Diyabetik Ve Nondiyabetik Hepatosteatozlu Hastalarda Biyokimyasal Parametreler Ve Noninvaziv Görüntüleme Verilerinin Değerlendirilmesi

Yıl 2021, , 47 - 51, 31.08.2021

Tuğba Sevinç Gamsız , Emine Köroğlu

https://doi.org/10.35514/mtd.2021.47

Öz

DİYABETİK VE NONDİYABETİK HEPATOSTEATOZLU HASTALARDA BİYOKİMYASAL PARAMETRELER VE NONİNVAZİV GÖRÜNTÜLEME VERİLERİNİN DEĞERLENDİRİLMESİ
ÖZET
Amaç: Nonalkolik yağlı karaciğer hastalığı (NAYKH) genel populasyonda en sık görülen kronik karaciğer hastalığıdır. Morbidite ve mortaliteyi artırması ve herhangi bir klinik semptom vermemesi, karaciğer yağlanmalarının erken tanı ve takibini önemli kılmaktadır. Çalışmamızda NAYKH tanısı almış olan diyabetik ve nondiyabetik hastalarımızın noninvaziv görüntüleme verileri ve biyokimyasal parametreleri arasındaki ilişkiyi değerlendirmeyi amaçladık.
Gereç ve Yöntem: Çalışmaya (Eylül, 2017 – Aralık, 2017) tarihlerinde İç Hastalıkları ve Gastroenteroloji polikliniklerine başvuran, son altı ay içinde ultrasonografi ve/veya transient elastografi ile hepatosteatoz tanısı almış olan erişkin yaş grubu hastalar dahil edilmiş; eşlik eden farklı bir karaciğer hastalığı olan ve alkol tüketmiş olan hastalar çalışmadan dışlanmıştır. Veriler retrospektif olarak değerlendirilmiştir. İstatistiksel veriler için NCSS 2007 programı kullanıldı.
Bulgular: Çalışmaya 116 hasta alındı. Diyabet tanısı olan hastaların CAP, E ve fibrozis değerleri, nondiyabetik gruptan anlamlı düzeyde yüksek bulundu. Yine hipertansiyon tanısı varlığı, hepatomegali olması, BMI, trigliserid düzeyi, kan Şekeri yüksekliği, Hemoglobin A1c ve ürik asit düzeylerinin de NAYKH ve fibrozis sürecini olumsuz yönde etkilediği görüldü.
Sonuç: Karaciğer yağlanmasının takibinde transient elastografi güvenilir sonuçlar veren noninvaziv bir teknik olarak günlük pratiğimize girmiştir. Özellikle metabolik sendrom kriterleri olan hastalarda fibrozis derecesinin erken dönemde belirlenmesi, takip ve tedaviye yön vermesi açısından önemlidir.
Anahtar kelimeler: diyabet, elastografi, fibrozis, karaciğer yağlanması, metabolik sendrom

Anahtar Kelimeler

diyabet, hepatosteatoz, elastografi, fibrosis, karaciğer

Assessment of Hepatosteatosis Among Diabetic And Nondiabetic Patıents Using Biochemical Parameters And Noninvasive Imaging Techniques

Öz

Aim: Nonalcoholic fatty liver disease (NAFLD) is considered the most common chronic liver disease in the general population.The higher mortality and morbidity among NAFLD patients and lack of symptoms makes early detection and management important. In our study, we aimed to evaluate the relationship between noninvasive imaging and biochemical markers in diabetic and nondiabetic patients diagnosed with NAFLD.
Materials and Methods: The study was conducted from (September, 2017) to (December, 2017) on adults admitted to Internal Medicine and Gastroenterology outpatient clinics with hepatic steatosis reported on ultrasound or transient elastography within the last six months that exclude patients with other liver diseases or alcohol abuse. The data was collected and analyzed retrospectively. Number cruncher statistical system (NCSS) 2007 program was used for statistical analysis.
Results: 116 patients were included in this study. Diabetic patients compared to nondiabetics had significantly higher Controlled Attenuation Parameter (CAP), Liver Stiffness Measurement (LSM) and fibrosis values. Also, hypertension, hepatomegaly, high BMI, hypertriglyceridemia, hyperglycemia, high A1c and hyperuricemia were found to be risk factors for NAFLD progression to fibrosis.
Advanced fibrosis (F3, F4) was present in 18,6 % of all our patients; 35,8 % of diabetic and 5,7 % of nondiabetic patients diagnosed with hepatic steatosis.
Conclusion: Transient elastography is now used in daily clinical practice as an accurate noninvasive tool during follow-up of patients with fatty liver. Early diagnosis of the stage of liver fibrosis improves monitoring and management of patients, especially in those with metabolic syndrome criteria.

Anahtar Kelimeler

diabetes, elastography, fatty liver, fibrosis, metabolic syndrome

Kaynakça

• REFERENCES (1) Mcpherson S., Henderson E., Hardy T., Burt A., Day C., Anstee QM., et al. “Natural history of NAFLD: A study of 108 patients with paired liver biopsies” Gut 2014;63(Suppl 1):A1– A288
• (2) Bertot LC., Adams LA. “The natural course of non-alcoholic fatty liver disease” Int J Mol Sci. 2016 May; 17(5): 774. Published online 2016 May 20.
• (3) Dulai PS., Singh S., Patel J., Soni M., Prokop LJ., Younossi Z., et al. “Increased risk of mortality by fibrosis stage in nonalcoholic fatty liver disease: Systematic review and metaanalysis” Hepatology. 2017 May;65(5):1557-1565.
• (4) Pathik P., Ravindra S., Ajay C., Prasad B., Jatin P., Prabha S. “Fibroscan versus simple noninvasive screening tools in predicting fibrosis in high-risk nonalcoholic fatty liver disease patients from Western India” Annals of Gastroenterology 2015 Apr-Jun; v28(2): 281–286
• (5) Sasso M., Beaugrand M., de Ledinghen V., Douvin C., Marcellin P., Poupon R., et al. “Controlled attenuation parameter (CAP): a novel VCTE™ guided ultrasonic attenuation measurement for the evaluation of hepatic steatosis: preliminary study and validation in a cohort of patients with chronic liver disease from various causes.” Ultrasound Med Biol 2010;36:1825-1835.
• (6) Yoneda M, Yoneda M, Fujita K, et al. Transient elastography in patients with non-alcoholic fatty liver disease (NAFLD). Gut 2007; 56: 1330–1331.
• (7) Angulo P., Hui J.M., Marchesini G., Bugianesi E., George J., “The NAFLD Fibrosis Score: A Noninvasive System That Identifies Liver Fibrosis in Patients with NAFLD”. Hepatology 2007 Apr;45(4):846-54. doi: 10.1002/hep.21496.
• (8) Vallet-Pichard A., Mallet V., Nalpas B., Verkarre V., Nalpas A. Et al. “FIB-4: an inexpensive and accurate marker of fibrosis in HCV infection. Comparison with liver biopsy and fibrotest” Hepatology 2007 Jul;46(1):32-6. doi: 10.1002/hep.21669
• (9) Ref*** Boursier J., Zarski JP., de Ledinghen V., Rousselet MC., Sturm M., Lebail B., et al. “Determination of reliability criteria for liver stiffness evaluation by transient elastography” Hepatology 2013 Mar; 57(3): 1182-91. Epub 2013 Feb 4.
• (10) Kwok R., Choi KC., Wong GL, Zhang Y., Chan HL., Luk AO., et al. “Screening diabetic patients for non-alcoholic fatty liver disease with controlled attenuation Parameter and liver stiffness measurements: a prospective cohort study” Gut 2016 August; 65 (8)
• (11) Yılmaz Y., Ergelen R., Akın H., İmeryüz N. “Noninvasive detection of hepatic steatosis in patients without ultrasonographic evidence of fatty liver using the controlled attenuation parameter evaluated with transient elastography” European Journal of Gastroenterology and Hepatology 2013 Nov; 25(11): 1330-4.
• (12) Setiawan VW., Stram DO., Porcel J., Lu SC., Le Marchand L., Noureddin M. “Prevalence of chronic liver disease and cirrhosis by underlying cause in understudied ethnic groups: The multiethnic cohort” Hepatology. 2016 Dec;64(6):1969-1977. doi: 10.1002/hep.28677. Epub 2016 Jul 17
• (13) Heidari Z., Gharebaghi A. “Prevalence of Non Alcoholic Fatty Liver Disease and its Association with Diabetic Nephropathy in Patients with Type 2 Diabetes Mellitus” J Clin Diagn Res. 2017 May; 11(5): OC04–OC07. Published online 2017 May 1. doi: 10.7860/JCDR/2017/25931.9823
• (14) Hajiani E., Alavinejad P., Hashemi SJ., Masjedizadeh AR., Shayesteh AA., Parishan F., et al. “Comparison of the Transient Elastography (Fibroscan) Results Among Diabetic and Non- Diabetic Patients with Non- Alcoholic Fatty Liver Disease” Gastroenterology and Hepatology, July 14, 2014 | Published: September 18,2014. Volume 1 Issue 4– 2014
• (15) Sporea I., Mare R., Lupuşoru R., Sima A., Sirli R., Popescu A., et al. “Liver Stiffness Evaluation by Transient Elastography in Type 2 Diabetes Mellitus Patients with Ultrasound proven Steatosis” J Gastrointestin Liver Dis. 2016 Jun;25(2):167-74. doi:10.15403/jgld.2014.1121.252.lsf.
• (16) Mikolasevic I., Milic S., Turk Wensveen T., Grgic I., Jakopcic I., Stimac D., et al. “Nonalcoholic fatty liver disease – A multisystem disease?” World J Gastroenterol. 2016 Nov 21; 22(43): 9488–9505. Published online 2016 Nov 21. doi: 10.3748/wjg.v22.i43.9488
• (17) Kwok R, Choi KC, Wong GL, Zhang Y., Chan HL., Luk AO., et al. “Screening diabetic patients for non-alcoholic fatty liverndisease with controlled attenuation parameter and liver stiffness measurements: a prospective cohort study” Gut. 2016 Aug;65(8):1359- 68.