Siroz Hastalarında Resistinin Hastalık Şiddeti, İnflamasyon ve İnsülin Direnci ile İlişkisi

Yıl 2022, Cilt: 3 Sayı: 2, 184 - 197, 01.08.2022

Serdar Efe Ayşegül Özakyol

Öz

Giriş: Glikoz intoleransının erken dönem karaciğer hastalığının siroza ilerlemesinde önemli bir rol oynadığı gösterilmiştir. Kronik karaciğer hastalarındaki glikoz intoleransından insülin direncinin sorumlu olduğu öne sürülmektedir. Kronik karaciğer hastalığında kronik inflamasyon aracılığıyla artan resistinin insülin direncinden sorumlu olabileceği düşünülmektedir. Çalışmamızda siroz hastalığı olanlarda adipoz dokudan salınan resistinin, insülin direnci, inflamasyon belirteçleri ve hastalık evresi ile ilişkisini değerlendirilmeyi amaçladık. Yöntemler: Eskişehir Osmangazi Üniversitesi Tıp Fakültesi Gastroenteroloji Bilim Dalı’nda Mart 2008 – Temmuz 2009 tarihleri arasında siroz tanısı alan 46 hasta ve kontrol grubu olarak 19 sağlıklı birey çalışmaya dahil edildi. Diabetes Mellitus, diğer endokrin hastalık veya Hepatocellüler Karsinoma tanılı, açlık kan glikozu 126 mg/dl nin üzerinde olan ve glikoz metabolizması üzerine etki edebilecek ilaç kullanan hastalar çalışma dışı bırakıldı. Deri kıvrım kalınlığı (biseps, triseps, suprailiyak ve subskapular) ölçümü yöntemiyle obezitesi olan katılımcılar belirlendi. Çalışma ve kontrol gruplarından obez hastalar dışlanarak istatistik incelemeler yapıldı. Serum resistin düzeyi tespitinde AssayMax Human Resistin ELISA Kiti kullanıldı. İnsülin direncini saptamak amacıyla “İnsülin Direnci için Homeostatik Model” (HOMA-IR) formülü kullanıldı. Çalışılan parametreler çalışma ve kontrol grupları arasında ayrıca çalışma grubunda hastalık evresine göre oluşturulan üç grup arasında (Child Pugh evre A, B ve C) istatistiksel olarak karşılaştırıldı. Bulgular: İnsülin direncini yansıtan tüm laboratuvar parametreleri, inflamasyon belirteçleri ve resistin düzeylerinin çalışma grubunda anlamlı ölçüde yüksek olduğu saptanmıştır. Hastalık şiddet ve prognozunu belirlemede kullanılan Child Pugh evresi ilerledikçe resistin seviyelerinde artış olduğu ancak total yağ oranında azalmayla birlikte insülin direncine sahip hasta oranının da azaldığı gözlenmiştir. Resistinin açlık insülin düzeyi dışında insülin direncinin diğer belirteçleriyle arasında anlamlı bir ilişki saptanmamıştır. Sonuç: Sirozlu hastalarda yapılacak metabolizma çalışmalarında vücut yağ oranının saptanmasında deri kıvrım kalınlığı tespiti faydalı olabilir. Siroz hastalarında insülin direnci belirteçleri anlamlı derecede yüksektir ve resistin düzeyleri hastalık şiddeti arttıkça artış gösterir. Siroz hastalarında değişik mekanizmalarla ortaya çıkan insülin direnci gelişiminde resistinin katkısının olmadığı görüşündeyiz.

Anahtar Kelimeler

HOMA-IR, insülin direnci, resistin, siroz

Destekleyen Kurum

Yoktur

Proje Numarası

Yoktur

Teşekkür

Çalışmamız için çalışma grubu hastalarının belirlenmesi aşamasındaki destekleri için Doç. Dr. Tuncer TEMEL'e ve istatistik analizlerin yapılmasındaki katkıları için Öğretim Görevlisi Ahmet MUSMUL’a teşekkür ederiz.

The Relationship of Resistin with Disease Severity, Inflammation and Insulin Resistance in Cirrhosis Patients

Öz

Introduction: Glucose intolerance has been shown to play an important role in the progression of early liver disease to cirrhosis. It has been suggested that insulin resistance is responsible for glucose intolerance in patients with chronic liver disease. It is thought that increased resistin through chronic inflammation in chronic liver disease may be responsible for insulin resistance. In our study, we aimed to evaluate the relationship of resistin which is released from adipose tissue with insulin resistance, inflammation markers and disease stage in patients with cirrhosis. Methods: Forty-six patients diagnosed with cirrhosis in Eskişehir Osmangazi University Faculty of Medicine, Department of Gastroenterology between March 2008 and July 2009, and 19 healthy individuals as a control group were included in the study. Patients with a diagnosis of Diabetes Mellitus, other endocrine disease or Hepatocellular Carcinoma, with fasting blood glucose above 126 mg/dl and using drugs that may affect glucose metabolism were excluded from the study. Participants with obesity were determined by skinfold thickness (biceps, triceps, suprailiac and subscapular) measurement. Statistical analyzes were performed by excluding obese patients from the study and control groups. AssayMax Human Resistin ELISA Kit was used to determine serum resistin level. The "Homaostatic Model for Insulin Resistance" (HOMA-IR) formula was used to detect insulin resistance. The studied parameters were statistically compared between the study and control groups and also between the three groups (Child Pugh stage A, B and C) formed according to the disease stage in the study group. Results: All laboratory parameters reflecting insulin resistance, inflammation markers and resistin levels were found to be significantly higher in the study group. As the Child Pugh stage advances, which is used to determine the severity and prognosis of the disease, resistin levels found higher, but it was observed that the rate of patients with decreased insulin resistance had lower levels in total fat ratio. No significant correlation was found between resistin and other markers of insulin resistance except fasting insulin level. Conclusion: In the future metabolism studies which to be performed in patients with cirrhosis detection of skinfold thickness may be useful in determining body fat ratio. Insulin resistance markers are significantly higher in patients with cirrhosis, as disease severity advances resistin levels increases. We are in the opinion that resistin does not contribute to the development of insulin resistance, which occurs with different mechanisms in patients with cirrhosis.

Anahtar Kelimeler

cirrhosis, HOMA-IR, insulin resistance, resistin

Proje Numarası

Yoktur

Kaynakça

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