Nonalkolik yağlı karaciğer hastalığında prematür ateroskleroz ile lipoprotein A ilişkisi
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Dosyalar
Tarih
2015
Yazarlar
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Cilt Başlığı
Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Son dönemde artan sıklıkta görülen nonalkolik yağlı karaciğer hastalığı ile prematür ateroskleroz arasındaki ilişki daha önce yapılan bazı çalışmalarda gösterilmiştir. Prematür aterosklerozda lipoprotein(a) etkisi ile ilgili literatürde çelişkili bilgiler bulunmakla birlikte; literatürde nonalkolik yağlı karaciğer hastalığı olanlardaki prematür aterosklerozda lipoprotein(a)'nın etkisini ayrı olarak değerlendiren herhangi bir çalışma bulunmamaktadır. Trakya Üniversitesi Tıp Fakültesi'nde yaptığımız çalışmamızda nonalkolik yağlı karaciğer hastalığı ile prematür ateroskleroz arasındaki ilişkiyi değerlendirip, bu ilişkinin metabolik sendrom parametreleri ve özellikle lipoprotein(a) ile ayrı olarak nasıl etkilendiğini göstermeyi amaçladık. Kliniğimizde herhangi bir nedenle ultrasonografi ile hepatosteatoz değerlendirmesi yapılmış olan, malignite tanısı almamış, ciddi alkol kullanım öyküsü olmayan ve dışlama kriterlerini taşımayan 55 yaş altı erkek ve 65 yaş altı bayan 144 gönüllü çalışmaya dahil edildi. Geriye dönük olarak ultrasonografi raporları ve laboratuar parametreleri tarandı. Gönüllüler hepatosteatoz derecesine göre grade 0, grade 1, grade 2-3 olarak gruplara ayrıldı. Yaş, cins, demografik özellikleri kayıt edilerek, kan basınçları, vücut ağırlıkları, boyları ve bel çevreleri ölçüldü. Nefelometrik olarak yüksek sensitif C-reaktif protein ve lipoprotein(a) değerleri ölçüldü. Radyoloji Ana bilim Dalı'nda tüm olguların boyun karotis doppler ultrasonografisi ile karotis intima media kalınlıkları ölçüldü. Hepatosteatoz grade artıkça hepatosteatoz derecesi ile sağ ve sol karotis intima media kalınlıkları arasında artmış pozitif korelasyon görüldü. Gruplar arasında grade artıkça anlamlı olarak daha yüksek karotis intima media kalınlıkları gözlendi (p<0.05). Yüksek sensitif C- reaktif protein düzeyleri açısından hepatosteatoz gruplar arasında anlamlı fark gözlenmedi (p=0.721). Hepatosteatoz grade artıkça hepatosteatoz ile lipoprotein(a) arasında düşük düzeyde anlamlı pozitif yönde korelasyon (r=0.184, p=0.027) görüldü. Hepatosteatoz grade 2-3 grubunda hepatosteatoz olmayan gruba göre anlamlı yüksek lipoprotein(a) düzeyi saptandı (p= 0.046). Nonalkolik yağlı karaciğer hastalığı olanlarda karotis intima media kalınlığı 0.800 mm kestirim değeri olarak alındığında; 0.800 mm üstü karotis intima media kalınlığı olanlar ile olmayanlar arasında lipoprotein(a) düzeyi açısından anlamlı fark saptanmadı (p=0.516). Yapılan parsiyel korelasyonda da lipoprotein(a)'nın hepatosteatoz varlığındaki prematür ateroskleroz üzerinde etkili olmadığı saptandı. 50 yaş üzeri olma (OR=27.19, 95%Cl, 2.66– 285.00, p=0.005), grade 2-3 hepatosteatoz varlığı (OR=15.56, 95%Cl, 3.20–76.60, p=0.001) ve 40-50 yaş arası olma (OR=11.13, 95%Cl, 1.07-115.25, p=0.043) diğer kardiyovasküler ve metabolik sendrom risk faktörlerinden bağımsız olarak prematür ateroskleroz ile ilişkili olduğu saptandı. Mevcut bulgular ışığında nonalkolik yağlı karaciğer hastalığının prematür ateroskleroz ile ilişkili olduğunu; özellikle şiddetli hepatosteatozun 40 yaş üzeri olma ile birlikte prematür ateroskleroz üzerinde diğer kardiyovasküler risk faktörlerinden bağımsız olarak etkisi olduğunu düşünüyoruz. Lipoprotein(a)'nın ise hepatosteatoz varlığındaki artmış prematür ateroskleroz üzerinde herhangi bir etkisinin olmadığı kanısındayız.
Abstract
Recently the relationship between nonalcoholic fatty liver disease seen with increasing frequency and premature atherosclerosis has been shown in some studies before. Although there are conflicting information about the effect of lipoprotein(a) on premature atherosclerosis; there are no studies that have evaluated the effect of lipoprotein(a) on premature atherosclerosis in the presence of hepatosteatosis particularly. In our study firstly we aim to evaluate the relationship between premature atherosclerosis and nonalcoholic fatty liver disease and secondly we aim to show how impressed this relationship from metabolic syndrome parameters and particularly lipoprotein(a). In our clinic, male under age of 55 and female under age of 65, without diagnosis of malignancy, without any significant history of alcohol use and without carrying exclusion criteria; 144 volunteers whom have been made hepatic steatosis assesment for any reason have been included in the study. Retrospective reports of hepatic ultrasond and laboratory parameters have been scanned. Volunteers have been divided into groups according to degree of hepatic steatosis grade 0, grade 1, grade 2-3. Age, sex and demographic characteristics have been recorded and blood pressure, body weight, height and waist circumference have been measured. High sensitivity C-reactive protein and lipoprotein(a) levels have been measured with nephelometric method. Carotid intima media thickness of all volunteers have been measured with carotid doppler ultrasonography in Department of Radiology. Although there is positive correlation between increasing degree of hepatosteatosis and left-right carotid intima media thickness; between groups, in higher grade hepatosteatosis have been observed higher carotid intima media thickness significantly (p<0.05). In terms of high sensitivity C-reactive protein levels, no significant difference have been observed between groups divided according to hepatosteatosis degree (p=0.721). Although hepatosteatosis grade increases, there have been positive low degree correlation (r=0.184, p= 0.027) with lipoprotein(a) levels. Higher lipoprotein(a) levels have been determined in hepatosteatosis grade 2-3 group compared to without hepatic steatosis group (p=0.046). When carotis intima media thickness 0,800 mm cut off have been received in hepatosteatosis group, there have been detected no significant difference between groups above 0,800 mm karotid intima media thickness and below 0,800 mm karotid intima media thickness (p=0.516). Also made partial correlation have been detected that lipoprotein(a) have no significant effect on premature atherosclerosis in the presence of hepatosteatosis. Being over the age 55 year old (OR=27.19, 95%Cl, 2.66–285.00, p=0.005), hepatosteatosis grade 2-3 (OR=15.56, 95%Cl, 3.20–76.60, p=0.001) and being age between 40–50 year old (OR=11.13, 95%Cl, 1.07-115.25, p=0.043) have been found to be assosiated with premature atherosclerosis independent of other cardiovascular and metabolic syndrome risk factors. In the light of available data we suggest that hepatosteatosis is associated with premature atherosclerosis and particularly severe hepatosteatosis with being age over 40 year old have been affected premature atherosclerosis independent of other cardiovascular risk factors. We believe that lipoprotein(a) have no effect on increasing premature atherosclerosis in the presence of hepatosteatosis.
Abstract
Recently the relationship between nonalcoholic fatty liver disease seen with increasing frequency and premature atherosclerosis has been shown in some studies before. Although there are conflicting information about the effect of lipoprotein(a) on premature atherosclerosis; there are no studies that have evaluated the effect of lipoprotein(a) on premature atherosclerosis in the presence of hepatosteatosis particularly. In our study firstly we aim to evaluate the relationship between premature atherosclerosis and nonalcoholic fatty liver disease and secondly we aim to show how impressed this relationship from metabolic syndrome parameters and particularly lipoprotein(a). In our clinic, male under age of 55 and female under age of 65, without diagnosis of malignancy, without any significant history of alcohol use and without carrying exclusion criteria; 144 volunteers whom have been made hepatic steatosis assesment for any reason have been included in the study. Retrospective reports of hepatic ultrasond and laboratory parameters have been scanned. Volunteers have been divided into groups according to degree of hepatic steatosis grade 0, grade 1, grade 2-3. Age, sex and demographic characteristics have been recorded and blood pressure, body weight, height and waist circumference have been measured. High sensitivity C-reactive protein and lipoprotein(a) levels have been measured with nephelometric method. Carotid intima media thickness of all volunteers have been measured with carotid doppler ultrasonography in Department of Radiology. Although there is positive correlation between increasing degree of hepatosteatosis and left-right carotid intima media thickness; between groups, in higher grade hepatosteatosis have been observed higher carotid intima media thickness significantly (p<0.05). In terms of high sensitivity C-reactive protein levels, no significant difference have been observed between groups divided according to hepatosteatosis degree (p=0.721). Although hepatosteatosis grade increases, there have been positive low degree correlation (r=0.184, p= 0.027) with lipoprotein(a) levels. Higher lipoprotein(a) levels have been determined in hepatosteatosis grade 2-3 group compared to without hepatic steatosis group (p=0.046). When carotis intima media thickness 0,800 mm cut off have been received in hepatosteatosis group, there have been detected no significant difference between groups above 0,800 mm karotid intima media thickness and below 0,800 mm karotid intima media thickness (p=0.516). Also made partial correlation have been detected that lipoprotein(a) have no significant effect on premature atherosclerosis in the presence of hepatosteatosis. Being over the age 55 year old (OR=27.19, 95%Cl, 2.66–285.00, p=0.005), hepatosteatosis grade 2-3 (OR=15.56, 95%Cl, 3.20–76.60, p=0.001) and being age between 40–50 year old (OR=11.13, 95%Cl, 1.07-115.25, p=0.043) have been found to be assosiated with premature atherosclerosis independent of other cardiovascular and metabolic syndrome risk factors. In the light of available data we suggest that hepatosteatosis is associated with premature atherosclerosis and particularly severe hepatosteatosis with being age over 40 year old have been affected premature atherosclerosis independent of other cardiovascular risk factors. We believe that lipoprotein(a) have no effect on increasing premature atherosclerosis in the presence of hepatosteatosis.
Açıklama
Tıpta Uzmanlık Tezi
Anahtar Kelimeler
Lipoprotein(a), Yüksek sensitif C-reaktif protein, Karotis intima media kalınlığı, Prematür ateroskleroz, Non alkolik yağlı karaciğer hastalığı, Lipoprotein (a), High sensitivity C-reactive protein, Premature atherosclerosis, Nonalcoholic fatty liver disease, Karotid intima media thickness
