Murat İSPİROĞLU, İbrahim Halil TÜRKBEYLER, Hacı Taner BULUT, Erkan ÇAKMAK, Mehmet Akif SARICA

NON-ALKOLİK HEPATOSTEATOZLU HASTALARDA ORTALAMA TROMBOSİT HACMİNİN ULTRASONOGRAFİK OLARAK HEPATOSTEATOZ EVRELEMESİ İLE İLİŞKİSİ

Amaç: Yağlı karaciğer (hepatosteatoz) karaciğerin kendi ağırlığının en az %5'inden fazlası kadaryağ içermesi anlamına gelir. Non-alkolik hepatosteatoz (NAHS) tüm yaş grupları ve etnikgruplarda görülebilir. Genel popülasyonda görülme sıklığı ise %14-30 civarındadır.Ultrasonografi ucuz, noninvaziv ve kolay ulaşılabilir olması nedeniyle hepatosteatoz tanısındaen sık kullanılan yöntemdir. Karaciğer ekojenitesinin dalak yada böbreğe oranla difüz olarakartması, intrahepatik vasküler yapılarda flulaşma, karaciğerin derin kısımlarına penetrasyonunazalması bulgularından ikisinin olması karaciğer yağlanması tanısını koydurur. Trombositaktivasyonunun bir göstergesi olan ortalama trombosit hacmi (OTH), insülin direnci ilekarakterize olan Tip 2 diyabetes mellitus, Metabolik Sendrom, Obezite için tanımlanmış riskfaktörlerinden biridir. Çalışmamızda patogenezinde insülin direncinin önemli bir yer tuttuğunubildiğimiz NAHS evrelemesi ile OTH arasındaki ilişkiyi incelemeyi planladık. Gereç Ve Yöntem: Çalışmaya dahiliye polikliniğine başvurup abdomen ultrasonografi istenenve hepatosteatoz saptanan toplam 359 hasta dahil edilmiştir. Ek hastalığı bulunanlar, sigara vealkol kullanan hastalar çalışmaya alınmamıştır. Hepatosteatozu saptanan hastalar ultrasonografikolarak grade 1, 2, 3 olarak sınıflanmıştır.Bulgular: OTH ile hepatosteatoz evrelemesi arasında ultrasonogrofik olarak evre arttıkça OTHdeğerlerinde artış saptanmasına rağmen bu artış istatistiksel olarak anlamlı değildi. Alt grupanalizi yapıldığında evre 1-2 ve evre 2-3 arasındada istatistiksel olarak anlamlı fark saptanmadı.Ancak evre 1 evre 3 arasında istatistiksel olarak anlamlı farklılık saptandı. Sonuç: Çalışmamızda NAHS tanısını klinik, laboratuar ve ultrason bulguları ile koyduk. İnvazivbir işlem olan biyopsiyi tercih etmedik. Çalışmamızın sonuçları itibarı ile NAHS tanısı konulanvakaların takibinde basit, ucuz ve heryerde bakılması mümkün olan OTH değerinindekullanılabileceği kanaatindeyiz. NASH hastalarında OTH değerlerindeki bu değişikliklerin rolüve olası klinik ilişki düzeylerini destekleyecek daha kapsamlı çalışmalara ihtiyaç vardır

Anahtar Kelimeler:

Hepatosteatoz, Ultrasonografi, Ortalama trombosit hacmi

The Relationship of Mean Platelet Volume With Ultrasonographic Hepatosteatosis Staging In Patients With Non-Alcholic Fatty Liver

Objective: Fatty liver (hepatosteatosis) means that fat in the liver exceeds 5% at least by ownliver weight. Nonalcoholic hepatosteatosis (NAHS) can be seen in all age and ethnic groups.The frequency in general population is about 14% to 30%. Ultrasonography is the mostcommonly used method for diagnosis of hepatosteatosis since it is cheap, non-invasive andeasily accessible. The two findings from among diffusely increased in liver echogenicity inproportion to spleen and kidney, blurred in intrahepatic vascular structures and reduction inpenetration to deep regions of liver indicates the diagnosis of fatty liver. Mean platelet volume(MPV), indicator of platelet activation, is one of the risk factors identified for Type 2 diabetesmellitus, metabolic syndrome and obesity that are charactrized wih insulin resistance.In our study, we planned to investigate the relationship between MPV and NAHS staging inwhich insulin resistance was known to have an important position in pathogenesis. Methods: Total 359 patients diagnosed with hepatosteatosis were included from among oneswho applied to internal medicine polyclinic and were requested for abdomen ultrasonography.Patients with other diseases, smoker patients and patients with use of alcohol did not include inthis study. Patients diagnosed with hepatosteatosis were ultrasonographically classified as grade1, 2, 3. Results: Although increase in MPV values was detected as long as ultrasonographic stagingincreased, this increment was not statistically significant. When subgroup analysis was done,statistically significant difference between grade 1 and 2 and between grade 2 and 3 was notdetermined. However, statistically significant difference betweengrade 1 and 3 was detected.Conclusion: In our study, NAHS was diagnosed according toclinical, laboratory and ultrasound findings. We do not preferbiopsy, invasive procedure. We are of the opinion that MPV valueswhich are simple, cheap and easily accessible in the follow-up ofcases diagnosed with NAHS can be used according to our results.More comprehensive studies are needed about the role of thesechanges in MPV values in patients with NASH and assisting theirpossible clinic relation levels

Keywords:

Hepatosteatosis, ultrasonography, mean plateletvolume,

PDF

___

Angulo P. Nonalcoholic fatty liver disease. N Engl J Med. 2002;346:1221–1231. [PubMed:11961152]

Bayard M, Holt J, Boroughs E. Nonalcoholic Fatty Liver

Resim3. Grade 3 hepatosteatozun Ultrasonografik görünümü. Disease Am Fam Physician. 2006 Jun 1;73(11):1961-1968.

Alisi A, Pinzani M, Nobili V. Diagnostic power of fibroscan in predicting liver fibrosis in nonalcoholic fatty liver disease. Hepatology 2009; 50: 2048-9.

Anastasiou J, Alisa A, Virtue S, et al. Noninvasive markers of fibrosis and inflammation in clinical practice: prospective comparison with liver biopsy. Eur J Gastroenterol Hepatol 2010; 22: 474-80.

Poynard T, Morra R, Ingiliz P, et al. Assessment of liver fibrosis: noninvasive means. Saudi J Gastroenterol 2008; 14: 163-73.

Totani L, Evangelista V. Platelet-leukocyte interactions in cardiovascular disease and beyond. Arterioscler Thromb Vasc Biol 2010;30:2357-2361.

Kilciler G, Genc H, Tapan S, Ors F, Kara M, Karadurmus N, Ercin CN, Karslioglu Y, Kilic S, Bagci S, Erbil MK, Dogru T. Mean platelet volume and its relationship with carotid atherosclerosis in subjects with non-alcoholic fatty liver disease. Ups J Med Sci. 2010 Nov;115(4):253-9. doi: 10.3109/03009734.2010.500062. Epub 2010 Aug 23. PubMed PMID: 20731535; PubMed Central PMCID: PMC2971483.

Alkhouri N, Tamimi TA, Yerian L, Lopez R, Zein NN, Feldstein AE. The Inflamed Liver and Atherosclerosis: A Link Between Histologic Severity of Nonalcoholic Fatty Liver Disease and Increased Cardiovascular Risk. Dig Dis Sci. 2009

Sung KC, Ryan MC, Wilson AM. The severity of nonalcoholic fatty liver disease is associated with increased cardiovascular risk in a large cohort of non-obese Asian subjects. Atherosclerosis. 2009; 203:581–586. [PubMed: 18774133]

Targher G, Day CP, Bonora E. Risk of cardiovascular disease in patients with nonalcoholic fatty liver disease. N Engl J Med. 2010; 363:1341–1350. [PubMed: 20879883]

Güldiken B, Özkan H, Kabayel L. Mean Platelet Volume and Peripheral Blood Count Response in Acute Ischemic Stroke. Trakya Univ Tıp Fak Derg 2008;2:130-135.

Van der Loo B, Martin JF. A role for changes in platelet production in the cause of acute coronary syndromes. Arterioscler Thromb Vasc Biol. 1999 Mar;19(3):672-9. Review. PubMed PMID: 10073972.

Bayard M, Holt J, Boroughs E. Nonalcoholic Fatty Liver Disease Am Fam Physician. 2006 Jun 1;73(11):1961-1968.

Garjani A, Safaeiyan A, Khoshbaten M. Association between platelet count as a noninvasive marker and ultrasonographic grading in patients with nonalcoholic Fatty liver disease. Hepat 10.5812/hepatmon.24449. eCollection 2015 Jan. PubMed PMID: 25741373; PubMed Central PMCID: PMC4344651.

Akgul O, Uyarel H, Pusuroglu H, et al. Prognostic value of elevated mean platelet volume in patients undergoing primary angioplasty for ST-elevation myoıcardial infarction. Acta Cardiol 2013;68:307-314.

Şen HS, Abakay Ö, Taylan M, et al. The importance of mean platelet volume in early mortality of pulmonary embolism. J Clin Exp Invest 2013;4:298-301.

Yılmaz N, Özkan OV, Büyükbaş S, et al. Mean platelet volume in patients with acute pancreatitis. J Clin Exp Invest 2011;2:362-365.

Arica S, Ozer C, Arica V, et al. Evaluation of the mean platelet volume in children with familial Mediterranean fever. Rheumatol Int 2012;32:3559-3563.

Ayhan Tuzcu E, Arica S, Ilhan N, et al. Relationship between mean platelet volume and retinopathy in paıtients with type 2 diabetes mellitus. Graefes Arch Clin Exp Ophthalmol 2013 Aug 17 (Epub ahead of print).

Erden EŞ, Dokuyucu R, Demirköse M, et al. Investiıgation of mean platelet volume in chronic obstructive pulmonary disease during stable and acute exacerbaıtion. J Clin Exp Invest 2013 (In press).

McClain CJ, Mokshagundam SP, Barve SS, et al. Mechanisms of non-alcoholic steatohepatitis. Alcohol 2004; 34: 67-79.

Alkhouri N, Kistangari G, Campbell C, Lopez R, Zein NN, Feldstein AE. Mean platelet volume as a marker of increased cardiovascular risk in patients with nonalcoholic steatohepatitis. Hepatology. 2012 Jan;55(1):331. doi: 10.1002/hep.24721. PubMed PMID: 21969091; PubMed Central PMCID: PMC3245344.