Title POVEZANOST TRANZIJENTNE ELASTOGRAFIJE JETRE I KOMPONENTI METABOLIČKOG SINDROMA
Title (english) THE INTERRELATION BETWEEN LIVER TRANSIENT ELASTOGRAPHY AND METABOLIC SYNDROME COMPONENTS
Author Neven Franjić
Mentor Sandra Milić (mentor) MBZ: 243151
Committee member Zlatko Trobonjača (predsjednik povjerenstva)
Committee member Irena Hrstić (član povjerenstva)
Committee member Davor Štimac (član povjerenstva)
Granter University of Rijeka Faculty of Medicine (Department of Internal Medicine) Rijeka
Defense date and country 2018, Croatia
Scientific / art field, discipline and subdiscipline BIOMEDICINE AND HEALTHCARE Clinical Medical Sciences Internal Medicine
Universal decimal classification (UDC ) 61 - Medical sciences
Thesaurus (MESH - Medical Subject Headings )
Fatty Liver
Metabolic Diseases
Abstract Uvod. Nealkoholna masna bolest jetre je kronična bolest jetre uzrokovana ekscesivnim nakupljanjem masti u jetrenom parenhimu, čija se prisutnost sve češće neinvazivno dijagnosticira primjenom tranzijentne elastografije. Metabolički sindrom i njegove sastavnice (intolerancija glukoze, pretilost, dislipidemija i arterijska hipertenzija) prediktori su kardiovaskularnih incidenata.
Ciljevi istraživanja su bili utvrditi razinu povezanosti izmeĎu pojedinih komponenti metaboličkog sindroma te vrijednosti stupnja masnoće i tvrdoće jetrenog parenhima, utvrditi koja od komponenti metaboličkog sindroma najviše utječe na stupanj jetrene masnoće i tvrdoće te utvrditi da li ispitanici koji boluju od metaboličkog sindroma imaju veće vrijednosti jetrene masnoće i tvrdoće u odnosu na ispitanike koji ne boluju od metaboličkog sindroma.
Ispitanici i metode. U istraţivanje je uključeno ukupno 675 ispitanika, razvrstanih prema prisutnosti ili odsutnosti metaboličkog sindroma. Stupanj masnoće i tvrdoće jetre su simultano bili odreĎeni primjenom tranzijentne elastografije, M sonde za normalno uhranjene i preuhranjene te XL sonde za pretile ispitanike. Vrijednost stupnja masnoće ≥238 dB/m označavala je jetrenu steatozu, a vrijednost stupnja tvrdoće ≥7,0 kPa izraţenu jetrenu tvrdoću. Za statističku analizu korišten je MedCalc programski sustav, uz razinu statističke značajnosti od 0,05.
Rezultati. Statistička analiza je provedena na 512 ispitanika, 307 s metaboličkim sindromom i 205 bez njega, prema početno provedenoj analizi snage studije. Sve komponente metaboličkog sindroma su pokazale statistički značajnu korelaciju sa stupnjem masnoće i tvrdoće, osim hipertrigliceridemije sa stupnjem tvrdoće. Najizraţenije vrijednosti koeficijenta korelacije je pokazala visceralna pretilost (r=0,58 sa stupnjem masnoće, odnosno r=0,39 sa stupnjem tvrdoće). Multivarijatna analiza je pokazala da su visceralna pretilost (omjer rizika 15,50) i hipertrigliceridemija (omjer rizika 1,89) statistički značajno povezane s pojavnošću masne bolesti jetre, odnosno visceralna pretilost (omjer rizika 4,55), arterijska hipertenzija (omjer rizika 2,36) i sniţena vrijednost HDL kolesterola (omjer rizika 0,56) s pojavnošću povećane jetrene tvrdoće. Ispitanici s metaboličkim sindromom su imali statistički značajno više vrijednosti jetrene masnoće i tvrdoće u odnosu na ispitanike bez metaboličkog sindroma (P<0,001).
Zaključak. Metabolički sindrom povezan je s masnom bolešću jetre. Visceralna pretilost pokazuje najveći stupanj povezanosti sa jetrenom masnoćom i tvrdoćom. Tranzijentna elastografija vijabilna je metoda za probir masne bolesti jetre.
Abstract (english) Introduction. Non-alcoholic fatty liver disease is a spectrum of liver disorders caused by excessive hepatic fat accumulation, where transient elastography is an increasingly useful non-invasive diagnostic method. Metabolic syndrome and its constituents (glucose intolerance, obesity, dyslipidemia and arterial hypertension) are important risk factors for cardiovascular disorders.
Objectives. The objectives of this research were to determine: the correlation between metabolic syndrome components and the levels of hepatic steatosis and fibrosis; the component that has the greatest influence on hepatic steatosis and fibrosis levels; whether there is a statistically significant difference in hepatic steatosis and fibrosis levels between subjects suffering from metabolic syndrome and those not suffering from it.
Patients and Methods. 675 subjects were enrolled in the study, divided into two subgroups according to the presence or absence of metabolic syndrome. Hepatic steatosis and fibrosis levels were simultaneously determined using transient elastography. The M probe was used in normal weight and overweight subjects, while the XL probe was used in obese subjects. Liver steatosis was defined as steatosis parameter ≥238 dB/m, while advanced liver fibrosis was defined as fibrosis parameter ≥7.0 kPa. Statistical analysis was performed using the MedCalc program package, at the 0.05 level of statistical significance.
Results. Statistical analysis was performed on 512 subjects, pursuant to the performed power analysis. Among these, 307 suffered from metabolic syndrome, while 205 subjects did not suffer from it. All metabolic syndrome components showed statistically significant correlation with both liver steatosis and fibrosis levels, except for hypertriglyceridemia and liver fibrosis. The greatest correlation level was seen with visceral obesity, both for liver steatosis (r=0.58) and fibrosis (r=0.39). According to the multivariate analysis, visceral obesity (odds ratio 15.50) and hypertriglyceridemia (odds ratio 1.89) were the only components correlated with increased fatty liver disease occurrence, while visceral obesity (odds ratio 4.55), arterial hypertension (odds ratio 2.36) and low HDL levels (odds ratio 0.56) were components associated with increased liver fibrosis. Subjects suffering from metabolic syndrome had statistically significantly higher levels of liver steatosis and fibrosis in comparison with subjects not suffering from the condition (P<0.001). The levels of steatosis and fibrosis were proportional with the number of metabolic syndrome components involved.
Conclusion. Metabolic syndrome is related to non-alcoholic fatty liver disease. Visceral obesity is the component with the greatest correlation to liver steatosis and fibrosis. Transient elastography is a viable screening method for early detection of non-alcoholic fatty liver disease
Keywords
nealkoholna masna bolest jetre
kontrolirani atenuacijski parametar
parametar jetrene tvrdoće
metabolički sindrom
Keywords (english)
non-alcoholic fatty liver disease
controlled attenuation parameter
liver stiffness measurement
metabolic syndrome
Language croatian
URN:NBN urn:nbn:hr:184:015811
Study programme Title: Biomedicine Postgraduate (doctoral) study programme Study programme type: university Study level: postgraduate Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstvo (doktor/doktorica znanosti, područje biomedicine i zdravstvo)
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Created on 2019-01-28 11:08:34