Gojaznost i metabolički sindrom kao faktori rizika od razvoja nealkoholne masne bolesti jetre dijagnostikovane ultrazvukom
Sažetak
Uvod/Cilj. Bolest nealkoholne masne jetre (NAFLD) je hronično oboljenje jetre, širokog histološkog spektra, koje karakteriše akumulacija triglicerida u više od 5% hepatocita u odsustvu konzumiranja alkohola u količinama štetnim za jetru. Cilj našeg istraživanja bio je da se utvdi značaj antropometrijskih, laboratorijskih parametara i metaboličkog sindroma u dijagnozi NAFLD i da se proceni njihov uticaj na stepen steatoze jetre procenjene ultrazvukom. Metode. Istraživanjem je bilo obuhvaćeno 86 ispitanika, od kojih je 55 imalo masnu jetru, dokazanu ultrazvukom, i oni su činili studijsku grupu. Kontrolnu grupu činio je 31 ispitanik bez bilo kakve bolesti jetre. Prilikom hospitalizacije u Klinici za gastroenterologiju i hepatologiju Kliničkog centra Niš, ispitanicima je uzeta anamneza, izvršena su antropometrijska merenja, biohemijske analize krvi i ultrazvučni pregled abdomena. Rezultati. Bolesnici sa NAFLD imali su statistički značajno povećan body mass index (BMI), obim struka (OS), sistolni i dijastolni krvni pritisak, vrednosti aspartat i alanin aminotransferaze (AST, ALT), gama-glutamil transpeptidaze (GGT) (p < 0,001), lipoproteina niske gustine (LDL), ukupnog bilirubina (p < 0,05), ukupnog holesterola (p < 0,01), triglicerida, urata, C reaktivnog proteina (CRP), feritina, fibrinogena, glikemije našte, insulina i Homeostasis Model Assessment (HOMA-IR) (p < 0,001), dok je vrednost lipoproteina visoke gustine (HDL) bila veća u kontrolnoj grupi (p < 0,05). U NAFLD grupi bilo je statistički značajno više bolesnika sa hipertenzijom (72,73% vs 12,90%, p < 0,001) i sa diabetesom melitusom (DM) tipa 2 (47,27%). Metabolički sindrom utvrđen je kod 48 (87,27%) bolesnika studijske grupe. Podjednak broj bolesnika, 16 (29,09%), imao je 3, 4 i 5 komponenti MS. U NAFLD grupi bilo je 17 (30,91%) bolesnika sa predgojaznošću (BMI od 25 kg/m2 do 29,9 kg/m2) i 38 (69,09%) gojaznih (BMI ≥ 30.0 kg/m2) bolesnika. Najveći broj bolesnika u grupi gojaznih, 22 (40,00%), bio je sa prvim stepenom gojaznosti (BMI od 30 kg/m2 do 34,99 kg/m2). Najveći broj bolesnika NAFLD grupe, 23 (41,82%), imao je ultrazvučni nalaz masne jetre gradusa 3, 20 (36,36%) gradusa 2 i 12 (21,82%) gradusa 1. Kruskal-Wallis test i ANOVA analiza pokazali su da postoje statistički značajne razlike između grupa sa različitim ultrazvučnim gradusom za insulin, LDL holesterol, OS, BMI (p < 0,05), kao i HOMA-IR i telesnu masu (TM) (p < 0,01). Metabolički sindrom bio je statistički zastupljeniji kod ispitanika sa UZ gradusom 2 i 3 (p < 0,01) u odnosu na UZ gradus 1, kao i gojaznost, hipertenzija i DM tip 2 (p < 0,05). Zaključak. Rezultati naše studije potvrđuju da veliki procenat bolesnika sa faktorima visokog rizika (DM, MS, dislipidemija, hipertenzija) ima NAFLD.
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