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Karaciğer sirozu hastalarında etiyolojiye ve siroz evrelerine göre metabolik parametrelerin karşılaştırılması

Comparison of metabolic parameters in patients with liver cirrhosis based on etiology and stages of cirrhosis

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  1. Tez No: 807847
  2. Yazar: GÜLDENİZ GİZEM SÜREN
  3. Danışmanlar: PROF. DR. YÜCEL ÜSTÜNDAĞ
  4. Tez Türü: Tıpta Uzmanlık
  5. Konular: Gastroenteroloji, İç Hastalıkları, Gastroenterology, Internal diseases
  6. Anahtar Kelimeler: Liver Cirrhosis, Glucose Metabolism, Lipid Metabolism, Osteoporosis
  7. Yıl: 2023
  8. Dil: Türkçe
  9. Üniversite: Zonguldak Bülent Ecevit Üniversitesi
  10. Enstitü: Tıp Fakültesi
  11. Ana Bilim Dalı: İç Hastalıkları Ana Bilim Dalı
  12. Bilim Dalı: Belirtilmemiş.
  13. Sayfa Sayısı: 69

Özet

Amaç: Çalışmamızda karaciğer sirozu hastalarında metabolik parametrelerin, kemik metabolizmasının, siroz etiyolojisi ve Child- Pugh sınıflamasına göre karşılaştırılması amaçlandı. Yöntem: Zonguldak Bülent Ecevit Üniversitesi Gastroenteroloji Kliniği'nde retrospektif olarak yapılan çalışmaya Ocak 2017- Mart 2022 yılları arasında karaciğer sirozu tanısıyla takip edilen 18 yaş üzeri hastalar dahil edildi. HCC dışı malignitesi olanlar, 18 yaş altı hastalar ve gebeler çalışmaya dahil edilmedi. Hastaların yaş, cinsiyet, vücut kitle indeksi gibi demografik verileri, sistolik ve diyastolik kan basıncı, serum açlık kan şekeri, tokluk kan şekeri, HbA1c, lipid profili, albümin, sodyum, kreatinin düzeyleri, protrombin zamanı (INR) tam kan sayımı, alfa-fetoprotein düzeyi, karaciğer fonksiyon testleri, kemik dansitometresi, kesitsel abdominal görüntüleme bulguları, abdominal ultrasonografi bulguları, karaciğer biyopsi histopatolojik verileri, siroz etiyolojisi, MELD ve Child-Pugh skorları kaydedildi. Bulgular: Çalışmada siroz nedenli takip edilen hastaların çoğunu kadın cinsiyet (%52) oluşturmaktaydı. Olguların yaş ortalaması 67±12,7; ortalama takip süresi 71±45,9 aydı. Hastaların %75' i hayatta iken, %25'inin eksitus olduğu tespit edildi. Olguların çoğunu viral sirozlar (%58) oluşturmaktaydı. HBV (%72,5) ve alkolik sirozda (%100) hastaların çoğunu erkek cinsiyet; HCV (%68), NASH (%79,4), otoimmün hepatit (%100), PBS (%66,7) gruplarında hastaların çoğunu kadın cinsiyet oluşturmaktaydı. Olguların %49,8 Child A, %35 Child B, %15,2 Child C olduğu tespit edildi. Viral ve non-viral siroz hastaları arasında AST, ALP, GGT, total bilirubin, INR, sodyum düzeyleri ve MELD skorları karşılaştırılmış olup, non-viral siroz hastalarında p% 6,5 bulundu. Child-Pugh sınıfları arasında açlık kan şekeri, HbA1c, tokluk kan şekeri karşılaştırıldığında p

Özet (Çeviri)

Aim: The goal of our research was to compare glucose, lipid profile, bone metabolism, and cardiovascular risk factors in cirrhosis patients based on the etiology and stages of the disease. Materials and methods: This study was conducted retrospectively in the Department of Internal Medicine of Zonguldak Bulent Ecevit University Health Application and Research Hospital. Patients over the age of 18 who were followed up with a diagnosis of“liver cirrhosis”and treated outpatient or inpatient at the Gastroenterology clinic of Zonguldak Bulent Ecevit University Health Application and Research Center between January 2017 and March 2022 were enrolled in the study. Patients with non-HCC malignancy, patients under the age of 18 and pregnant women were not included in the study. Age, gender, height, weight, body mass index, systolic and diastolic blood pressure, fasting blood glucose, postprandial blood glucose, HbA1c, lipid profile, serum albumin, creatinine, complete blood count, bone densitometer, magnetic resonance, pet ct, ultrasound results, liver biopsy reports, etiology of cirrhosis, status of compensation/decompensation, alpha-fetoprotein, liver function tests, MELD and Child-Pugh scores, the data of routine blood tests were analyzed. When evaluating the findings obtained in the study, the IBM SPSS Statistics 22 (IBM SPSS, Turkey) program was used for statistical analyses. Results: The majority of the patients in the study who were being monitored for cirrhosis were female (52%). The mean age of the patients was 67±12.7 and the mean follow-up period was 71±45.9 months. 25% of the patients were found to be deceased, while 75% of them were still alive. Viral cirrhosis accounted for the majority of cases (58%). HBV (72.5%) and alcoholic cirrhosis (100%) had a higher percentage of male patients than HCV (68%), NASH (79.4%), autoimmune hepatitis (100%), and PBS (66.7%), which had a higher percentage of female patients. The Child-Pugh score of 297 of the cases could be calculated. Of these, 49.8% were Child A, 35% were Child B, and 15.2% were Child C. Patients with viral and non-viral cirrhosis were compared in terms of AST, ALP, GGT, total bilirubin, INR, sodium levels, and MELD scores; they were found to be significantly higher in non-viral cirrhosis patients (p 6.5%. When the Child-Pugh classes were compared using fasting blood sugar, HbA1c, and postprandial blood sugar, there was a significant difference between the groups with a p0.05. When body mass index (BMI) and fasting insulin were assessed, there was no significant difference between the Child groups (p:0.139, p:0.211, respectively). Patients with viral and non-viral cirrhosis had their fasting blood sugar, HbA1c, and postprandial blood sugar levels compared; it was discovered that non-viral cirrhosis patients had significantly higher fasting and postprandial blood sugar levels with a p-value of 0.05. There was no significant difference in HbA1c value (p:0.094). According to the lipid panel statistics, the average LDL of our patients was 78 mg/dL, triglycerides were 101 mg/dL, HDL was 39 mg/dL, and total cholesterol was 139 mg/dL. With a p-value of 0.05, we found that there was a significant difference in LDL and total cholesterol levels between the child categories. However, there was no significant difference between triglyceride levels. Between Child A and Child B, and Child A and Child C, a statistically significant difference in HDL levels was discovered with p:0,000. Between individuals with viral and non-viral cirrhosis, LDL, HDL, triglyceride, and total cholesterol values were compared. HDL was considerably lower in non-viral cirrhosis patients with a p value of 0.006. There was no significant difference in LDL, triglyceride and total cholesterol values (respectively p:0.323, p:0.088, p:0.728). When the lumbar bone mineral densitometry (BMD) of 93 of 304 patients and the femoral BMD of 91 of them were examined, the mean lumbar t score was found to be -1.5 and the mean femur t score was -1.2. 14 of these patients had a femoral t score below -2.5, while 26 of them had a lumbar t score below -2.5. Femur t scores between Child B and C and Child A and C categories were compared, and a significant difference was discovered (p:0.001, p:0.003, respectively). When Child B and C categories and Child A and C categories' lumbar t scores were examined, a significant difference was discovered (p:0.003, p:0.012, respectively). Patients with viral and non-viral cirrhosis had their lumbar and femoral t scores examined, but no discernible difference was identified (p:0.954, p:0.423, respectively). Conclusion: In our study, similar to the literature, viral factors have emerged as the most common etiological factor for cirrhosis. As the Child-Pugh stage progresses, pre and postprandial plasma glucose leves were higher; total cholesterol and LDL levels are lower, and the severity of osteoporosis has been found to increase. Patients with non-viral cirrhosis were shown to have decreased HDL levels and higher pre- and postprandial plasma glucose levels.

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