Agustos 2022
Elastografik fibroz ve steatozun klinik, demografik ve laboratuvar belirleyicileri
Demographic, clinical and laboratory predictors of hepatic steatosis and fibrosis by elastography
- Ana Sayfa
- Sayılar
- Agustos 2022
- Elastografik fibroz ve steatozun klinik, demografik ve laboratuvar belirleyicileri...
Özet
Giris ve Amaç: Viral hepatitler tüm dünyada en önemli karaciger hastaligi nedeni olma özelligini sürdürmektedir. Bunun yaninda alkolik ve nonalkolikkaraciger hastaliklarina da artan siklikta rastlanmaktadir. Obezite ve diyabet sikligi ile alkol tüketimindeki artislar, bu faktörlerin önümüzdeki yillarda kronikkaraciger hastaliklari etiyolojisinde daha önemli olacagini düsündürmektedir. Karaciger fibrozisi ve sonucunda gelisen siroz, kronik karaciger hastaligininbaslica morbidite ve mortalite sebebidir. Çalismada elastografi ile elde edilen fibrozis ve steatozis sonuçlarinin biyokimyasal ve antropometrik parametrelerleolan iliskisinin incelenmesi amaçlandi. Gereç ve Yöntem: Karadeniz Teknik Üniversitesi Tip Fakültesi Hastanesi Gastroenteroloji Klinigi’ne basvuran veelastografi yapilan 50 hasta çalismaya dâhil edildi. Hastalarin biyokimyasal parametreleri ve beden kitle indeksi ile elastografik steatoz ve fibrozis skorlariarasindaki iliski degerlendirildi. Elastografi kontrollü atenüasyon parametresi degerleri Li’nin skalasi baz alinarak S0-S3 arasinda; fibrozis/elastisite degerleriise Petroff’un skalasi baz alinarak F0-F4 arasinda siniflandirildi. Bulgular: Çalismaya dâhil edilen 50 hastanin 26’si erkek, 24’ü kadindi. Ortalama yas 49.9± 13.4 yildi. Vücut kitle indeksi için ortanca deger 29.4 kg/m2 olarak saptandi. En sik eslik eden hastaliklar hipertansiyon (n = 19, %38), diyabetes mellitus (n= 19, %38), hiperlipidemi (n = 11, %22) ve hipotiroidi (n = 7, %14) idi. Hastalarin transient elastografi ile ölçülen fibrozis skorlari; F0-1 %84 (n = 42), F2 %4 (n= 2), F3 %4 (n = 2 ve F4 %8 (n = 4); elastografi kontrollü atenüasyon parametresi degerleri ise S0 %61.2 (n = 30), S1 %2 (n = 1), S2 %10.2 (n = 5), S3 %6.1(n = 3), S4 %20.4 (n = 10) seklinde idi. Steatoz derecesi ? S2 olanlarda vücut kitle indeksi ve trigliserit düzeyi anlamli olarak daha yüksekti (p < 0.05). Fibrozisdüzeyi ? F2 olanlarda total kolesterol, yüksek dansiteli lipoprotein, alanin aminotransferaz ve gama glutamil transpeptidaz degerleri anlamli olarak yüksekti(p < 0.05). Alici islem karakteristikleri egrisi kullanilarak yapilan analiz sonucunda steatoz derecesi ? S2 varligini öngördüren vücut kitle indeksi degerinin29.6 kg/m2 oldugu saptanmistir (%73.7 duyarlilik, %65.5 özgüllük, egrinin altinda kalan: 0.808, %95 güven araligi: 0.687-0.028). Sonuç: Elastografik olarakkaraciger steatoz ve fibrozisinin belirlenmesi, hastalarin rutin takiplerinde klinik durumu, prognozu ve tedavi cevabinin degerlendirilmesi açisindan faydali veetkin bir yöntemdir. Ekonomik nedenlerle uygulanamadigi durumlarda noninvaziv testlerin kullanimi ihmal edilmemelidir.
Abstract
Background and Aims: Viral hepatitis continues to be the most important cause of liver disease all over the world. In addition, alcoholic and non-alcoholicliver diseases are also encountered with increasing frequency. The prevalence of obesity and diabetes and the increase in alcohol consumption suggestthat these factors will be more important in the etiology of chronic liver diseases in the coming years. Liver fibrosis and associated cirrhosis are the maincauses of morbidity and mortality in chronic liver disease. In our study, we aimed to examine the relationship between fibrosis and steatosis results obtainedby elastography and biochemical and anthropometric parameters. Materials and Method: Fifty patients who applied to Karadeniz Technical UniversityMedical Faculty Hospital Gastroenterology Clinic and underwent elastography were included in the study. The relationship between the patients’ biochemicalparameters and body mass index, and elastographic steatosis and fibrosis scores were evaluated. Elastography controlled attenuation parameter values arebetween S0 and S3 based on the scale of Li; fibrosis/elasticity values were classified between F0-F4 based on Petroff’s scale. Results: Of the 50 patientsincluded in the study, 26 were male and 24 were female. The mean age was 49.9 ± 13.4 years. The median value for body mass index was 29.4 kg/m2.The most common comorbidities were hypertension (n = 19, 38%), diabetes mellitus (n = 19, 38%), hyperlipidemia (n = 11, 22%) and hypothyroidism (n =7, 14%). Fibrosis scores of patients measured by transient elastography; F0-1 was 84% (n = 42), F2 4% (n = 2), F3 4% (n = 2), and F4 8% (n = 4). Elastography controlled attenuation parameter values are S0 61.2% (n = 30), S1 2% (n = 1), S2 10.2% (n = 5), S2-3 6.1% (n = 3), S4 20.4% (n = 10). In those witha degree of steatosis ? S2; body mass index and triglyceride levels were significantly higher (p < 0.05). Total cholesterol, high density lipoprotein, alanineaminotransferase and gamma glutamyl transferase values were significantly higher in patients with fibrosis level ? F2 (p < 0.05). As a result of the analysisusing the receiver operating characteristic curve, the body mass index value predicting the presence of steatosis degree ? S2 was found to be 29.6 kg/m2 (73.7% sensitivity, 65.5% specificity, under the curve: 0.808, 95% confidence interval: 0.687-0.028). Conclusion: Elastographic determination of liversteatosis and fibrosis is a useful and effective method in the routine follow-up of patients, in terms of evaluating the clinical status, prognosis and treatmentresponse. The use of non-invasive tests based on biochemical parameters should not be neglected in cases where device-dependent noninvasive testscannot be applied for economic reasons.
