SGLT-2 inhibitörü tedavisi alan ve NAFLD tanısı olan tip 2 diyabetli olguların metabolik parametreleri ve karaciğer fibrozis skorlarının retrospektif olarak değerlendirilmesi
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Dosyalar
Tarih
2020
Yazarlar
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Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş ve Amaç: NAFLD (non-alkolik yağlı karaciğer hastalığı), dünya çapında genel popülasyonun %25'ini etkileyen kronik karaciğer hastalığının en yaygın nedeni haline gelmiştir. NAFLD, basit karaciğer yağlanmasından NASH (non-alkolik steatohepatit) ve siroza uzanan geniş bir tanımlamadır. NAFLD diyabetin yeni bir komplikasyonudur. Diyabetli olgularda, basit bir steatozun erken evrede saptanması, NASH'e ilerlemeyi önlemede atılacak ilk adımdır. SGLT-2 (Sodyum-glukoz ko-transporter 2) inhibitörleri, Tip 2 Diabetes Mellitus (T2DM) tedavisinde kullanılan yeni bir oral ilaç sınıfıdır. SGLT-2 inhibitörlerinin kardiyorenal, kardiyovasküler faydaları ve tüm nedenlere bağlı mortaliteyi, hastaneye yatışı azalttığı bilinmektedir. Bu çalışmada tip 2 diyabete bağlı NAFLD tanılı hastalarda SGLT-2 inhibitörleri ile tedavinin karaciğer fibrozisi üzerine olan etkisi Transient Elastografi (TE) kullanılarak araştırıldı. Gereç-Yöntem: Ege Üniversitesi Tıp Fakültesi Hastanesi, İç Hastalıkları Kliniği, Endokrinoloji ve Hepatoloji polikliniğinde 2018-2020 yılları arasında takipli, tip 2 diyabete bağlı NAFLD tanısı alıp, HbA1c≥6,5 ve fibroscande fibrozis ≥ F2 olan ve takip süreçlerinde tedavilerine SGLT-2 inhibitörü eklenen 17'si kadın ve 9'u erkek toplam 26 hastanın dosyası retrospektif olarak incelendi. Hastaların biyokimyasal parametreleri, kilo, VKİ (vücut kitle indeksi), TE, NAFLD fibrozis skoru (NFS) ve FİB-4 skoru tedaviye başlamadan önce ve 6.ay kontrolleri kaydedildi. Bulgular: SGLT-2 inhibitörleri ile 6 ay tedavi sonrası kilo (Δ=-2 kg; p<0,001), VKİ (Δ=-1,9 kg/m2; p<0,001), HbA1c (glikozillenmiş hemoglobin) (Δ=-%0,7; p<0,001), ALT (alanin aminotransferaz) (Δ=-7 U/L; p=0,005), AST (aspartat aminotransferaz) (Δ=-6,5 U/L; p=0,012) ve TE ile ölçülen karaciğer katılığında (Δ=-3,9 kPa; p=0,006) istatistiksel anlamlı regresyon izlendi. Çalışmada karaciğer fibrozisini değerlendirmek için NFS ve FİB-4 skoru kullanıldı. NFS (Δ=-0,42) ve FİB-4 skorunda (Δ=-0,33) regresyon izlendi, ancak bu istatistiksel anlamlı değildi (p>0,05). HbA1c>%1 değişiklik olan grupta serum ALT, AST, GGT (gama glutamil transferaz) düzeyinde daha fazla azalma olduğu görüldü (p<0,001). Metformin, pioglitazon ve SGLT-2 inhibitörü ile olan tedavi kombinasyonu kilo (Δ=-3,5 kg), VKİ (Δ=-2,4 kg/m2), HbA1c (Δ=-%0,75), serum ALT (Δ=-11,5 U/L), AST (Δ=-11,5 U/L), GGT (Δ=-13,5 U/L), LDL (düşük yoğunluklu lipoprotein) (Δ=-30 mg/dl) ve trigliserid (Δ=- x 30,5 mg/dl) düzeyinde iyileşme sağladı ve TE ile ölçülen karaciğer katılığı Δ=-3,7 kPa geriledi. Sonuç: SGLT-2 inhibitörleri ile tedavi sonrası kilo, VKİ, HbA1c, ALT, AST ve TE ile değerlendirilen karaciğer fibrozisinde istatistiksel anlamlı regresyon izlendi. Metformin, pioglitazon ve SGLT-2 inhibitörü ile olan tedavi kombinasyonu kilo, VKİ, HbA1c, karaciğer transaminazları, LDL, trigliserid düzeyinde iyileşme sağladı ve en iyi tedavi şekliydi.
Background: Recently, NAFLD (non-alcoholic fatty liver disease) has become the most common cause of chronic liver disease affecting 25% of the general population worldwide. NAFLD definiton has a broad spectrum from simple fatty liver to NASH (non-alcoholic steatohepatitis) and cirrhosis. Detection of the simple hepatosteatosis at early stage is the first step for preventing progression to NASH in indiviudals with diabetes. SGLT-2 (Sodiumglucose co-transporter 2) inhibitors are a new class of oral drugs used in the treatment of Type 2 Diabetes Mellitus (T2DM). It is known that SGLT-2 inhibitors have cardiovasculer benefits and these drugs reduce all-cause mortality and hospitalization. In this study, the effect of treatment with SGLT-2 inhibitors on liver fibrosis in patients diagnosed with NAFLD due to type 2 diabetes was evauleated by using Transient Elastography (TE). Methods: The files of 26 patients, 17 female and 9 male who were followed up with the diagnosis of NAFLD due to type 2 diabetes between 2018-2020 in Ege University Faculty of Medicine, Internal Diseases Clinic, Endocrinology and Hepatology outpatient clinic, were retrospectively analyzed. All of these patients had HbA1c≥6,5, TE ≥ F2. SGLT2 inhibitors had been started to these patients during follow-up. Biochemical parameters, weight, BMI (body mass index), TE, NAFLD fibrosis score and FIB-4 score were recorded in all patients before starting treatment and at the 6th month follow-up. Results: After 6 months of treatment with SGLT-2 inhibitors, a significant regression was observed in liver stiffness (Δ=-3,9 kPa; p=0,006) measured by weight (Δ=-2 kg; p<0,001), BMI (Δ=-1,9 kg/m2; p<0,001), HbA1c (glycated hemoglobin) (Δ=-%0,7; p<0,001), ALT (alanine aminotransferase) (Δ=-7 U/L; p=0,005), AST (aspartate aminotransferase) (Δ=-6,5 U/L; p=0,012) and TE. NFS and FIB-4 score were used to evaluate liver fibrosis in the study. Regression was observed in NFS (Δ=-0,42) and FİB-4 score (Δ=-0,33), but this was not statistically significant (p>0.05). A greater decrease in ALT, AST, GGT (gamma glutamyl transferase) was observed in the group with more than 1% change in HbA1c (p<0,001). The best improvement of weight (Δ=-3,5 kg), BMI (Δ=-2,4 kg/m2), HbA1c (Δ=-%0,75), serum ALT (Δ=-11,5 U/L), AST (Δ=-11,5 U/L), GGT (Δ=-13,5 U/L), LDL (low-density lipoprotein) (Δ=-30 mg/dl) and triglyceride levels (Δ=-30,5 mg/dl) was observed in the combination group of metformin, pioglitazone and SGLT-2 inhibitor and liver stiffness that was measured by TE decreased as Δ=-3,7 kPa. Conclusion: After 6 months of treatment with SGLT-2 inhibitors, a significant regression was observed in liver stiffness measured by weight, BMI, HbA1c, ALT, AST and TE. The best improvement of weight, BMI, HbA1c, liver enzymes, LDL and triglyceride levels was observed in the combination group of metformin, pioglitazone and SGLT-2 inhibitor.
Background: Recently, NAFLD (non-alcoholic fatty liver disease) has become the most common cause of chronic liver disease affecting 25% of the general population worldwide. NAFLD definiton has a broad spectrum from simple fatty liver to NASH (non-alcoholic steatohepatitis) and cirrhosis. Detection of the simple hepatosteatosis at early stage is the first step for preventing progression to NASH in indiviudals with diabetes. SGLT-2 (Sodiumglucose co-transporter 2) inhibitors are a new class of oral drugs used in the treatment of Type 2 Diabetes Mellitus (T2DM). It is known that SGLT-2 inhibitors have cardiovasculer benefits and these drugs reduce all-cause mortality and hospitalization. In this study, the effect of treatment with SGLT-2 inhibitors on liver fibrosis in patients diagnosed with NAFLD due to type 2 diabetes was evauleated by using Transient Elastography (TE). Methods: The files of 26 patients, 17 female and 9 male who were followed up with the diagnosis of NAFLD due to type 2 diabetes between 2018-2020 in Ege University Faculty of Medicine, Internal Diseases Clinic, Endocrinology and Hepatology outpatient clinic, were retrospectively analyzed. All of these patients had HbA1c≥6,5, TE ≥ F2. SGLT2 inhibitors had been started to these patients during follow-up. Biochemical parameters, weight, BMI (body mass index), TE, NAFLD fibrosis score and FIB-4 score were recorded in all patients before starting treatment and at the 6th month follow-up. Results: After 6 months of treatment with SGLT-2 inhibitors, a significant regression was observed in liver stiffness (Δ=-3,9 kPa; p=0,006) measured by weight (Δ=-2 kg; p<0,001), BMI (Δ=-1,9 kg/m2; p<0,001), HbA1c (glycated hemoglobin) (Δ=-%0,7; p<0,001), ALT (alanine aminotransferase) (Δ=-7 U/L; p=0,005), AST (aspartate aminotransferase) (Δ=-6,5 U/L; p=0,012) and TE. NFS and FIB-4 score were used to evaluate liver fibrosis in the study. Regression was observed in NFS (Δ=-0,42) and FİB-4 score (Δ=-0,33), but this was not statistically significant (p>0.05). A greater decrease in ALT, AST, GGT (gamma glutamyl transferase) was observed in the group with more than 1% change in HbA1c (p<0,001). The best improvement of weight (Δ=-3,5 kg), BMI (Δ=-2,4 kg/m2), HbA1c (Δ=-%0,75), serum ALT (Δ=-11,5 U/L), AST (Δ=-11,5 U/L), GGT (Δ=-13,5 U/L), LDL (low-density lipoprotein) (Δ=-30 mg/dl) and triglyceride levels (Δ=-30,5 mg/dl) was observed in the combination group of metformin, pioglitazone and SGLT-2 inhibitor and liver stiffness that was measured by TE decreased as Δ=-3,7 kPa. Conclusion: After 6 months of treatment with SGLT-2 inhibitors, a significant regression was observed in liver stiffness measured by weight, BMI, HbA1c, ALT, AST and TE. The best improvement of weight, BMI, HbA1c, liver enzymes, LDL and triglyceride levels was observed in the combination group of metformin, pioglitazone and SGLT-2 inhibitor.
Açıklama
Anahtar Kelimeler
Tip 2 DM, NAFLD, NASH, SGLT-2 İnhibitörü, Transient Elastografi, Tip 2 DM, NAFLD, NASH, SGLT-2 Inhibitor, Transient Elastography
