KARACİĞER BİYOPSİ İLE NONALKOLİK YAĞLI KARACİĞER HASTALIĞI TANISI ALAN 220 HASTANIN RETROSPEKTİF DEĞERLENDİRİLMESİ

Yıl 2020, Cilt: 6 Sayı: 1, 50 - 64, 30.01.2020

Alihan Oral Tolga Şahin

Öz

Non alkolik yağlı karaciğer hastalğı (NAYKH)
alkol tüketimi olmadan karaciğer yağlanması olarak tanımlanır. NAYKH, dünyada
en sık görülen kronik karaciğer hastalığı olarak bilinir. NAYKH, siroz ve
hepatoselüler kanser gibi ciddi hastalıklara sebep olabilmektedir. Bu çalışmada
karaciğer biyopsisi ile NAYKH tanısı alan 220 hastayı retrospektif
olarak değerlendirmeyi amaçladık. Araştırmaya 2010-2019 yılları arasında
Demiroğlu Bilim Üniversitesi Tıp Fakültesi gastroenteroloji polikliniğinde
takip edilen karaciğer biyopsi ile NAYKH tanısı alan toplam 220 hasta alındı.
Olguların demografik (yaş, cinsiyet, boy, kilo, beden kitle indeksi (BMI),
laboratuvar (biyokimyasal parametreler) ve biyopsi sonuçları hastane bilgi
sisteminden ve dosyalarından retrospektif olarak toplandı. Hastaların yaş ortalaması 34.14 ± 6.72 ve % 60’ı erkek, % 40’ı
kadındı. Erkek ve kadın hastalarda karaciğer yağlanma yüzdesi ortalaması
benzerdi (p: 0.41). Hastaların BMI ortalaması: 27.32 ± 3.02, ortalama karaciğer
steatoz yüzdesi % 12.1 ± 8.68 ve ortalama Homeostatic Model of Assessment-Insulin
Resistance (HOMA-IR) değeri 2.64 saptandı. Yağlanma derecesi ile BMI, aspartat
aminotransferaz, alanin aminotransferaz, alkalen fosfataz, gamaglutamil
transferaz, total kolesterol, trigliserit , kreatinin ve HOMA-IR arasında
pozitif korelasyon saptanırken yaş, üre ve total biluribin ile herhangi bir
korelasyon belirlenmedi. Çalışmamızda
genç ve orta yaş grubu ile obez olmayan kişilerde de NAYKH görülebileceği, BMI
ve insülin direncinin bu hasta grubunda da NAYKH ile ilişkili olabileceği gözlendi.
Ayrıca, karaciğer enzimleri normal aralıkta olsa bile NAYKH ile ilişkili
olabilecekleri görülmüştür. Yeni ve daha geniş kapsamlı çalışmalarla, bu konuda
daha güvenilir veriler elde edilebileceği düşünülmektedir.

Anahtar Kelimeler

Karaciğer yağlanması, NAFLD, hepatosteatoz

RETROSPECTIVE EVALUATION OF 220 PATIENTS WITH NONALCOHOLIC FATTY LIVER DISEASE DIAGNOSED BY LIVER BIOPSY

Öz

Non-alcoholic fatty liver disease (NAFLD)
defined as fatty accumulation in liver without alcohol consumption. NAFLD is
known as the most common chronic liver disease worldwide. NAFLD can cause serious diseases such as
cirrhosis and hepatocellular cancer (HCC). We aimed to evaluate retrospectively
220 liver biopsy proven patients with NAFLD in this study. A total of 220 patients diagnosed with NAFLD
by liver biopsy followed in the gastroenterology outpatient clinic of Demiroğlu
Bilim University Faculty of Medicine between 2010-2019 were included in the
study. Demographic data (age, gender, height, weight and body mass index),
biochemical laboratory parameters and biopsy results were scanned and recorded
retrospectively from hospital information system and files of patients. The mean age of the patients was 34.14 ± 6.72
and 60% of the patients were male and 40% were female. Mean liver steatosis
percentage was similar in male and female patients (p: 0.41). The mean BMI of
the patients was 27.32 ± 3.02, the mean liver steatosis percentage was 12.1 ±
8.68% and the mean Homeostatic Model of Assessment-Insulin Resistance (HOMA-IR)
value was 2.64. There was a positive correlation between liver steatosis and
BMI, aspartate aminotransferase, alanine aminotransferase, alkaline
phosphatase, gamaglutamyl transferase, total cholesterol, triglyceride,
creatinine and HOMA-IR, but no correlation was found between liver steatosis
and age, urea and bilirubin. In our study, it was observed that NAFLD can be
seen in young and middle-aged, non-obese individuals, and BMI and insulin
resistance may be associated with NAFLD in this patient group. In addition,
liver enzymes were found to be associated with NAFLD even if they were in the
normal range. More reliable data can be obtained with new and more extensive
studies.

Anahtar Kelimeler

Liver steatosis, NAFLD, hepatosteatosis

Kaynakça

• 1. LaBrecque DR, Abbas Z, Anania F, Ferenci P, Khan AG, Goh KL. Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. J Clin Gastroenterol. 2012;48(6):467-73.
• 2. Ratziu V, Bellentani S, Cortez-Pinto H, Day C, Marchesini G. A position statement on NAFLD/NASH based on the EASL 2009 special conference. J Hepatol. 2010;53(2):372–84.
• 3. Neuschwander-Tetri BA, Caldwell SH. Nonalcoholic steatohepatitis: Summary of an AASLD Single Topic Conference. Hepatology 2003; 37:1202–19.
• 4. Sookoian S, Pirola CJ. Systematic review with meta-analysis: Risk factors for non-alcoholic fatty liver disease suggest a shared altered metabolic and cardiovascular profile between lean and obese patients. Aliment. Pharmacol. Ther. 2017;46:85–95.
• 5. Marchisello, S.; Di Pino, A.; Scicali, R.; Urbano, F.; Piro, S.; Purrello, F.; Rabuazzo, A.M. Pathophysiological, Molecular and Therapeutic Issues of Nonalcoholic Fatty Liver Disease: An Overview. Int. J. Mol. Sci. 2019; 20: 1948.
• 6. Lomonaco R, Chen J, Chen K. An endocrine perspective of nonalcoholic fatty liver disease. Ther Adv Endocrinol Metab 2011;2(5):211–4.
• 7. Yki-Järvinen H. Nutritional modulation of non-alcoholic fatty liver disease and insulin resistance. Nutrients 2015;7:9127–38.
• 8. Fan, J.G.; Saibara, T.; Chitturi, S.; Kim, B.I.; Sung, J.J.Y.; Chutaputti, A. What are the risk factors and settings for non-alcoholic fatty liver disease in Asia-Pacific? J. Gastroenterol. Hepatol. 2007, 22, 794–800.
• 9. LaBrecque DR, Abbas Z, Anania F, Ferenci P, Khan AG, Goh KL. Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. J. Clin. Gastroenterol. 2012; 48: 467–473.
• 10. Miyake T, Kumagi T, Furukawa S, Tokumoto Y, Hirooka M, Abe M, Hiasa Y, Matsuura B, Onji M. Non-alcoholic fatty liver disease: Factors associated with its presence and onset. J. Gastroenterol. Hepatol. 2013; 28: 71–78.
• 11. Tankurt E. Yağlı Karaciğer Hastalığı. Gastroenteroloji Hepatoloji Tanı ve Tedavi. (Ed). Kalaycı C, Dabak R. 2010; 219-224.
• 12. Sonsuz A, Baysal B. Karaciğer Yağlanması ve Non Alkolik Steatohepatit. Güncel Gastroenteroloji 2011; 15: 98-106.
• 13. Kuyumcu A, Pürnak T, Yıldız A. Nonalkolik yağlı karaciğer hastalığı olan bireylerde fruktoz tüketiminin değerlendirilmesi. Turk J Clin Lab 2019;10:190-196.
• 14. Şenyiğit A, Yaprak B, Orhanoğlu T . "An Investigation of Degrees and Possible Biomarkers of Non-Alcoholic Fatty Liver (NAFL) Disease". Anatolian Clinic the Journal of Medical Sciences 2018; 23: 73-78
• 15. Byrne CD, Targher G. NAFLD: a multisystem disease. J Hepatol 2015;62:47–64.
• 16. Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liverdisease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology 2016;64:73-84.
• 17. Fattahi MR, Niknam R, Safarpour A, Sepehrimanesh M, Lotfi M. The prevalence of metabolic syndrome in non-alcoholic fatty liver disease; a population-based study. Middle East J Dig Dis 2016;8:131-7.
• 18. Park KS, Lee YS, Park HW, Seo SH, Jang BG, Hwang JY, et al. Factors associated or related to with pathological severity of nonalcoholic fatty liver disease. Korean J Intern Med 2004;19:19-26.
• 19. Targher G, Bertolini L, Chonchol M, et al. Non-alcoholic fatty liver disease is independently associated with an increased prevalence of chronic kidney disease and retinopathy in type 1 diabetic patients. Diabetologia 2010;53:1341-8.Buzzetti E, Pinzani M, Tsochatzis EA. The multiple-hit pathogenesis of non-alcoholic fatty liver disease (NAFLD) Metabolism. 2016;65:1038–48.
• 20. Peverill W, Powell LW, Skoien R. Evolving concepts in the pathogenesis of NASH: beyond steatosis and inflammation. Int J Mol Sci. 2014;15:8591–638.
• 21. Benedict M, Zhang X. Non-alcoholic fatty liver disease: An expanded review. World J Hepatol. 2017;9(16):715–32.
• 22. Marchesini G, Bugianesi E, Forlani G, Cerrelli F, Lenzi M, Manini R, et al. Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome. Hepatology 2003;37:917–23.
• 23. Yki-Järvinen H. Nutritional modulation of non-alcoholic fatty liver disease and insulin resistance. Nutrients 2015;7:9127–38.
• 24. Huang JF, Yeh ML, Yu ML, Huang CF, Dai CY, Hsieh MY, Hsieh MH, Huang CI, Lin ZY, Chen SC et al. Hyperuricemia Inversely Correlates with Disease Severity in Taiwanese Nonalcoholic Steatohepatitis Patients. PLoS ONE 2015;10:e0139796.
• 25. Fernández-Rodríguez CM, Aller R, Gutiérrez-García ML, Ampuero J, Gómez-Camarero J, Martín-Mateos,, RM, Burgos-Santamaría D, Rosales JM, Aspichueta P, Buque X et al. Higher levels of serum uric acid influences hepatic damage in patients with non-alcoholic fatty liver disease (NAFLD). Rev. Esp. Enferm. Dig. 2019;111:264–9.
• 26. Hsu CL, Wu FZ, Lin KH, Chen YH, Wu PC, Chen YH, Chen CS, Wang WH, Mar GY, Yu HC. Role of Fatty Liver Index and Metabolic Factors in the Prediction of Nonalcoholic Fatty Liver Disease in a Lean Population Receiving Health Checkup. Clin. Transl. Gastroenterol. 2019;10:1–8.
• 27. Myers GL, Miller WG, Coresh J, Fleming J, Greenberg N, Greene T, Hostetter T, Levey AS, Panteghini M, Welch M et al. Recommendations for improving serum creatinine measurement: A report from the Laboratory Working Group of the National Kidney Disease Education Program. Clin. Chem. 2006;52:5–18.
• 28. Lanaspa MA, Sanchez-Lozada LG, Cicerchi C, Li N, Roncal-Jimenez CA, Ishimoto T, Le M, Garcia GE, Thomas JB, Rivard CJ et al. Uric acid stimulates fructokinase and accelerates fructose metabolism in the development of fatty liver. PLoS ONE 2012;7:e47948.
• 29. Xu C, Yu C, Xu L, Miao M, Li Y. High serum uric acid increases the risk for nonalcoholic Fatty liver disease: A prospective observational study. PLoS ONE 2010;5:e11578.
• 30. Liu X, Zhang H, Liang J. Blood urea nitrogen is elevated in patients with non-alcoholic fatty liver disease. Hepatogastroenterology 2013;60:343–5.
• 31. Kirvar A, Ayaz T, Durakoğlugil T, Şahin SB, Şahin OZ, Durakoğlugil E. The Association Between Non-Alcholic Fatty Liver Disease with Carotid Intima Media Thickness. J. Kartal. TR 2015;26,:13–8.