Nonalkolik hepatosteatozda portal ven pulsatilite indeksi hepatik arter rezistif indeksi ile karaciğer fibrozisi öngörüsü için bir prediktif parametre olarak kullanılabilir mi?

Yıl 2020, Cilt: 4 Sayı: 2, 156 - 160, 12.07.2020

Okan Dilek Ömer Kaya

https://doi.org/10.30565/medalanya.689601

Öz

Amaç: Nonalkolik yağlı karaciğer hastalığı (NAYKH); izole karaciğer yağlanması, steatohepatit hatta siroza kadar uzanan geniş bir spektrumu barındıran klinik antitedir. Hepatit ya da siroz gelişiminde hepatik arter ve portal vendeki akım değişiklikleri saptanabilir. Çalışmanın amacı nonalkolik hepatosteatozlu hastalarda steatoz evresine göre hemodinamik bulgulardaki değişikliğin anlamlı olup olmadığının araştırılmasıdır.

Gereç ve Yöntem: Çalışma Şubat-Eylül 2018 tarihleri arasında Radyoloji Bölümüne batın ultrasonografi tetkiki için başvuran hastalardan bakılan B-mod ve Doppler ultrasonografik ölçümlerle yapılmıştır. Hepatik arter rezistif indeksi (HARİ) ve portal venin pulsatilite indeksi (PVPİ) değerlendirildi. Steatozu olmayan 30 hasta ve her 3

hepatosteatoz evresinden 30’ar hasta çalışmaya dahil edildi. Hastaların çalışmaya dahil edilme kriteri olarak ek hastalık öyküsünün olmamasına bakıldı. <0.05 değerler istatistiksel olarak anlamlı kabul edildi.

Bulgular: Evre 3 steatozda HARİ kontrol grubu, evre 1 ve 2 steatozdan anlamlı olarak daha düşüktü (p< 0.05). . Evre 3 steatozda, portal ven çapı evre 0, evre 1, evre 2 den anlamlı (p<0.05) olarak daha yüksekti. Evre 2 steatozda, PVPİ control grubu ve evre 1 steatozdan anlamlı olarak daha düşüktü (p<0.05). Kontrol ve hasta grupları ile karşılaştırıldığında hepatik arter ve portal vende anlamlı hemodinamik değişiklikler saptanmıştır.

Sonuç: PVPİ, NAYKH’de parankim hasarının değerlendirilmesinde, HARİ gibi noninvaziv değerli bir yöntem olarak görülmektedir.

Anahtar Kelimeler

nonalkolik, hepatosteatoz, hepatik arter rezistif indeks, portal ven pulsatilite indeksi

Can portal vein pulsatility index be used as predictive parameter with hepatic artery resistive index for liver fibrosis in nonalcoholic hepatosteatosis?

Öz

Aim: Nonalcoholic fatty liver disease (NAFLD) is a clinical entity with a broad spectrum of isolated liver steatosis, steatohepatitis and even cirrhosis. In the development of hepatitis or cirrhosis, flow changes in the hepatic artery and portal vein may be detected. The aim of this study was to investigate the significance of the changes in hemodynamic findings according to the steatosis grade in patients with nonalcoholic hepatosteatosis. 

Materials and Methods: the study was performed with B-mode and Doppler ultrasonographic (US) measurements of patients who applied to the radiology department for abdominal ultrasonography examination between February and September 2018. Hepatic artery resistive index (HARI) and portal vein pulsatility index (PVPI) were evaluated. Thirty patients without steatosis and 30 patients from each 3 hepatosteatosis grade were included into the study. As the criteria for inclusion of patients in the study, there was no history of additional disease. p<0.05 values were considered statistically significant. 

Results: HARI was significantly lower in grade 3 steatosis than the control group, grade 1 and 2 steatosis (p<0.05). In grade 3 steatosis, portale vein diameter was significantly wider than the control group, grade 1 and 2 steatosis (p<0.05). PVPI was significantly lower in grade 2 steatosis than the control group and grade 1 steatosis (p<0.05). Significant hemodynamic changes were detected in the hepatic artery and portal vein when compared with control and patients groups. 

Conclusion: The evaluation of PVPI is considered as a noninvasive valuable method as if HARI in the evaluation of liver parenchymal damage in NAFLD. 

Anahtar Kelimeler

nonalcoholic, hepatosteatosis, hepatic artery resistive index, portal vein pulsatility index

Kaynakça

• 1. Ahmed MH, Byrne CD. Current treatment of non-alcoholic fatty liver disease. Diabetes Obes Metab 2009;11:188-95.  doi: 10.1111/j.1463-1326.2008.00926.x
• 2. Marchesini G, Marzocchi R, Agostini F, Bugianesi E. Nonalcoholic fatty liver disease and the metabolic syndrome. Curr Opin Lipidol 2005;16:421-7. doi: 10.1097/01.mol.0000174153.53683.f2
• 3. Schwimmer JB, Deustch R, Rauch JB, Behling C, Newbury R, Lavine JE. Obesity, insulin resistance, and other clinicopathological correlates of pediatric nonalcoholic fatty liver disease. J Pediatr 2003;143:500-5. doi: 10.1067/S0022-3476(03)00325-1
• 4. Aube C, Oberti F, Korali N, Namour MA, Loisel D, Tanguy JY, et al. Ultrasonographic diagnosis of hepatic fibrosis or cirrhosis. J Hepatol 1999;30:472-8.doi: 10.1016/s0168-8278(99)80107-x
• 5. Joy D, Thava VR, Scott BB. Diagnosis of fatty liver disease: is biopsy necessary? Eur J Gastroenterol Hepatol 2003;15:539-43. doi: 10.1097/01.meg.0000059112.41030.2e
• 6. Kaya E, Yılmaz Y. Non-alcoholic fatty liver disease: a growing public health problem in Turkey. Turk J Gastroenterol 2019;30:865-71. doi: 10.5152/tjg.2019.18045
• 7. Solhjoo E, Mansour-Ghanaei F, Moulaei-Langorudi R, Joukar F. Comparison of portal vein doppler indices and hepatic vein doppler waveform in patients with nonalcoholic fatty liver disease with healthy control. Hepat Mon 2011;11(9):740-4. doi: 10.5812/kowsar.1735143X.729
• 8. Younossi Z, Tacke F, Arrese M, Chander Sharma B, Mostafa I, Bugianesi E, et al. Global perspectives on nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. Hepatology 2019;69: 2672-82. doi: 10.1002/hep.30251
• 9. Tana C, Schiavone C, Ticinesi A, Lauretani F, Nouvenne A, Dietrich CF, et al. Hepatic artery resistive index as surrogate marker for fibrosis progression in NAFLD patients: a clinical perspective. Int J Immunopathol Pharmacol 2018;32:1-3. doi: 10.1177/2058738418781373
• 10. Tana C, Tana M, Rossi S, Silingardi M, Schiavone C. Hepatic artery resistive index (HARI) and non-alcoholic fatty liver disease (NAFLD) fibrosis score in NAFLD patients: cut-off suggestive of non-alcoholic steatohepatitis (NASH) evolution. J Ultrasound 2016;19:183-9. doi: 10.1007/s40477-016-0203-8
• 11. Mihmanli I, Kantarci F, Yilmaz MH, Gurses B, Selcuk D, Ogut G, et al. Effect of diffuse fatty infiltration of the liver on hepatic artery resistance index. J Clin Ultrasound 2005;33:95-9. doi: 10.1002/jcu.20095
• 12. Hizli S, Kocyigit A, Arslan N, Tuncel S, Demircioglu F, Cakmakci H, et al. The role of ultrasonographic hepatic artery resistive index in the diagnosis of insulin resistance in obese children with non-alcoholic fatty liver disease. Turk J Med Sci 2010;40(3):335-42. doi:10.3906/sag-0906-22
• 13. Ulusan S, Yakar T, Koc Z. Evaluation of portal venous velocity with doppler ultrasound in patients with nonalcoholic fatty liver disease. Korean J Radiol 2011;12(4):450-5. doi: 10.3348/kjr.2011.12.4.450
• 14. Mohammadi A, Ghasemi-rad M, Zahedi H, Toldi G, Alinia T. Effect of severity of steatosis as assessed ultrasonographically on hepatic vascular indices in non-alcoholic fatty liver disease. Med ultrason 2011;13(3):200-6. PMID: 21894290
• 15. Catalano D, Caruso G, DiFazzio S, Carpinteri G, Scalisi N, Trovato GM. Portal vein pulsatility ratio and heart failure. J Clin Ultrasound 1998;26(1):27-31. doi: 10.1002/(sici)1097-0096(199801)26:1<27: aid-jcu6>3.0.co;2-l.
• 16. Abu-Yousef MM, Milam SG, Farner RM. Pulsatile portal vein flow: a sign of tricuspid regurgitation on duplex Doppler sonography. Am J Roentgenol 1990;155(4):785-8. doi: 10.2214/ajr.155.4.2119108
• 17. Gaiani S, Avogaro A, Bombonato GC, Bolognesi M, Amor F, de Kreutzenberg SV, et al. Nonalcoholic fatty liver disease (NAFLD) in nonobese patients with diabetes: Prevalence and relationships with hemodynamic alterations detected with Doppler sonography. J Ultrasound 2009;12(1):1- doi: 10.1016/j.jus.2008.12.002