Erişkin lipodistrofi hastalarında visseral adiposite indeksi, vücut şekil indeksi, lipid akümülasyon indeksi, trigliserid-glukoz indeksi ve hepatik elastografi (fibroscan) korelasyonunun değerlendirilmesi
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Tarih
2021
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Ege Üniversitesi, Tıp Fakültesi
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info:eu-repo/semantics/openAccess
Özet
AMAÇ: Lipodistrofi nadir görülen, yağ doku dağılımında anormalliklerle seyreden, şiddetli insülin direnci bulguları ile karakterize bir hastalık grubudur. Özellikle kalıtsal lipodistrofi alt tiplerinde; şiddetli insülin direnci, metabolik sendrom kriterleri ile birlikte alkol dışı yağlı karaciğer hastalığı (ADYKH) görülmektedir. Günümüzde; insülin direnci, ADYKH ve kardiyometabolik risk belirteci olarak yeni kullanılmaya başlanan basit matematiksel indeksler mevcuttur. Çalışmamızda Ege Üniversitesi Tıp Fakültesi (EÜTF) Hastanesi Endokrinoloji polikliniğinde takip edilen erişkin yaş lipodistrofi hastalarında, geriye dönük olarak metabolik risk öngörüdürücü bu indekslerin, ADYKH tespit etmede kullanılan güvenilir bir yöntem olan hepatik elastografi ile korelasyonuun değerlendirilmesi amaçlanmıştır. GEREÇ ve YÖNTEM: Çalışmamıza EÜTF Hastanesi Endokrinoloji polikliniğinde; Ocak 2010 - Haziran 2021 tarihleri arasında takip edilen; 18 yaşını doldurmuş, HIV enfeksiyonu olmayan 29 erişkin lipodistrofi hastası (11'i konjenital jeneralize lipodistrofili-KJL, 18'i familyal parsiyel lipodistrofili-FPL); elektronik hasta dosyaları üzerinden dahil edildi. EÜTF Hastanesi Endokrinoloji polikliniğinde DM tanısı ile takipli ve Amerikan Karaciğer Hastalıkları Araştırma Birliği (American Association for the Study of Liver DiseasesAASLD) 2018 tanı kriterlerine uygun ADYKH olan 11 hasta dosyası; lipodistrofinin alt grubu olan; familyal parsiyel lipodistrofilere kontrol grubu olarak alındı. Toplamda 40 elektronik hasta dosyası çalışmaya dahil edildi. Hastaların demografik verileri, antropometrik ölçümleri, biyokimyasal sonuçları, hemogram verileri, karaciğer ultrason ve fibroscan değerleri kaydedildi. Hastalar için vücut kitle indeksi (VKİ), viseral adipozite indeksi (VAİ), lipid akümülasyon indeksi (LAİ), vücut şekil indeksi (VŞİ), trigliserid-glukoz indeksi, ADYKH fibrozis skoru, aspartat aminotransferaz-platelet oranı indeksi (APRI), fibrozis-4 skoru (Fib4) hesaplandı. Ek hastalıkları, kullandıkları ilaçlar, fertilite, anne baba akrabalık durumları kaydedildi. BULGULAR: Çalışmamızda lipodistrofilerin alt grubu olan FPL (n=18) grubunda antropometrik ölçümlerde; ortalama kilo 67.1 ± 11.3 kg, VKİ 25.4 ± 3.2 kg/m2 , bel çevresi 92.6 ± 8.7 cm saptandı. Diyabetik ve alkol dışı yağlı karaciğer hastalığı olan kontrol grubunda ix ise ortalama kilo 76,1±7 kg, vücut kitle indeksi 30,1±3,9 kg/m2, bel çevresi 101,1±4,3 cm saptandı. İki grup arasında antropometrik ölçümlerde bel çevresi (p= 0,002), kilo (p= 0,025) ve vücut kitle indeksi ölçümlerinde (p= 0,002) ile istatistiksel anlamlı fark saptandı. Trigliserid düzeyleri FPL grubunda ortalama 653,2±423,6 mg/dl tip 2 diyabete göre anlamlı yüksek bulundu (p <0,001). FPL grubunda HDL-K ortalaması 32,2±9,5 mg/dl, tip 2 diyabet grubunda ise 43,2±5,5 mg/dl ile daha yüksek seviyelerde saptandı. HDL-K düzeyleri FPL grubunda daha düşük olduğu görüldü. İstatistiksel olarak tip 2 diyabet grubu ile anlamlı fark saptandı (p=0,001). Hba1c (glikozillenmiş hemoglobin a1c) ortalaması FPL grubunda %8,5 ±2,2 saptandı. FPL grubunda, hba1c tip 2 diyabet grubuna göre anlamlı olarak daha yüksek bulundu (p=0,011). ADYKH fibrozis skoru; ortalama -2,3±0,7, tip 2 diyabet grubunda ortalama -1,3±1 ve her iki grup karşılaştırıldığında (p= 0,004) istatistiksel olarak anlamlı fark saptandı. FPL grubunda ortalama APRİ (aspartat aminotransferaz/platelet oranı indeksi) 0,2±0,1, tip 2 diyabet grubunda ise APRİ indeksi 0,3±0,1 bulundu ve iki grup arasında (p=0,034) istatistiksel anlamlı fark saptandı. FPL grubunda FIB4 skor ortalaması 0,6±0,2, tip 2 diyabet grubunda FİB-4 (fibrozis 4) skor ortalaması daha yüksek 1,04±0,44 (p=0,007) bulundu. Yine FİB-4 skorunda da iki grup arasında istatistiksel anlamlı fark saptandı (p=0,007). KJL, FPL ve Tip 2 Diyabet gruplarının ADYKH fibrozis skoru, APRİ, FİB-4, viseral adiposite indeksi, vücut şekil indeksi, lipit akümülasyon indeksi, disfonksiyonel adiposite indekslerinin korelasyonu istatistiksel olarak değerlendirildiğinde; vücut şekil indeks dışında tüm indeksler arasında yüksek veya çok yüksek pozitif korelasyon saptandı. SONUÇ: Lipodistrofi; şiddetli insülin direnci ve komplikasyonları ile karakterize nadir bir hastalık grubudur. Alkol-dışı yağlı karaciğer hastalığı ve ilerlemesi halinde gelişecek siroz ve komplikasyonları bu hasta grubunda en önemli morbidite ve mortalite nedenleri arasındadır. Günümüzde kullanılan metabolik komplikasyonları ve karaciğer fibrozisini öngördürücü çeşitli indeks ve skorlar, lipodistrofi hastalarında da metabolik komplikasyonları belirlemede ve özellikle şiddetli insülin direnci ile karakterize olan tip 2 diyabetli hastalarla ayırıcı tanıda işlevsel olabilir.
OBJECTIVE: Lipodystrophy is a rare disease group, characterized by abnormalities in adipose tissue distribution and severe insulin resistance findings. Especially in hereditary lipodystrophy subtypes, severe insulin resistance, fatty liver with metabolic syndrome criteria and non-alcoholic fatty liver disease are seen. Today, there are simple mathematical indices that have just started to be used as indicators of insulin resistance, non-alcoholic fatty liver disease and cardiometabolic risk. Evaluation of correlation with hepatic elastography is intended, which is a reliable method used to detect non-alcoholic fatty liver disease, by calculating these retrospective metabolic risk predictors in adult lipodystrophy (non-HIV positive) patients followed in the Endocrinology Polyclinic of Ege University Medical Faculty (EUMF) Hospital. MATERIALS and METHOD: In our study, 29 adult lipodystrophy patients who were over 18 years old and had no HIV infection and were followed up in Ege University Hospital Endocrinology outpatient clinic between January 2010 and June 2021; were included via electronic patient file. Files of 11 patients with non-alcoholic fatty liver, who were followed up in the EUTF Endocrinology outpatient clinic, were diagnosed with diabetes in accordance with the 2018 diagnostic criteria of the American Association for the Study of Liver Diseases (AASLD); were taken as a comparison group to familial partial lipodystrophy. A total of 40 electronic patient files were included in the study. Demographic data, anthropometric measurements, biochemical and hemogram data, liver ultrasound and liver fibroscan values of the patients were recorded. Visceral adiposity index, lipid accumulation index, body shape index, triglyceride-glucose index, non-alcoholic fatty liver disease fibrosis score, AST-platelet ratio index, fibrosis-4 index were calculated. Comorbidities, medications, fertility, and parental consanguinity were recorded. RESULTS: In our study, anthropometric measurements in the FPL (n=18) group, which is a subgroup of lipodystrophy; mean weight was 67.1±11.3 kg, body mass index was 25.4±3.2 kg/m2, waist circumference was 92.6±8.7 cm. In the control group with diabetic and non- xi alcoholic fatty liver disease, mean weight was 76.1±7 kg, body mass index was 30.1±3.9 kg/m2, and waist circumference was 101.1±4.3 cm. A statistically significant difference was found between the two groups in anthropometric measurements of waist circumference (p=0.002), weight (p=0.025) and body mass index (p=0.002). Triglyceride levels were found to be significantly higher in the FPL group compared to type 2 diabetes, with an average of 653.2±423.6 mg/dl (p <0.001). The mean HDL-C was found to be 32.2±9.5 mg/dl in the FPL group, and higher at 43.2±5.5 mg/dl in the type 2 diabetes group. HDL-C levels were lower in the FPL group. A statistically significant difference was found between the type 2 diabetes group (p=0.001). The mean of Hba1c (glycosylated hemoglobin a1c) was 8.5% ±2.2% in the FPL group. Hba1c was found to be significantly higher in the FPL group than in the type 2 diabetesgroup (p=0.011). Non-alcoholic fatty liver disease fibrosis score (NFS); mean -2.3±0.7, mean -1.3±1 in the type 2 diabetes group, and a statistically significant difference was found when both groups were compared (p= 0.004). The mean APRI (aspartat aminotransferase/platelet ratio index) was 0.2±0.1 in the FPL group, and 0.3±0.1 in the type 2 diabetes group, and a statistically significant difference was found between the two groups (p=0.034). The mean FIB4 score was 0.6±0.2 in the FPL group, and the mean FIB-4 (fibrosis 4) score was higher in the type 2 diabetes group, 1.04±0.44 (p=0.007). There was also a statistically significant difference between the two groups in the FIB-4 score (p=0.007). When the correlation of NFS, APRI, FIB-4, visceral adipocyte index, body shape index, lipid accumulation index, dysfunctional adipocyte indices of KJL, FPL and Type 2 Diabetes groups was evaluated statistically; High or very high positive correlation was found between all indices except body shape index. CONCLUSION: Lipodystrophy; It is a rare disease group, characterized by severe insulin resistance and its complications. Non-alcoholic fatty liver disease and cirrhosis and its complications in its progression are among the most important causes of morbidity and mortality in this patient group. Various indices and scores predicting metabolic complications and liver fibrosis used today may be functional in determining metabolic complications in patients with lipodystrophy and in the differential diagnosis of patients with type 2 diabetes, which is characterized by severe insulin resistance.
OBJECTIVE: Lipodystrophy is a rare disease group, characterized by abnormalities in adipose tissue distribution and severe insulin resistance findings. Especially in hereditary lipodystrophy subtypes, severe insulin resistance, fatty liver with metabolic syndrome criteria and non-alcoholic fatty liver disease are seen. Today, there are simple mathematical indices that have just started to be used as indicators of insulin resistance, non-alcoholic fatty liver disease and cardiometabolic risk. Evaluation of correlation with hepatic elastography is intended, which is a reliable method used to detect non-alcoholic fatty liver disease, by calculating these retrospective metabolic risk predictors in adult lipodystrophy (non-HIV positive) patients followed in the Endocrinology Polyclinic of Ege University Medical Faculty (EUMF) Hospital. MATERIALS and METHOD: In our study, 29 adult lipodystrophy patients who were over 18 years old and had no HIV infection and were followed up in Ege University Hospital Endocrinology outpatient clinic between January 2010 and June 2021; were included via electronic patient file. Files of 11 patients with non-alcoholic fatty liver, who were followed up in the EUTF Endocrinology outpatient clinic, were diagnosed with diabetes in accordance with the 2018 diagnostic criteria of the American Association for the Study of Liver Diseases (AASLD); were taken as a comparison group to familial partial lipodystrophy. A total of 40 electronic patient files were included in the study. Demographic data, anthropometric measurements, biochemical and hemogram data, liver ultrasound and liver fibroscan values of the patients were recorded. Visceral adiposity index, lipid accumulation index, body shape index, triglyceride-glucose index, non-alcoholic fatty liver disease fibrosis score, AST-platelet ratio index, fibrosis-4 index were calculated. Comorbidities, medications, fertility, and parental consanguinity were recorded. RESULTS: In our study, anthropometric measurements in the FPL (n=18) group, which is a subgroup of lipodystrophy; mean weight was 67.1±11.3 kg, body mass index was 25.4±3.2 kg/m2, waist circumference was 92.6±8.7 cm. In the control group with diabetic and non- xi alcoholic fatty liver disease, mean weight was 76.1±7 kg, body mass index was 30.1±3.9 kg/m2, and waist circumference was 101.1±4.3 cm. A statistically significant difference was found between the two groups in anthropometric measurements of waist circumference (p=0.002), weight (p=0.025) and body mass index (p=0.002). Triglyceride levels were found to be significantly higher in the FPL group compared to type 2 diabetes, with an average of 653.2±423.6 mg/dl (p <0.001). The mean HDL-C was found to be 32.2±9.5 mg/dl in the FPL group, and higher at 43.2±5.5 mg/dl in the type 2 diabetes group. HDL-C levels were lower in the FPL group. A statistically significant difference was found between the type 2 diabetes group (p=0.001). The mean of Hba1c (glycosylated hemoglobin a1c) was 8.5% ±2.2% in the FPL group. Hba1c was found to be significantly higher in the FPL group than in the type 2 diabetesgroup (p=0.011). Non-alcoholic fatty liver disease fibrosis score (NFS); mean -2.3±0.7, mean -1.3±1 in the type 2 diabetes group, and a statistically significant difference was found when both groups were compared (p= 0.004). The mean APRI (aspartat aminotransferase/platelet ratio index) was 0.2±0.1 in the FPL group, and 0.3±0.1 in the type 2 diabetes group, and a statistically significant difference was found between the two groups (p=0.034). The mean FIB4 score was 0.6±0.2 in the FPL group, and the mean FIB-4 (fibrosis 4) score was higher in the type 2 diabetes group, 1.04±0.44 (p=0.007). There was also a statistically significant difference between the two groups in the FIB-4 score (p=0.007). When the correlation of NFS, APRI, FIB-4, visceral adipocyte index, body shape index, lipid accumulation index, dysfunctional adipocyte indices of KJL, FPL and Type 2 Diabetes groups was evaluated statistically; High or very high positive correlation was found between all indices except body shape index. CONCLUSION: Lipodystrophy; It is a rare disease group, characterized by severe insulin resistance and its complications. Non-alcoholic fatty liver disease and cirrhosis and its complications in its progression are among the most important causes of morbidity and mortality in this patient group. Various indices and scores predicting metabolic complications and liver fibrosis used today may be functional in determining metabolic complications in patients with lipodystrophy and in the differential diagnosis of patients with type 2 diabetes, which is characterized by severe insulin resistance.
Açıklama
Anahtar Kelimeler
Lipodistrofi, Alkol Dışı Yağlı Karaciğer Hastalığı, Viseral Adipozite İndeksi, Lipid Akümülasyon İndeksi, Vücut Şekil İndeksi, Trigliserid-Glukoz İndeksi, ADYKH Fibrozis Skoru, AST-Platelet Oranı İndeksi, Fibrozis-4 Skoru, Lipodystrophy, Non-Alcoholic Fatty Liver Disease, Visceral Adiposity Index, Lipid Accumulation Index, Body Shape Index, Triglyceride-Glucose Index, NAFLD Fibrosis Score, AST-Platelet Ratio Index, Fibrosis-4 Score
