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2013, vol. 19, br. 1-2, str. 9-18
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Aktivnosti enzima jetre kod dijabetičara tip 2 i nedijabetičara sa steatozom jetre, u odnosu na prisustvo metaboličkog sindroma
Activity of liver enzymes in diabetics type 2 and non-diabetics with hepatic steatosis, related to presence of metabolic syndrome
Sažetak
Uvod. Metabolički sindrom (MS) predstavlja istovremeno postojanje više metaboličkih poremećaja, a dominantan među njima je insulinska rezistencija. Nalaz nealkoholne masne jetre je često udružen sa komponentama MS i generalno se smatra manifestacijom metaboličkog sindroma. Cilj rada je bio da se ispita povezanost metaboličkog sindroma i steatoze jetre (dijagnostikovane ultrasonografski), kod pacijenata sa dijabetesom tip 2 i nedijabetičara; da se ispita povezanost vrednosti transaminaza (AST i ALT) i ultrasonografskog nalaza steatoze jetre u odnosu na prisustvo metaboličkog sindroma; da se utvrdi odnos ALT / AST kod pacijenata sa MS i nalazom steatoze jetre. Metod. U studiju su uključena 82 pacijenta sa ultrazvučnim nalazom masne jetre, sa dijabetesom (n=40) i bez dijabetesa (n=42); u odnosu na prisustvo metaboličkog sindroma, podeljeni su u četiri grupe: Grupa 1, n=21 oboleli od dijabetesa tip 2 sa MS; Grupa 2, n=19 - oboleli od tip 2 dijabetesa bez MS; Grupa 3, n=19 nedijabetičari sa MS; Grupa 4, n=23 nedijabetičari bez MS. Kod svih pacijenata su izvršena antropometrijska merenja (OS obim struka, BMI Body Mass Index); utvrđeni nivoi ukupnog holesterola, LDL-holesterola, HDL-holesterola, triglicerida, glikemije, ALT-a, AST-a u krvi, zatim merenje arterijskog pritiska i ultrasonografski pregled abdomena. Na osnovu kriterijuma za metabolički sindrom (IDF International Diabetes Federation 2005), izvršeno je uzorkovanje po grupama. Rezultati. Srednja vrednost godina života ispitanika je bila 58,89±9,044, bez statistički značajne razlike (p>0,05). U grupama sa DM, srednje vrednosti ukupnog holesterola, LDL-holesterola, triglicerida, značajno su veće uz prisustvo MS. U grupama bez dijabetesa, prosečne vrednosti glikemije, ukupnog holesterola, HDL-holesterola, LDL-holesterola su približno iste. Vrednosti triglicerida su veće u grupi nDM sa MS, sa značajnom razlikom (p=0,000). Veće prosečne vrednosti AST i ALT su zabeležene u grupama sa MS; AST / ALT odnos je veći kod pacijenata kod kojih je verifikovan dijabetes; ALT / AST je veći od 1 u grupama bez DM. Zaključak. Kod osoba sa metaboličkim sindromom, čest je ultrazvučni nalaz steatoze jetre, koja je često praćena povećanjem enzima jetre, ali u odnosu na prisustvo DM tip 2 i/ili MS, vrednosti ALT nisu značajno različite. Zavisno od zastupljenosti komponenti MS, osobe koje imaju MS i/ili masnu jetru, u riziku su da obole od dijabetesa, što zahteva preventivni pristup. Tretman treba da se usmeri na smanjenje taloženja masti u jetri, smanjenju insulinske rezistencije terapijom insulinskim senzibilizatorima i suzbijanju posledičnih faktora rizika.
Abstract
Introduction: Metabolic syndrome (MS) is a combination of metabolic dis- orders, with insulin resistance as the most prominent disorder. Non-alcoholic fatty liver often coincides with MS, and generally is considered as a manifestation of MS. Objective: The aim of work was to asses relations between metabolic syndrome and hepatic steatosis (ultrasonographically confirmed) in patients with type 2 diabetes and non diabetics; relation between MS and aminotranspherase (AST and ALT) levels and ultrasound assessment of fatty liver; and ALT/AST ratio in patients with MS and fatty liver. Method: Study comprised 82 patients with evidence of fatty liver on ultra- sonography, 40 of them had diabetes mellitus type 2, and 42 were non-diabetic. Depending on MS, patient belonged to one of 4 groups. group 1, n=21- diabetes mellitus type 2 with MS group 2, n=19 - diabetes mellitus type 2 without MS group 3, n=19 - non-diabetics with MS group 4, n=23 - non-diabetics, without MS Each patient underwent anthropometric measurements (waist circumference, BMI); blood levels of total cholesterol, LDL, HDL, triglycerides, glycemia, ALT, AST; blood pressure measurement, and abdominal ultrasound. Sampling to the groups was performed according to metabolic syndrome criteria (IDF 2005) Results: Mean age of patients was 58.89±9.04, without significant difference (p>0.05). In diabetic groups, median levels of total cholesterol, LDL and triglycerides were significantly higher in patients with MS. Levels of total cholesterol, HDL and LDL were approximately the same in non-diabetic groups, but triglyceride levels were significantly higher in group with MS (p=0.000). Higher median levels of AST and ALT were recorded in groups with MS. AST/ALT ratio was higher in patients with verified diabetes mellitus. ALT/AST ratio in non- diabetic patients was higher than 1. Conclusion: Fatty liver is common finding in patients with metabolic syndrome, often with increase of liver enzymes, but ALT levels are not significantly different in relation to diabetes type 2 and/or MS. Persons with MS and/or fatty liver are at higher risk of diabetes mellitus and require preventive approach. Treatment should be focused on decrease of fatty deposits in liver, decrease of insulin resistance (insulin sensitizing agents medication) and suppression of consequent risk factors.
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