dis. 2020:19; 236.

9. Wen J, Wang A, Liu G et al. Elevated triglyceride-glucose (TyG) index predicts incidence of Prediabetes: a prospective cohort study in China. Lipids Health Dis. 2020;19:226.
10. Liu YT, Wang W, Tong J, Wang BY. Relationship between triglyceride-glucose index and non-alcoholic fatty liver disease. Zhonghua Gan Zang Bing Za Zhi. 2021;29(5):451-455.
11. Masson W, Siniawski D, Lobo M, Molinero G, Huerin M. Association between triglyceride/HDL cholesterol ratio and carotid atherosclerosis in postmenopausal middle-aged women. Endocrinologíay Nutrición. 2016; 63:327-332.
12. Zheng R, Mao Y. Triglyceride and glucose (TyG) index as a predictor of incident hypertension: a 9-year longitudinal population-based study. Lipids in Health and Disease. 2017; 16:175.
13. Khamseh ME, Malek M, Abbasi R et al. Triglyceride Glucose Index and Related Parameters (Triglyceride Glucose-Body Mass Index and Triglyceride Glucose-Waist Circumference) Identify Nonalcoholic Fatty Liver and Liver Fibrosis in Individuals with Overweight/Obesity. Metab Syndr Relat Disord. 2021;19(3):167-173.
14. Fan N, Peng L, Xia Z et al. Triglycerides to high-density lipoprotein cholesterol ratio as a surrogate for nonalcoholic fatty liver disease: a cross-sectional study. Lipids Health Dis. 2019;18(1):39.
15. Zheng R, Du Z, Wang M, Mao Y, Mao W. A longitudinal epidemiological study on the triglyceride and glucose index and the incident nonalcoholic fatty liver disease. Lipids Health Dis. 2018;17(1):262.
16. Zhang S, Du T, Zhang J et al. The triglyceride and glucose index (TyG) is an effective biomarker to identify nonalcoholic fatty liver disease. Lipids Health Dis. 2017;16(1); 15.
17. Huanan C, Sangsang L, Amoah AN et al. Relationship between triglyceride glucose index and the incidence of non-alcoholic fatty liver disease in the elderly: a retrospective cohort study in China. BMJ Open. 2020;10(11):e039804.
18. Guo W, Lu J, Qin P et al. The triglyceride-glucose index is associated with the severity of hepatic steatosis and the presence of liver fibrosis in non-alcoholic fatty liver disease: a cross-sectional study in Chinese adults. Lipids Health Dis. 2020;19(1):218.
19. Christou GA, Kiortsis DN. Adiponektin ve lipoprotein metabolizması. Obez Rev. 2013;14(12):939-949.
20. Steffes MW, Gross MD, Schreiner PJ et al. Serum adiponectin in young adults – interactions with central adiposity, circulating levels of glucose, and insulin resistance: the CARDIA study. Ann Epidemiol. 2004;14(7):492–498.
21. Oh DK, Ciaraldi T, Henry RR. Adiponectin in health and disease Diabetes Obesity and Metabolism. 2007;9(3):282–289.
22. Zhang H, Niu Y, Gu H et al. Low serum adiponectin is a predictor of progressing to nonalcoholic fatty liver disease. J Clin Laboratory Anal. 2019;33(3):e22709.
23. Yakar B, Önalan E, Barım AÖ, Gürsu MF. Adiponektin Düzeyleri ile Metabolik Sendrom, Tip 2 Diyabetes Mellitus ve Metabolik Parametreler Arasındaki İlişkinin Değerlendirilmesi. F.Ü.Sağ.Bil.Tıp.Derg. 2021;35(1):40–45
24. Alataş E.T, Kökçam İ. Investigation of adiponectin, leptin and apelin levels in patients with psoriasis vulgaris. Dicle Tıp Dergisi. 2014;41(1):144-150