Subklinik ve aşikar hipotiroidi ile nonalkolik yağlı karaciğer hastalığı arasındaki ilişki
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Tarih
2024
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç; Subklinik ve aşikar hipotiroidi tanılı hastaların nonalkolik yağlı
karaciğer hastalığı ile ilişkisinin değerlendirilmesi ve tanısında non-invaziv testlerin
ve görüntüleme yönteminin tanısal değerini değerlendirmeyi amaçladık
Gereç ve yöntem; Bu çalışma Haziran 2020-Ekim 2022 tarihleri arasında İç
Hastalıkları Endokrinoloji Anabilim Dalı polikliniğine başvuran hastaların dosyaları
incelenerek hazırlandı. Hastalar üç grupta incelendi. Subklinik hipotiroidi, aşikar
hipotiroidi ,ötiroid(kontrol grubu). Her birinin boy uzunluğu, kilosu, BKI, yaşı
kaydedildi. Çalışmaya katılan hastaların biyokimya ve hemogram bulguları ( ALT,
AST, ALP, GGT, PLT) ve lipid paneli (LDL kolestrol, trigliserit) kullanıldı. Yaş,
trombosit sayısı, AST ve ALT değerleriyle Fib-4 skor hesaplandı.. Çekilen
ultrasonografideki hepatostetaoz bulguları (grade yok, grade 1, grade 2, grade 3 )
şeklinde kaydedildi. Hastaların usg bulguları diğer parametrelerle 3 grup şeklinde
karşılaştırıldı. Hepatosteatoz olmayanlar, Grade 1 ve Grade 2 hepatostetaozu olanlar
şeklinde ayrıldı. Grade 3 az kişi olduğu için Grade 2 grubuna dahil edildi. Çalışmaya
dahil edilme kriterleri;18 yaş üstü hastalar, subklinik hipotiroidi (50 kişi) ve aşikar
hipotiroidi (50 kişi) tanısı almış olan hastalar, kontrol grubu (50 kişi) ;20-70 yaş
aralığında herhangi bir hastalığı olmayan, kronik kullandığı ilaç olmayan ötiroid hasta.
Çalışmadan hariç tutulma kriterleri; Ek hastalık olarak diyabetes mellitusu olan
hastalar dışlanmıştır. NAFLD’ ye neden olabilecek diğer kronik karaciğer hastalıkları
( Hepatit B, Hepatit C, Wilson, Hemakromatozis, Çölyak, Otoimmün Hepatit)
ilaçlardan (metotreksat, tamoksifen, glukokortikoid) kullananlar dahil edilmemiştir.
gebe hastalar, bariatrik cerrahi yapılmış kişiler ,kronik alkol kullanımı(erkek 30gr/gün
,kadın 20gr/gün) olanlar .
Bulgular; Çalışmaya katılan hastaların USG grade sınıfı ile gruplar arasındaki
ilişki istatistiki olarak anlamlıdır (p=0.024). Hastaların 42(28.0%) si Grade 1,
28(18.7%) si Grade 2, 3(2.0%) ü Grade 3, sınıfına düşmüştür. BKI ile hepatosteatoz
arasındaki ilişki subklinik hipotiroidi hastalarında (p=0.004) ve kontrol grubunda
(p=0.003) istatiksel açıdan anlamlıdır. Kolestrol ile hepatosteatoz arasındaki ilişki
aşikar hipotiroidi hastalarında (p=0.015) istatiksel olarak anlamlıdır.
Sonuçlar; Hipotiroidi ile NAYKH arasındaki ilişki son yıllarda yapılan birçok
çalışmada araştırılmıştır. Çalışmamızda ise subklinik ve aşikar hipotiroidi hastalarında
kolestrol ve beden kitle indeksi yüksekliğinin hepatostetaoz ile ilişkisi istatiksel açıdan
anlamlı görüldü. Hipotiroidi temelinde dislipidemiye ve son yıllarda artış gösteren
beden kitle indeksindeki yüksekliğe bağlı bir takım fizyopatolojik değişikliklerle
karaciğerde gelişen hepatosteatoz ve bunun sonucunda NAYKH gelişimi son yıllarda
bir çok çalışmada saptanmıştır. Çalışmamızda da subklinik ve aşikar hipotiroidi
hastalarının ultrasonografi ile saptanan NAYKH ile ilişkisinin istatiksel açıdan anlamlı
olduğu tespit edildi. NAYKH tanısında ultrsonografi yanında noninvaziv testlerden
Fib-4 skorlama sistemi çalışmamızda anlamlı sonuçlar vermemiştir. İleriki
çalışmalarda yeni noninvaziv testler ve görüntüleme yöntemleri NAYKH’ında fibrozis
değerlendirmesinde yol gösterici olabilir.
Aim; We aimed to evaluate the relationship between nonalcoholic fatty liver disease and nonalcoholic fatty liver disease in patients with subclinical and overt hypothyroidism and to evaluate the diagnostic value of non-invasive tests and imaging method in their diagnosis. Materials and method; This study was prepared by examining the files of patients admitted to the outpatient clinic of the Department of Endocrinology, Internal Medicine between June 2020 and October 2022. Patients were analyzed in three groups. Subclinical hypothyroidism, overt hypothyroidism, euthyroid (control group). Each patient's height, weight, BMI and age were recorded. Biochemistry and hemogram findings (ALT, AST, ALP, GGT, PLT) and lipid panel (LDL cholesterol, triglyceride) were used. Age, platelet count, AST and ALT values and Fib-4 score were calculated. Hepatostetaosis findings on ultrasonography were recorded as (no grade, grade 1, grade 2, grade 3). Ultrasound findings of the patients were compared with other parameters in 3 groups. Those without hepatosteatosis were divided into those with Grade 1 and Grade 2 hepatosteatosis. Grade 3 was included in the Grade 2 group because there were fewer people. Inclusion criteria; Patients over 18 years of age, patients diagnosed with subclinical hypothyroidism (50 people) and overt hypothyroidism (50 people), control group (50 people); Euthyroid patients between the ages of 20-70 without any disease and without chronic medication. Exclusion criteria; Patients with diabetes mellitus as an additional disease were excluded. Other chronic liver diseases that may cause NAFLD (Hepatitis B, Hepatitis C, Wilson's disease, Hemachromatosis, Celiac disease, Autoimmune hepatitis) and those using drugs (methotrexate, tamoxifen, glucocorticoids) were not included. Pregnant patients, people who underwent bariatric surgery, chronic alcohol use (male 30 g/day, female 20 g/day). Results; The relationship between the USG grade class of the patients participating in the study and the groups was statistically significant (p=0.024). 42(28.0%) of the patients were classified as Grade 1, 28(18.7%) as Grade 2, and 3(2.0%) as Grade 3. The relationship between BMI and hepatosteatosis was statistically significant in patients with subclinical hypothyroidism (p=0.004) and in the control group (p=0.003). The association between cholesterol and hepatosteatosis was statistically significant in patients with overt hypothyroidism (p=0.015). Conclusions; The relationship between hypothyroidism and NAFLD has been investigated in many studies in recent years. In our study, the association of elevated cholesterol and body mass index with hepatostatosis in patients with subclinical and overt hypothyroidism was statistically significant. Hepatosteatosis and consequent development of NAFLD in the liver due to some physiopathologic changes related to dyslipidemia on the basis of hypothyroidism and high body mass index, which has increased in recent years, have been found in many studies in recent years. In our study, the relationship between subclinical and overt hypothyroidism patients with NAFLD detected by ultrasonography was statistically significant. In addition to ultrasonography, the Fib-4 scoring system, which is one of the noninvasive tests in the diagnosis of NAFLD, did not yield significant results in our study. In future studies, new noninvasive tests and imaging methods may guide the evaluation of fibrosis in NAFLD.
Aim; We aimed to evaluate the relationship between nonalcoholic fatty liver disease and nonalcoholic fatty liver disease in patients with subclinical and overt hypothyroidism and to evaluate the diagnostic value of non-invasive tests and imaging method in their diagnosis. Materials and method; This study was prepared by examining the files of patients admitted to the outpatient clinic of the Department of Endocrinology, Internal Medicine between June 2020 and October 2022. Patients were analyzed in three groups. Subclinical hypothyroidism, overt hypothyroidism, euthyroid (control group). Each patient's height, weight, BMI and age were recorded. Biochemistry and hemogram findings (ALT, AST, ALP, GGT, PLT) and lipid panel (LDL cholesterol, triglyceride) were used. Age, platelet count, AST and ALT values and Fib-4 score were calculated. Hepatostetaosis findings on ultrasonography were recorded as (no grade, grade 1, grade 2, grade 3). Ultrasound findings of the patients were compared with other parameters in 3 groups. Those without hepatosteatosis were divided into those with Grade 1 and Grade 2 hepatosteatosis. Grade 3 was included in the Grade 2 group because there were fewer people. Inclusion criteria; Patients over 18 years of age, patients diagnosed with subclinical hypothyroidism (50 people) and overt hypothyroidism (50 people), control group (50 people); Euthyroid patients between the ages of 20-70 without any disease and without chronic medication. Exclusion criteria; Patients with diabetes mellitus as an additional disease were excluded. Other chronic liver diseases that may cause NAFLD (Hepatitis B, Hepatitis C, Wilson's disease, Hemachromatosis, Celiac disease, Autoimmune hepatitis) and those using drugs (methotrexate, tamoxifen, glucocorticoids) were not included. Pregnant patients, people who underwent bariatric surgery, chronic alcohol use (male 30 g/day, female 20 g/day). Results; The relationship between the USG grade class of the patients participating in the study and the groups was statistically significant (p=0.024). 42(28.0%) of the patients were classified as Grade 1, 28(18.7%) as Grade 2, and 3(2.0%) as Grade 3. The relationship between BMI and hepatosteatosis was statistically significant in patients with subclinical hypothyroidism (p=0.004) and in the control group (p=0.003). The association between cholesterol and hepatosteatosis was statistically significant in patients with overt hypothyroidism (p=0.015). Conclusions; The relationship between hypothyroidism and NAFLD has been investigated in many studies in recent years. In our study, the association of elevated cholesterol and body mass index with hepatostatosis in patients with subclinical and overt hypothyroidism was statistically significant. Hepatosteatosis and consequent development of NAFLD in the liver due to some physiopathologic changes related to dyslipidemia on the basis of hypothyroidism and high body mass index, which has increased in recent years, have been found in many studies in recent years. In our study, the relationship between subclinical and overt hypothyroidism patients with NAFLD detected by ultrasonography was statistically significant. In addition to ultrasonography, the Fib-4 scoring system, which is one of the noninvasive tests in the diagnosis of NAFLD, did not yield significant results in our study. In future studies, new noninvasive tests and imaging methods may guide the evaluation of fibrosis in NAFLD.
Açıklama
Anahtar Kelimeler
Subklinik ve Aşikar Hipotiroidi, Subclinical and overt hypothyroidism, Ultrasonografi, ultrasonography, Fib-4 skor, Fib-4 score, NAYKH prevalansı, NAFLD prevalence, hepatosteatoz, dislipidemi, BK, hepatosteatosis, dyslipidemia, BMI
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Korkmaz, K. N. (2024). Subklinik ve aşikar hipotiroidi ile nonalkolik yağlı karaciğer hastalığı arasındaki ilişki. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Dahili Tıp Bilimleri Bölümü İç Hastalıkları Anabilim Dalı, Konya.
