| Abstract | Jetra je središnji organ u izmjeni tvari u organizmu. Klinička slika jetrenih bolesti je često nespecifična pa se jetrena steatoza u većini slučajeva otkrije prilikom obavljanja pretraga nevezanih uz samu steatozu. Jetrena steatoza obuhvaća širok spektar stanja karakteriziranih akumulacijom triglicerida u citoplazmi hepatocita. Dva stanja koja uobičajeno povezujemo s masnom jetrom su alkoholna bolest jetre (ALD) i nealkoholna masna bolest jetre (NAFLD). Nealkoholna masna bolest jetre je najčešći uzrok kronične bolesti jetre u općoj populaciji. S obzirom na mogućnost napredovanja prema nealkoholnom steatohepatitisu, fibrozi, kriptogenoj cirozi, hepatocelularnom karcinomu te s obzirom na povećan rizik kardiovaskularnih incidenata meĎu pacijentima kod kojih je utvrĎena NAFLD kao imperativ se nameće pravovremena i pouzdana dijagnostika masne jetre. Ciljevi našeg istraţivanja bili su (1) utvrditi prevalenciju masne jetre u ambulantnih bolesnika koji dolaze na ultrazvučni pregled abdomena što bi bio pokazatelj zastupljenosti masne jetre u općoj populaciji geografske regije za čiju zdravstvenu skrb brine KB Dubrava kao tercijarna ustanova; (2) utvrditi stupanj steatoze kod bolesnika s masnom jetrom i (3) utvrditi odnos indeksa tjelesne mase sa teţinom (stupnjem) jetrene steatoze. Analizom je obuhvaćeno ukupno 631 pacijenta, od čega 269/631 muškarca (42,63%) i 362/631 ţena (57,37%), prosječne starosti 58 ±14,5 godina. Prosječna dob, tjelesna teţina, visina i indeks tjelesne teţine (BMI) bile su redom za muškarce: 57,7±14,8 godina; 87,2±14,5 kg; 175,7±7,4 cm; 28,2±4,1 kg/m2 , a za ţene: 58,3±14,3 godina; 73,1±13,7 kg; 168,6±9,1 cm; 27,4±4,9 kg/m2 . Ultrazvukom odreĎena prevalencija masne jetre iznosila je 48,5%, a utvrĎeni stupanj steatoze značajno je korelirao s indeksom tjelesne mase. Masna jetra naĎena je u 76,84% pretilih osoba, 74,29% bolesnika s dijabetesom, 63,51% bolesnika s dislipidemijom i 63,64% bolesnika s arterijskom hipertenzijom, te su ovo rizične skupine za razvoj steatoze. Masna jetra utvrĎena je u 22,86% bolesnika koji nisu imali niti jednu komponentu metaboličkog sindroma, 42,86% bolesnika s 1-2 komponente i 80,85% bolesnika s 3-4 komponente iz čega je razvidno da se rizik razvoja masne jetre povećava s porastom broja komponenti metaboličkog sindroma koje su zastupljene u pojedinog bolesnika. Prevalencija masne jetre veća je u bolesnika iznad 40. godine ţivota. Nije uočena značajna razlika u zastupljenosti masne jetre izmeĎu muškaraca i ţena. Moţe se zaključiti da je ultrazvuk jednostavna, neinvaziva i korisna metoda za utvrĎivanje masne jetre, te procjenu stupnja steatoze koji pokazuje dobru korelaciju s indeksom tjelesne mase. |
| Abstract (english) | The liver plays a central role in metabolic homeostasis as well as removing toxins. Liver disease is either asymptomatic or the symptoms are limited. In most cases, liver steatosis is detected during medical screening unrelated to the steatosis. Liver steatosis includes a wide spectrum of conditions characterized by triglyceride accumulation in the cytoplasm of hepatocytes. Two conditions usually linked to steatosis are alcoholic liver disease (ALD) and non-alcoholic liver diesease (NAFLD). NAFLD is the common cause of chronic liver disease in the general population. With respect to its potential for progression towards non-alcoholic steatohepatitis, fibrosis, cryptogenic cirrhosis, hepatocellular carcinoma and higher risks of cardiovascular incidents among patients with NAFLD, detection in a timely manner and reliable diagnosis is imperative. The main goals of our research were (1) to assess the prevalence of liver steatosis in our group of subclinical patients who were submitted to ultrasound examination (an indicator of liver steatosis prevalence in the general population of the region monitored by KB Dubrava, a tertiary health institution); (2) to determine the degree of steatosis among patients with fatty liver and (3) to determine the relationship between the patients' body mass index and the degree of steatosis. The analysis included 631 patients. 269 of 631 were men (42,63%) and 362 of 631 women (57,31%), the average age of the patients was: 58±14,5 years. The average age, height, weight and body mass index (BMI) for men were: 57,7±14,8 years; 87,2±14,5 kg; 175,7±7,4 cm; 28,2±4,1 kg/m2, for women: 58,3±14,3 years; 73,1±13,7 kg; 168,6±9,1 cm; 27,4±4,9 kg/m2 . The ultrasound screening revealed that the prevalence of liver steatosis was 48,5%, and degree of steatosis found significantly correlated with body mass index. Fatty liver was found among 76,84% of overweight patients; 74,29% patients with diabetes mellitus type II; 63,51% patients with dyslipidemia and among 63,64% patients with hypertension. These groups are considered to be at high risk of developing steatosis. Fatty liver was detected in 22,86% patients without any component of metabolic syndrome, among 42,86% patients with 1-2 components of metabolic syndrome and among 80,85% patients with 3-4 components. This shows there is a clear correlation between the risk of steatosis development and the number of metabolic syndrome components occurring in patients' anamnesis. The prevalence of liver steatosis is higher among patients over the age of 40. No significant differences in the prevalence of liver steatosis were found with respect to gender. We can conclude that the ultrasound is a useful, common, and non-invasive method for the detection of fatty liver disease and for the estimation of the degree of steatosis, showing a substantial correlation with body mass index. |
