Obez çocuklarda alkolsüz yağlı karaciğer hastalığı ile serum c-peptit, c-peptit-glikoz ve c-peptit-HbA1C oranı arasındaki ilişkinin değerlendirilmesi

Öz

Amaç: Obeziteye bağlı görülen metabolik sendrom, insulin direnci ve non-alkolik yağlı karaciğer hastalığı (NAYKH)gibi komplikasyonlar çocukluk çağında da sıklığı giderek artmaktadır. Bu çalışmanın amacı, NAYKH ile ilişkili obez çocuklarda açlık c-peptit, c-peptit-glukoz ve c-peptit-HbA1C oranlarını araştırmaktır. Yöntemler: Bu vaka-kontrol çalışması Ağustos-Kasım 2018 arasında gerçekleştirildi. Çalışmaya 40'ı NAYKH ile ilişkili ve 20'si NAYKH olmayan toplam 60 obez çocuk alındı. VKİ> 2 z-skoru olan hastalar obez olarak kabul edildi. NAYKH’nin ultrasonografik özellikleri, karaciğer kontrastı ve ekojenitede parlaklık olarak tanımlandı. Hastaların serum açlık c-peptit düzeyleri karşılaştırıldı. Bulgular: Çalışmaya dahil edilen 60 hastanın 37'si (%61,7) erkekti ve ortalama yaş 11,9 (2,9) yıldı. NAYKH'li hastalarda ortalama ALT, ağırlık, BMI, bel çevresi, bel çevresi-boy oranı, serum c-peptit, açlık c-peptit-glikoz oranı, açlık c-peptit-HbA1C oranı ve insülin seviyeleri, NAYKH olmayan obez çocuklara göre anlamlı olarak daha yüksekti. (her biri için P<0,05). Bütün hastalar içinde ROC analizi ile değerlendirildiğinde, NAYKH’li hastalar için eğri altındaki alan 0,70 (%95 CI: 0,725-0,955) ve c peptit kesme değeri 2,62 ng / ml (duyarlılık %60, özgüllük %75, P=0,011) idi. Lojistik regresyon analizi ile, c-peptit seviyesi 2.62 ng / ml'den yüksek olan obez çocuklarda NAYKH riski anlamlı derecede daha yüksekti (OR: 4,52 %95 CI: 1,65-3,25) (P<0,001). Sonuç: Bu çalışmada, NAYKH ile serum c-peptit düzeyi, c-peptit-glukoz ve c-peptit-HbA1C oranları arasında anlamlı bir ilişki bulunmuştur. NAYKH hastalarında insülin direncini belirlemede BMI, bel çevresi, bel-boy oranı, HbA1c ve insülin daha iyi standart parametreler olsa da, c-peptit tarama için pahalı olmayan bir yöntem olarak kullanılabilir.

Anahtar Kelimeler

• çocukluk çağı
• c-peptit
• c-peptit-glikoz oranı
• c-peptit-HbA1C oranı
• non-alkolik yağlı karaciğer hastalığı
• obezite

Evaluation of the relationship between non-alcoholic fatty liver disease and serum c-peptide, c-peptide to glucose and c-peptide to HbA1C ratio in obese children

Öz

Aim: Obesity-related complications such as metabolic syndrome, insulin resistance and non-alcoholic fatty liver disease (NAFLD) have increased in childhood. The aim of this study is to investigate the fasting c-peptide, c-peptide to glucose and c-peptide to HbA1C ratios in obese children with NAFLD. Methods: This case-control study was conducted from August through November 2018. A total of 60 obese children, 40 with and 20 without NAFLD, were included in the study. Patients with BMI > 2 z-score were considered obese. The ultrasonographic characteristics of NAFLD were identified with liver contrast and brightness in echogenicity. Serum fasting c-peptide levels of patients were compared. Results: Of the 60 patients included in the study, 37 (61.7%) were male and the mean age was 11.9 (2.9) years. The mean ALT, weight BMI, waist circumference, waist to height ratio, serum c-peptide, fasting c-peptide to glucose ratio, fasting c-peptide to HbA1C ratio and insulin levels were considerably higher in patients with NAFLD (P<0.05 for each). When the c-peptide levels of all the patients was evaluated by ROC analysis, the area under the curve in patients with NAFLD was 0.70 (95% CL: 0.725-0.955) and the c-peptide cut off value was 2.62 ng/ml (sensitivity 60%, specificity 75%, P=0.011). Logistic regression analysis results showed that the risk of NAFLD was significantly higher in obese children with c-peptide levels greater than 2.62 ng/ml (OR: 4.52 95% CI: 1.65-3.25) (P<0.001). Conclusion: In our study, a significant relationship was found between NAFLD and serum c-peptide level, c-peptide to glucose and c-peptide to HbA1C ratios. Even though BMI, waist circumference, waist to height ratio, HbA1c and insulin are better parameters in determining insulin resistance in NAFLD patients, c-peptide can be used as an inexpensive method for screening.

Anahtar Kelimeler

• Childhood,
• C-peptide, c-peptide-to-glucose ratio, c-peptide-to-HbA1C ratio
• Non-alcoholic fatty liver disease,
• obesity

Kaynakça

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