Diyabetik Ve Nondiyabetik Hepatosteatozlu Hastalarda Biyokimyasal Parametreler Ve Noninvaziv Görüntüleme Verilerinin Değerlendirilmesi

DİYABETİK VE NONDİYABETİK HEPATOSTEATOZLU HASTALARDA BİYOKİMYASAL PARAMETRELER VE NONİNVAZİV GÖRÜNTÜLEME VERİLERİNİN DEĞERLENDİRİLMESİ ÖZET Amaç: Nonalkolik yağlı karaciğer hastalığı (NAYKH) genel populasyonda en sık görülen kronik karaciğer hastalığıdır. Morbidite ve mortaliteyi artırması ve herhangi bir klinik semptom vermemesi, karaciğer yağlanmalarının erken tanı ve takibini önemli kılmaktadır. Çalışmamızda NAYKH tanısı almış olan diyabetik ve nondiyabetik hastalarımızın noninvaziv görüntüleme verileri ve biyokimyasal parametreleri arasındaki ilişkiyi değerlendirmeyi amaçladık. Gereç ve Yöntem: Çalışmaya (Eylül, 2017 – Aralık, 2017) tarihlerinde İç Hastalıkları ve Gastroenteroloji polikliniklerine başvuran, son altı ay içinde ultrasonografi ve/veya transient elastografi ile hepatosteatoz tanısı almış olan erişkin yaş grubu hastalar dahil edilmiş; eşlik eden farklı bir karaciğer hastalığı olan ve alkol tüketmiş olan hastalar çalışmadan dışlanmıştır. Veriler retrospektif olarak değerlendirilmiştir. İstatistiksel veriler için NCSS 2007 programı kullanıldı. Bulgular: Çalışmaya 116 hasta alındı. Diyabet tanısı olan hastaların CAP, E ve fibrozis değerleri, nondiyabetik gruptan anlamlı düzeyde yüksek bulundu. Yine hipertansiyon tanısı varlığı, hepatomegali olması, BMI, trigliserid düzeyi, kan Şekeri yüksekliği, Hemoglobin A1c ve ürik asit düzeylerinin de NAYKH ve fibrozis sürecini olumsuz yönde etkilediği görüldü. Sonuç: Karaciğer yağlanmasının takibinde transient elastografi güvenilir sonuçlar veren noninvaziv bir teknik olarak günlük pratiğimize girmiştir. Özellikle metabolik sendrom kriterleri olan hastalarda fibrozis derecesinin erken dönemde belirlenmesi, takip ve tedaviye yön vermesi açısından önemlidir. Anahtar kelimeler: diyabet, elastografi, fibrozis, karaciğer yağlanması, metabolik sendrom

Anahtar Kelimeler:

diyabet, hepatosteatoz, elastografi, fibrosis, karaciğer

Assessment of Hepatosteatosis Among Diabetic And Nondiabetic Patıents Using Biochemical Parameters And Noninvasive Imaging Techniques

Aim: Nonalcoholic fatty liver disease (NAFLD) is considered the most common chronic liver disease in the general population.The higher mortality and morbidity among NAFLD patients and lack of symptoms makes early detection and management important. In our study, we aimed to evaluate the relationship between noninvasive imaging and biochemical markers in diabetic and nondiabetic patients diagnosed with NAFLD. Materials and Methods: The study was conducted from (September, 2017) to (December, 2017) on adults admitted to Internal Medicine and Gastroenterology outpatient clinics with hepatic steatosis reported on ultrasound or transient elastography within the last six months that exclude patients with other liver diseases or alcohol abuse. The data was collected and analyzed retrospectively. Number cruncher statistical system (NCSS) 2007 program was used for statistical analysis. Results: 116 patients were included in this study. Diabetic patients compared to nondiabetics had significantly higher Controlled Attenuation Parameter (CAP), Liver Stiffness Measurement (LSM) and fibrosis values. Also, hypertension, hepatomegaly, high BMI, hypertriglyceridemia, hyperglycemia, high A1c and hyperuricemia were found to be risk factors for NAFLD progression to fibrosis. Advanced fibrosis (F3, F4) was present in 18,6 % of all our patients; 35,8 % of diabetic and 5,7 % of nondiabetic patients diagnosed with hepatic steatosis. Conclusion: Transient elastography is now used in daily clinical practice as an accurate noninvasive tool during follow-up of patients with fatty liver. Early diagnosis of the stage of liver fibrosis improves monitoring and management of patients, especially in those with metabolic syndrome criteria.

Keywords:

diabetes, elastography, fatty liver, fibrosis, metabolic syndrome,

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