Aknu steatozes marķieru asociācija ar vēlīno diabētisko komplikāciju izpausmēm 1. tipa cukura diabēta pacientiem Latvijā
Date
2015
Authors
Sviklāne, Laura
Journal Title
Journal ISSN
Volume Title
Publisher
Latvijas Universitāte
Abstract
Ievads. Dažos pētījumos ir parādīta aknu steatozes saistība ar vēlīno diabētisko komplikāciju attīstību 1. tipa cukura diabēta pacientiem. Lai atvieglotu aknu steatozes diagnostiku, tika izstrādāti specifiski marķieri aknu tauku satura novērtēšanai.
Darba mērķis. Pārbaudīt aknu steatozes marķieru efektivitāti aknu steatozes diagnostikā un analizēt tās asociāciju ar diabētisko komplikāciju izpausmēm, glikozilēto hemoglobīnu, metabolo sindromu 1. tipa cukura diabēta pacientiem Latvijā.
Materiāli un metodes. Aknu steatozes marķieru validācijai izmantota magnētiskās rezonances attēlveidošana 19 pacientiem. Aknu steatozes marķieri tika aprēķināti pēc HSI un FLI formulām. Tika analizēti dati par 176 „LatDiane: Latvijas diabētiskās nefropātijas pētījumā” iesaistītiem 1. tipa cukura diabēta pacientiem. No aprēķiniem tika izslēgti pacienti ar augstu alkohola patēriņu un diabēta stāžu zem pieciem gadiem.
Rezultāti. Mikroskopiskais tauku daudzums aknās pēc MRI datiem korelē ar FLI (p<0,01), HSI (p<0,05), albuminūriju (p<0,05). Pacientu grupā ar augstu aknu steatozes attīstības risku pēc FLI rādītāja, mikroskopiskais tauku daudzums aknās bija lielāks nekā grupā pacientiem ar zemu aknu steatozes attīstības risku (attiecīgi 13% pret 1%) (p=0,042). Noteicām FLI marķiera efektivitāti 81% gadījumu (p=0,007) un HSI marķiera efektivitāti - 69% (p=0,052). Pacienti tika iedalīti grupās pēc FLI un HSI marķieru vērtības: zemu, iespējamu un augstu aknu steatozes attīstības risku. Grupā ar augstu risku (HSI>36, n=13; FLI≥60, n=18) pēc abiem indeksiem prevalē pacienti ar metabolo sindromu, šajā grupā pacienti bija gados vecāki, ar ilgāku diabēta stāžu, zemāku glomerulāro filtrācijas ātrumu, ar lielāku komplikāciju skaitu, šajās grupās neiropātija, retinopātija, arteriālā hipertensija tiek novērotas biežāk, nekā grupā ar zemu aknu steatozes attīstības risku. Glikozilētais hemoglobīns pa grupām neatšķirās. FLI un HSI korelē savā starpā, ar diabēta stāžu, glomerulāro filtrācijas ātrumu; FLI korelē arī ar komplikāciju skaitu.
Secinājumi. Pētījuma rezultāti apstiprina FLI marķiera izmantojamību aknu steatozes diagnostikā 1. tipa cukura diabēta pacientiem. 11% no pētījumā iesaistītajiem pacientiem ir augsts aknu steatozes attīstības risks, pamatojoties uz HSI un FLI rādītājiem. FLI marķierim ir spēcīgāka saistība ar aknu steatozi un vēlīnām diabētiskajām komplikācijām nekā HSI marķierim. Šiem pacientiem biežāk novēro diabētiskās komplikācijas, neatkarīgi no glikozilētā hemoglobīna, kas norāda uz iespējamo aknu steatozes lomu 1. tipa cukura diabēta patoģenēzē.
Introduction. There are some data showing hepatic steatosis association with long-term diabetes complications. In order to facilitate hepatic steatosis diagnosis, specific markers have been developed, which are based on biochemistry parameters in blood. Aim. The aims of the work were to verify hepatic steatosis markers efficiency for hepatic steatosis diagnosis (via validation with magnetic resonance imaging) and to analyse association of hepatic steatosis markers with diabetes long-term complications, metabolic syndrome, glycated hemoglobin. Materials and methods. For hepatic steatosis markers (FLI, HSI) validation we used liver magnetic resonance imaging to 19 patients. Hepatic steatosis markers were calculated by HSI and FLI formulas. There were analysed 176 patients with type 1 diabetes mellitus of “LatDiane: Latvian diabetic nephropathy study”. Patients with high alcohol consumption and duration of diabetes less than five years were excluded. The Results. Microscopic fat content in the liver detected by MRI correlates with FLI (p<0,01) and HSI (p<0,05), albuminuria (p<0,05). In a group with high risk of hepatic steatosis development based on FLI, microscopic fat content was higher than in group with low risk of hepatic steatosis (13% versus 1%) (p=0,042). FLI marker could detect hepatic steatosis with a efficiency 81% (p=0,007) and HSI marker with a efficiency 69% (p=0,052). Patients were divided into groups: high, possible and low risk of hepatic steatosis development. In a group with high risk of hepatic steatosis (HSI>36, n=13; FLI≥60, n=18) patients were older, with longer diabetes duration, lower glomerular filtration rate, with more long-term diabetes complications and metabolic syndrome than in a group with low risk. glycated hemoglobin in groups were similar. FLI and HSI markers correlate with each other, duration of diabetes, glomerular filtration rate; FLI correlate with number of complications. The Conclusion. Results of this study confirm the applicability of FLI in diagnosis of liver steatosis in type 1 diabetes patients. There were detected 11% patients with high risk of developing liver steatosis based on FLI and HSI markers. Patients with high FLI more often developed long-term diabetes complications independently of glycated hemoglobin that indicates on possible hepatic steatosis role in type 1 diabetes mellitus pathogenesis.
Introduction. There are some data showing hepatic steatosis association with long-term diabetes complications. In order to facilitate hepatic steatosis diagnosis, specific markers have been developed, which are based on biochemistry parameters in blood. Aim. The aims of the work were to verify hepatic steatosis markers efficiency for hepatic steatosis diagnosis (via validation with magnetic resonance imaging) and to analyse association of hepatic steatosis markers with diabetes long-term complications, metabolic syndrome, glycated hemoglobin. Materials and methods. For hepatic steatosis markers (FLI, HSI) validation we used liver magnetic resonance imaging to 19 patients. Hepatic steatosis markers were calculated by HSI and FLI formulas. There were analysed 176 patients with type 1 diabetes mellitus of “LatDiane: Latvian diabetic nephropathy study”. Patients with high alcohol consumption and duration of diabetes less than five years were excluded. The Results. Microscopic fat content in the liver detected by MRI correlates with FLI (p<0,01) and HSI (p<0,05), albuminuria (p<0,05). In a group with high risk of hepatic steatosis development based on FLI, microscopic fat content was higher than in group with low risk of hepatic steatosis (13% versus 1%) (p=0,042). FLI marker could detect hepatic steatosis with a efficiency 81% (p=0,007) and HSI marker with a efficiency 69% (p=0,052). Patients were divided into groups: high, possible and low risk of hepatic steatosis development. In a group with high risk of hepatic steatosis (HSI>36, n=13; FLI≥60, n=18) patients were older, with longer diabetes duration, lower glomerular filtration rate, with more long-term diabetes complications and metabolic syndrome than in a group with low risk. glycated hemoglobin in groups were similar. FLI and HSI markers correlate with each other, duration of diabetes, glomerular filtration rate; FLI correlate with number of complications. The Conclusion. Results of this study confirm the applicability of FLI in diagnosis of liver steatosis in type 1 diabetes patients. There were detected 11% patients with high risk of developing liver steatosis based on FLI and HSI markers. Patients with high FLI more often developed long-term diabetes complications independently of glycated hemoglobin that indicates on possible hepatic steatosis role in type 1 diabetes mellitus pathogenesis.
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Keywords
Medicīna , 1. tipa cukura diabēts , aknu steatoze , nealkohola taukainā aknu slimība , taukaino aknu indekss , aknu steatozes indekss