Tip 2 Diabetes Mellitus Tanılı Hastalarda Nonalkolik Yağlı Karaciğer Hastalığının Diabetin Süresi ve Diabetin Kronik Komplikasyonları İle İlişkisinin Değerlendirilmesi

Öz

Amaç: Çalışmamızda, tip 2 diabetes mellitus tanılı hastaların nonalkolik yağlı karaciğer hastalığı sıklığı; hepatosteatoz gelişimi ile diyabet süresi, kronik komplikasyonlar, laboratuvar ve klinik parametreler arasındaki ilişki incelenmiştir. Gereç ve Yöntemler: Kasım 2017-Şubat 2018 arası tarihlerde, Tip 2 diabetes mellitus tanısı ile takipli herhangi nedenle üst abdomen ultrasonografisi istenen hastalar dahil edilmiş, alkol kullanımı, hepatit, malignite, gebelik ve belirli ilaç kullanımları dışlanmıştır. Hastaların klinik-demografik bilgileri, antropometrik ölçümleri ve diyabetin kronik komplikasyonları kaydedilmiştir. Bulgular: Dahil edilen hastaların yaş ortalaması 56,1±11,3 yıl olup %45,5’i erkek, %54,5’i kadındı. Hastaların %66,5’inde hepatosteatoz saptandı ve bu oran kadınlarda erkeklere göre daha yüksekti (%72,5 vs %59,3, p=0,05). Hepatosteatoz olan grupta beden kütle indeksi ve kilo değerleri daha yüksek bulunurken (sırasıyla p<0,001 ve p=0,002), bu grupta A1C, açlık plazma glukozu, aspartat aminotransferaz, gama glutamil transpeptitaz, alanin aminotransferaz ve trigliserid düzeyleri anlamlı derecede yüksekti. Diyabet süresi ve komplikasyon oranları açısından gruplar benzerdir. Hipertansiyon, hepatosteatoz için anlamlı bir risk faktörü olarak tespit edilmiştir (p=0,022). Sonuç: Tip 2 diabetes mellitus hastalarında nonalkolik yağlı karaciğer hastalığı prevalansı yüksektir ve hipertansiyon varlığı nonalkolik yağlı karaciğer hastalığı açısından risk faktörüdür. Tip 2 diabetes mellitus ve hipertansiyon tanısı olan hastalarda nonalkolik yağlı karaciğer hastalığı gelişimi açısından daha dikkatli olunmalıdır

Anahtar Kelimeler

• Ultrasonografi
• nonalkolik yağlı karaciğer hastalığı
• hepatosteatoz
• tip 2 diabetes mellitus

Destekleyen Kurum

yok

Etik Beyan

Necmettin Erbakan Üniversitesi meram tıp Fakültesi 17/11/2017 tarih ve 2017/1084 nolu etik kurul onayı mevcuttur.

The Evaluation of The Relationship of Nonalcoholic Fatty Liver Disease to Duration of Diabetes and Chronic Complications of Diabetes in Patients with Type 2 Diabetes Mellitus

Öz

Aim: In our study, the frequency of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus and the relationship between the development of hepatosteatosis and diabetes duration, chronic complications, laboratory and clinical parameters were investigated. Material and Methods: Between November 2017 and February 2018, patients with type 2 diabetes mellitus who required upper abdominal ultrasonography for any reason were included. Alcohol use, hepatitis, malignancy, pregnancy and certain drug use were excluded. Clinicaldemographic information, anthropometric measurements and chronic complications of diabetes were recorded. Results: The mean age of the included patients was 56.1±11.3 years, 45.5% were male and 54.5% were female. Hepatosteatosis was found in 66.5% of the patients and this rate was higher in women than in men (72.5% vs 59.3%, p=0.05). While body mass ındex and weight values were higher in the group with hepatosteatosis (p<0.001 and p=0.002, respectively), A1C, fasting plasma glucose, aspartate aminotransferase, gamma glutamyl transpeptidase, alanine aminotransferase, and triglyceride levels were significantly higher in this group. The groups were similar in terms of diabetes duration and complication rates. Hypertension was found to be a significant risk factor for hepatosteatosis (p=0.022). Conclusion: The prevalence of nonalcoholic fatty liver disease is high in patients with type 2 diabetes mellitus and the presence of hypertension is a risk factor for nonalcoholic fatty liver disease. Patients with type 2 diabetes mellitus and hypertension should be more cautious about the development of nonalcoholic fatty liver disease.

Anahtar Kelimeler

• Ultrasonography
• nonalcoholic fatty liver disease
• type 2 diabetes mellitus
• hepatosteatosis

Kaynakça

1. 1. Vernon G, Baranova A, Younossi Z. Systematic review: the epidemiology and natural history of non‐alcoholic fatty liver disease and non‐alcoholic steatohepatitis in adults. Alimentary pharmacology & therapeutics. 2011;34(3):274-85.
2. 2. Matteoni CA, Younossi ZM, Gramlich T, Boparai N, Liu YC, McCullough AJ. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology. 1999;116(6):1413-9.
3. 3. NASH Çalıştay Sonuç Raporu 2018. Kaya PDA, editor. İstanbul: Türkiye Diyabet Vakfı; 2018.
4. 4. Younossi ZM, Stepanova M, Afendy M, Fang Y, Younossi Y, Mir H, Srishord M Changes in the prevalence of the most common causes of chronic liver diseases in the United States from 1988 to 2008. Clinical gastroenterology and hepatology. 2011;9(6):524-30. e1.
5. 5. Harrison SA, Gawrieh S, Roberts K, Lisanti CJ, Schwope RB, Cebe KM, Paradis V, Bedossa P, Aldridge Whitehead JM, Labourdette A, Miette V, Neubauer S, Fournier C, Paredes AH, Alkhouri N. Prospective evaluation of the prevalence of non-alcoholic fatty liver disease and steatohepatitis in a large middle- aged US cohort. Journal of hepatology. 2021;75(2):284-91.
6. 6. Forlani G, Giorda C, Manti R, Mazzella N, De Cosmo S, Rossi MC, Nicolucci A, Di Bartolo P, Ceriello A, Guida P; AMD-Annals Study Group. The Burden of NAFLD and Its Characteristics in a Nationwide Population with Type 2 Diabetes. J Diabetes Res. 2016;2016:2931985.
7. 7. Leite NC, Salles GF, Araujo AL, Villela‐Nogueira CA, Cardoso CR. Prevalence and associated factors of non‐alcoholic fatty liver disease in patients with type‐2 diabetes mellitus. Liver international. 2009;29(1):113-9.
8. 8. Targher G, Bertolini L, Rodella S, Tessari R, Zenari L, Lippi G, Arcaro G. Nonalcoholic fatty liver disease is independently associated with an increased incidence of cardiovascular events in type 2 diabetic patients. Diabetes care. 2007;30(8):2119-21.

9. 9. Loomba R, Friedman SL, Shulman GI. Mechanisms and disease consequences of nonalcoholic fatty liver disease. Cell. 2021;184(10):2537-64.
10. 10. Dai W, Ye L, Liu A, Wen SW, Deng J, Wu X, Lai Z. Prevalence of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus: a meta-analysis. Medicine. 2017;96(39):e8179.
11. 11. Kim BY, Jung CH, Mok JO, Kang SK, Kim CH. Prevalences of diabetic retinopathy and nephropathy are lower in K orean type 2 diabetic patients with non‐alcoholic fatty liver disease. Journal of diabetes investigation. 2014;5(2):170-5.
12. 12. TEMD Diabetes Mellitus ve Komplikasyonlarının Tanı, Tedavi ve İzlem Kılavuzu - 2024, https://file.temd.org.tr/ Uploads/publications/ guides/documents/diabetesmellitus2024.pdf, erişim tarihi 26.06.2024
13. 13. Mendler MH, Kanel G, Govindarajan S. Proposal for a histological scoring and grading system for non-alcoholic fatty liver disease. Liver Int. 2005 Apr;25(2):294-304.
14. 14. Price CP, Newall RG, Boyd JC. Use of protein:creatinine ratio measurements on random urine samples for prediction of significant proteinuria: a systematic review. Clin Chem. 2005 Sep;51(9):1577-86.
15. 15. Schwenzer NF, Springer F, Schraml C, Stefan N, Machann J, Schick F. Non-invasive assessment and quantification of liver steatosis by ultrasound, computed tomography and magnetic resonance. Journal of hepatology. 2009;51(3):433-45.
16. 16. Hernaez R, Lazo M, Bonekamp S, Kamel I, Brancati FL, Guallar E, Clark JM. Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: a meta‐analysis. Hepatology. 2011;54(3):1082-90.
17. 17. Lomonaco R, Godinez Leiva E, Bril F, Shrestha S, Mansour L, Budd J, Portillo Romero J, Schmidt S, Chang KL, Samraj G, Malaty J, Huber K, Bedossa P, Kalavalapalli S, Marte J, Barb D, Poulton D, Fanous N, Cusi K. Advanced liver fibrosis is common in patients with type 2 diabetes followed in the outpatient setting: the need for systematic screening. Diabetes Care. 2021;44(2):399-406.
18. 18. Chalasani N, Younossi Z, Lavine JE, Diehl AM, Brunt EM, Cusi K, Charlton M, Sanyal AJ. The diagnosis and management of non‐alcoholic fatty liver disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology. 2012;55(6):2005-23.
19. 19. Baratta F, Pastori D, Angelico F, Balla A, Paganini AM, Cocomello N, Ferro D, Violi F, Sanyal AJ, Del Ben M. Nonalcoholic fatty liver disease and fibrosis associated with increased risk of cardiovascular events in a prospective study. Clinical Gastroenterology and Hepatology. 2020;18(10):2324-31. e4.
20. 20. Canıtez VB, Güney İ, Erkuş E. Metabolik Sendromlu Olmayan Hastalarda Non-Alkolik Yağlı Karaciğer Hastalığı. Batı Karadeniz Tıp Dergisi 5.2 (2021): 143-149
21. 21. Kanwal F, Shubrook JH, Adams LA, Pfotenhauer K, Wai-Sun Wong V, Wright E, Abdelmalek MF, Harrison SA, Loomba R, Mantzoros CS, Bugianesi E, Eckel RH, Kaplan LM, El-Serag HB, Cusi K. Clinical Care Pathway for the Risk Stratification and Management of Patients With Nonalcoholic Fatty Liver Disease. Gastroenterology. 2021 Nov;161(5):1657-1669.
22. 22. Zhang Z, Wang J, Wang H. Correlation of blood glucose, serum chemerin and insulin resistance with NAFLD in patients with type 2 diabetes mellitus. Experimental and therapeutic medicine. 2018;15(3):2936-40.
23. 23. Cusi K, Isaacs S, Barb D, Basu R, Caprio S, Garvey WT, Kashyap S, Mechanick JI, Mouzaki M, Nadolsky K, Rinella ME, Vos MB, Younossi Z. American Association of Clinical Endocrinology clinical practice guideline for the diagnosis and management of nonalcoholic fatty liver disease in primary care and endocrinology clinical settings: co-sponsored by the American Association for the Study of Liver Diseases (AASLD). Endocrine Practice. 2022;28(5):528-62.
24. 24. Portillo-Sanchez P, Bril F, Maximos M, Lomonaco R, Biernacki D, Orsak B, Subbarayan S, Webb A, Hecht J, Cusi K. High prevalence of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus and normal plasma aminotransferase levels. The journal of clinical endocrinology & metabolism. 2015;100(6):2231-8.
25. 25. A Aminian A, Al-Kurd A, Wilson R, Bena J, Fayazzadeh H, Singh T, Albaugh VL, Shariff FU, Rodriguez NA, Jin J, Brethauer SA, Dasarathy S, Alkhouri N, Schauer PR, McCullough AJ, Nissen SE. Association of bariatric surgery with major adverse liver and cardiovascular outcomes in patients with biopsy-proven nonalcoholic steatohepatitis. Jama. 2021;326(20):2031-42.
26. 26. Gupte P, Amarapurkar D, Agal S, Baijal R, Kulshrestha P, Pramanik S, Patel N, Madan A, Amarapurkar A, Hafeezunnisa. Non‐alcoholic steatohepatitis in type 2 diabetes mellitus. Journal of gastroenterology and hepatology. 2004;19(8):854-8.
27. 27. Younossi ZM, Henry L. Fatty liver through the ages: nonalcoholic steatohepatitis. Endocrine Practice. 2022;28(2):204-13. 28. Simon TG, Roelstraete B, Khalili H, Hagström H, Ludvigsson JF. Mortality in biopsy-confirmed nonalcoholic fatty liver disease: results from a nationwide cohort. Gut. 2021;70(7):1375-82.