EVALUATION OF HEPATIC VASCULAR FLOW ALTERATIONS IN OBESE CHILDREN WITH AND WITHOUT NON-ALCOHOLIC FATTY LIVER DISEASE

Öz

Objective: To evaluate hepatic vascular flow alterations using Doppler ultrasound in obese children with and without non-alcoholic fatty liver disease.

Material and Methods: Ninety-one obese and 30 healthy lean (control) children were enrolled in this study. Obese children were divided into two groups: children with non-alcoholic fatty liver disease and children without non-alcoholic fatty liver disease; according to hepatic fatty changes on ultrasound, and blood serum alanine aminotransferase levels above 30 IU/L. Portal vein diameter, portal blood flow volume and hepatic artery resistive index were calculated using Doppler ultrasound.

Results: Portal vein diameter and portal blood flow volume values in children with non-alcoholic fatty liver disease were found close to the controls. However, the values of portal vein diameter and portal blood flow volume were lower in children without non-alcoholic fatty liver disease group than the other groups (p<0.001). Hepatic artery resistive index was higher in children without non-alcoholic fatty liver disease group than children with non-alcoholic fatty liver disease group (0.64±0.1 and 0.60±0.1, respectively) (p=0.03), whereas hepatic artery resistive index was found to be close in children with non-alcoholic fatty liver disease and controls. These findings were similar to the differences in hepatic vascular changes observed during the development of non-alcoholic fatty liver disease, which were described in physio-pathological studies.

Conclusion: Portal vein diameter, portal blood flow volume and hepatic artery resistive index values in obese children show significant differences according to the presence or absence of fatty liver. These differences are consistent with hepatic physio-pathological changes in non-alcoholic fatty liver disease. Therefore, hepatic vascular Doppler indices may be a new tool that can be used to monitor the development and progression of non-alcoholic fatty liver disease in obese children. 

Anahtar Kelimeler

• Non-alcoholic fatty liver disease
• portal vein
• hepatic artery
• Doppler ultrasound

Non-Alkolik Yağlı Karaciğer Hastalığı Olan ve Olmayan Obez Çocuklarda Hepatik Vasküler Akım Değişikliklerinin Değerlendirilmesi

Öz

Amaç: Non-alkolik yağlı karaciğer hastalığı olan ve olmayan obez çocuklarda hepatik vasküler akım değişikliklerini Doppler ultrason ile değerlendirmektir.

Gereç ve Yöntemler: Bu çalışmaya 91 obez ve 30 sağlıklı zayıf (kontrol) çocuk alındı. Obez çocuklar, ultrasondaki hepatik steatoz varlığı ve kan serumu alanin aminotransferaz düzeyinin 30 IU/L'nin üzerinde olması durumuna göre, non-alkolik yağlı karaciğer hastalığı olan ve non-alkolik yağlı karaciğer hastalığı olmayan şeklinde iki gruba ayrıldı. Portal ven çapı, portal ven akım hacmi ve hepatik arter rezistif indeksi Doppler ultrason kullanılarak hesaplandı.

Bulgular: Non-alkolik yağlı karaciğer hastalığında portal ven çapı ve portal ven akım hacmi değerleri kontrol grubuna yakın bulundu. Ancak non-alkolik yağlı karaciğer hastalığı olmayan grupta portal ven çapı ve portal ven akım hacmi değerleri, diğer gruplara göre daha düşüktü (p<0.001). Hepatik arter rezistif indeksi değerleri, non-alkolik yağlı karaciğer hastalığı olmayan grupta non-alkolik yağlı karaciğer hastalığı grubundan istatistiksel olarak anlamlı yüksek bulundu (sırasıyla 0.64±0.1 ve 0.60±0.1) (p=0.03). Buna karşın, non-alkolik yağlı karaciğer hastalığı ve kontrol gruplarında hepatik arter rezistif indeksi değerleri birbirine yakındı. Bulgular, fizyopatolojik çalışmalarda tanımlanmış, non-alkolik yağlı karaciğer hastalığı gelişim sürecinde izlenen, hepatik vasküler değişimlerdeki farklılıklar ile benzerdi.

Sonuç: Obez çocuklarda portal ven çapı, portal ven akım hacmi ve hepatik arter rezistif indeksi değerleri karaciğer yağlanması olup olmamasına göre anlamlı farklılıklar göstermektedir. Bu farklılıklar non-alkolik yağlı karaciğer hastalığındaki hepatik fizyopatolojik değişimler ile uyumludur. Bu nedenle, hepatik vasküler Doppler indeksleri obez çocuklarda non-alkolik yağlı karaciğer hastalığı gelişimi ve ilerlemesinin takibinde kullanılabilecek yeni bir araç olabilir.

Anahtar Kelimeler

• Non alkolik yağlı karaciğer hastalığı
• portal ven
• hepatik arter
• Doppler ultrasonografi

Kaynakça

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