Birnur YILMAZ, Özgür Kürşat ŞENER, Halime ÇEVİK

Non-alkolik yağlı karaciğer hastalığı bulunan diyabetik hastalarda Shear Wave Elastografi sonuçları

Amaç: Non-alkolik yağlı karaciğer hastalığı bulunan Tip II diyabetes mellituslu hastalarda, Shear Wave Elastography (SWV) ile karaciğer sertliği derecesini değerlendirmek amaçlandı. SWV elastografi değerleri ile hepatik steatoz derecesi, karaciğer aminotransferazları, lipit profili ve vücut kitle indeksi karşılaştırıldı.Gereç ve Yöntemler: Bu vaka-kontrol çalışmasında, dahiliye kliniğine başvuran non-alkolik yağlı karaciğer hastalığı olan 110 hasta, (57 erkek, 53 kadın, ortalama yaş 50,17) ve kontrol grubunda karaciğer hastalığı olmayan 50 sağlıklı yetişkin (26 erkek, 24 kadın), yaş ortalaması (48,26) çalışmaya alındı. Her bireyde karaciğer parankiminin sağ lobundan toplam on ölçüm için alındı. Hastalarda hepatik steatozun sonografik derecesi, SWV değerleri ve eş zamanlı alınan laboratuvar değerleri karşılaştırıldı.Bulgular: SWV ortalama hız değeri hasta grubunda 2,26 ± 0,5 m/sn) olarak hesaplandı; Kontrol grubunda 1,71±0,3 m/sn; Grade I steatozu olan hastalarda 2,15±0,6 m/sn; Grade II steatozlu hastalarda 2,25±0,4 m/s, grade III steatozlu hastalarda 2,72±0,4 m/s. SWV değerleri hasta ve kontrol gruplarında istatistiksel olarak anlamlı bir fark olduğunu göstermektedir (p < 0,01). Her üç grade karaciğer steatozu ile SWV değerlerinin arasında, istatistiksel olarak anlamlı bir farkı yoktu.Sonuç: Akustik radiyasyon forse impuls, kanda trigliserit, aspartat transaminaz ve alanin transaminaz artışıyla birlikte, karaciğerdeki (ortalama SWV değerleri 2 ve üzerinde ise) doku sertliğinin artışının tespitinde kullanılabilir.

Anahtar Kelimeler:

Karaciğer steatozu, Akustik radyasyon forse impuls, Tip II diabetes mellitus

Shear Wave Velocity results of non-alcoholic fatty liver disease in diabetic patients

Aim: To evaluate liver stiffness degree in non-alcoholic fatty liver disease with type II diabetes mellitus patients via Shear Wave Elastography (SWV) measurement. SWV elastography values were compared to degree of hepatic steatosis, liver aminotransferases, lipid profile and body-mass index.Methods: In this case-control study, 110 patients with non-alcoholic fatty liver disease, followed by a general internal medicine out patient clinic (57 male 53 female mean age 50.17) and a control group of 50 healthy adults (26 males 24 females mean age 48.26) without liver disease and sonographically grade 0 steatosis were admitted to the study. Right lobe of the liver parenchyma in each person was evaluated for a total of ten measurements. Sonographic grade of the hepatic steatosis in patients, SWV values and laboratory values simultaneously received were compared.Results: SWV average speed value is calculated to be 2.26 ± 0.57 m/s in patient group; 1.71± 0.34 m/s in the control group; 2.15 ± 0.63 m/s in patients with grade I steatosis; 2.25 ± 0.42 m/s in patients with grade II steatosis, 2.72 ± 0.43 m/s in patients with grade III steatosis. SWV values indicate a statistically significant difference in patient and control groups (p < 0.01). There wasn’t a statistically significant difference of liver SWV values among the three grades of steatosis.Conclusion: Acoustic radiation force impulse can be used to detect of decreased stiffness in liver (on average 2 and over SWV values) with increase of triglycerides, aspartate aminotransferase and alanin aminotransferaz in patients.

Keywords:

Liver steatosis, Acoustic radiation force impulse, Tip II diabetes mellitus,

PDF

___

1. Shaker M, Tabbaa A, Albeldawi M, Alkhouri N. Liver transplantation for nonalcoholic fatty liver disease: New challenges and new opportunities. World Journal of Gastroenterology. WJG 20.18 2014;5320–30.
2. Rinella ME. Nonalcoholic fatty liver disease: a systematic review. JAMA (Systematic review). 2014;313(22):2263–73.
3. Sanyal A J. AGA Technical Review on Nonalcoholic Fatty Liver Disease. Gastroenterology. 2002;123(5):1705-25.
4. Clark JM, Diehl AM. Nonalcoholic fatty liver disease: an underrecognized cause of cryptogenic cirrhosis. JAMA.2003;289 (22): 3000–04.
5. McCulough, Arthur J. The clinical features, diagnosis and natural history of nonalcoholic fatty liver disease. Clinics in Liver Disease.2004;8(3):521-33.
6. Yoshioka K, Hashimoto S, Kawabe N. Measurement of liver stiffness as a non-invasive method for diagnosis of non-alcoholic fatty liver disease. Hepatology Research. 2015;45(2):142-51.
7. De Robertis R, D’Onofrio M, Demozzi E, Crosara S, Canestrini S, Mucelli RP. Noninvasive diagnosis of cirrhosis: A review of different imaging modalities. World Journal of Gastroenterology: WJG. 2014;20(23):7231.
8. Ziol M, Handra-Luca A, Kettaneh A, Christidis C, Mal F, Kazemi F, et al. Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C. Hepatology. 2005;41(1):48–54.
9. Yanrong G, Haoming L, Xinyu Z, Huiying W, Siping C, Xin C. The influence of hepatic steatosis on the evaluation of fibrosis with non-alcoholic fatty liver disease by acoustic radiation force impulse. Conf Proc IEEE Eng Med Biol Soc. 2017;2988-91.
10. Palmeri ML, Wang MH, Rouze NC, Abdelmalek MF, Guy CD, Moser B, et al. Noninvasive evaluation of hepatic fibrosis using acoustic radiation force-based shear stiffness in patients with nonalcoholic fatty liver disease. Journal of Hepatology. 2011;55(3):666–72.
11. Fierbinteanu Braticevici C, Sporea I, Panaitescu E, Tribus L. Value of acoustic radiation force impulse imaging elastography for non-invasive evaluation of patients with nonalcoholic fatty liver disease. Ultrasound in Medicine & Biology. 2013;39(11):1942–50.
12. Yoneda M, Suzuki K, Kato S, Fujita K, Nozaki Y, Hosono K, et al. Nonalcoholic Fatty Liver Disease: US-based Acoustic Radiation Force Impulse Elastography 1. Radiology. 2010;256(2):640–7.