THE EFFECT OF FATTY LIVER DISEASE ON PORTAL VEIN FLOW IN OBESE ADOLESCENTS

Yıl 2023, Cilt: 30 Sayı: 3, 294 - 300, 23.09.2023

Ayşe Aydınoğlu Müge Atar Hüseyin Aydın Özgür Pirgon

https://doi.org/10.17343/sdutfd.1209036

Öz

Objective
The increase in obesity in children has caused
nonalcoholic fatty liver disease to become the most
important chronic liver disease in the pediatric age
group. In this study, we aimed to evaluate the portal
diameter and blood flow velocity in obese children with
fatty liver (NAFLD) and to compare them with normal
healthy children.
Material and Method
71 obese adolescent patients aged 10-18 years were
divided into two groups (NAFLD group and non-
NAFLD group) according to the presence of elevated
transaminases and the presence of hepatosteatosis
on ultrasound. 30 healthy adolescents were included
in the study as the control group. Blood samples
were taken from each patient for fasting glucose,
insulin, transaminases, and thyroid functions. Insulin
resistance was calculated using the HOMA index.
Portal vein measurements were performed from the
main portal vein before bifurcation.
Results
The portal vein diameter (8.5 ± 0.9 mm) of the NAFLD
group was statistically significantly wide compared
to both the control group (7.8 ± 2.0 mm) and the
non-NAFLD obese group (7.6 ± 1.1 mm) (p= 0.004)
and (p= 0.002). There was no significant difference
between the non-NAFLD obese group and the control
group (p=0.460, p=0.214). There was no significant
difference between the groups in terms of portal vein
Vmax, Vmin, RI, S/D. Although there was no difference
in portal vein diameter in the obese groups classified
according to insulin resistance, Vmax (33.9 ± 10.3 and
28.6 ± 10.6 cm/sec, p= 0.03) and Vmin (24.8 ± 6.2 and
20.5 ± 5.5 cm/sec) were significantly different in the
insulin resistance group.
Conclusion
In this study, it was determined that portal vein diameter
and flow velocities (Vmax and Vmin) increased in
obese adolescents with NAFLD. Thus, we suggest
that resistance develops in hepatic venous flow due
to hepatic portal vein steatosis, especially in obese
patients with insulin resistance in adolescence. This
finding suggests that when fatty liver continues, portal
diameter will increase in adulthood, leading to portal
hypertension.

Anahtar Kelimeler

obesity, hepatosteatosis, doppler ultrasonography

OBEZ ADOLESANLARDA YAĞLI KARACİĞER HASTALIĞININ PORTAL VEN AKIMINA ETKİSİ

Öz

Amaç
Çocuklarda obezitenin artması, nonalkolik yağlı karaciğer
hastalığının pediatrik yaş grubunda en önemli
kronik karaciğer hastalığı haline gelmesine neden
olmuştur. Bu çalışmada alkolik olmayan karaciğer
yağlanması (NAFLD) olan obez çocuklarda portal ven
çapı ve kan akım hızını değerlendirmesi ve normal
sağlıklı çocuklarla karşılaştırması amaçlanmıştır.
Gereç ve Yöntem
10-18 yaş arası 71 obez adolesan hasta, transaminaz
yüksekliği ve ultrasonda hepatosteatoz (NAFLD grubu
ve NAFLD olmayan grup) varlığına göre iki gruba
ayrıldı. Kontrol grubu olarak 30 sağlıklı ergen çalışmaya
dahil edildi. Her hastadan açlık glukozu, insülin,
transaminaz düzeyleri ve tiroid fonksiyonları için kan
örnekleri alındı. İnsülin direnci HOMA indeksi kullanılarak
hesaplandı. Portal ven ölçümleri, bifurkasyon
öncesi ana portal venden yapıldı.
Bulgular
NAFLD grubunda portal ven çapı (8.5 ± 0.9 mm) hem
kontrol grubuna (7.8 ± 2.0 mm) hem de NAFLD olmayan
obez gruba (7.6 ± 1.1 mm) göre istatistiksel
olarak anlamlı derecede geniş olarak saptandı (p=
0.004) ve (p=0.002). NAFLD olmayan obez grup ile
kontrol grubu arasında anlamlı fark yoktu (p=0.460,
p=0.214). Portal ven Vmax, Vmin, RI, S/D açısından
gruplar arasında anlamlı fark yoktu. İnsülin direncine
göre sınıflandırılan obez gruplarda portal ven çaplarında
farklılık olmamasına rağmen, Vmax (33.9 ± 10.3
ve 28.6 ± 10.6 cm/sn, p= 0.03) ve Vmin (24.8 ± 6.2
ve 20.5 ± 5.5 cm/sn) insülin direnci grubunda önemli
ölçüde farklıydı.
Sonuç
Bu çalışmada NAFLD olan obez adolesanlarda portal
ven çapı ve akım hızlarının (Vmax ve Vmin) arttığı
belirlendi. Bu nedenle özellikle ergenlik döneminde
insülin direnci olan obez hastalarda hepatik portal ven
steatozuna bağlı hepatik venöz akımda direnç geliştiği
düşünüldü. Bu bulgu, karaciğer yağlanmasının
devam etmesi durumunda erişkin dönemde portal çapının
artacağını ve bunun da portal hipertansiyona yol
açacağını düşündürmektedir.

Anahtar Kelimeler

obezite, hepatosteatoz, doppler ultrasonografi

Kaynakça

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