Non-alkolik steatohepatite bağlı sirozda komplikasyonların ve mortalitenin değerlendirilmesi

Yıl 2019, Cilt: 32 Sayı: 1, 44 - 49, 29.01.2019

Sezgin Vatansever Zehra Betül Paköz

https://doi.org/10.5472/marumj.476330

Öz

Amaç: Non-alkolik yağlı karaciğer hastalığı (NAYKH) saptanan

hastaların %4-8’inde siroz ve %1-5’inde hepatoselüler karsinom

(HCC) nedeni ile ölüm görülmektedir. Bu çalışmada amaç, nonalkolik

steatohepatit (NASH)’e sekonder siroz gelişen hastalarda,

siroza ait komplikasyonlar ve mortalite ile ilişkili faktörlerin

belirlenmesidir.

Gereçler ve Yöntemler: Çalışmaya, 2008-2018 yılları

arasında kliniğimizde NASH’e bağlı siroz tanısı alan hastalar

alındı. Diyabeti, obezitesi ya da insülin direnci olan ve diğer siroz

nedenleri dışlanan hastalar NASH’e bağlı siroz olarak kabul edildi.

Hastalar prospektif olarak kayıt altına alınıp takip edildi, analizler

retrospektif olarak yapıldı.

Bulgular: Çalışmaya toplam 185 hasta dahil edildi. Sağkalım

1. yılda %94,6 ve 5. yılda %57,0 bulundu. Median sağkalım 5,83

yıl saptandı. HCC’un ortaya çıkması 1. yılda %0,7 ve 5. yılda

%9,7 bulundu. Çok değişkenli Cox analizinde yaş (OR 1,12, 95%

CI 1,04-1,21; P=0.003), kreatinin (OR 24,4, %95 CI 2,32-257,8;

P=0.008) ve ensefalopati (OR 24,49, %95 CI 1.06-19.6; p=0.042)

bağımsız prediktörler olarak saptandı. Hastalarda 5. yılda assit

gelişimi %46,9, varis kanaması gelişimi %21,9 ve ensefalopati

gelişimi %18 saptandı.

Sonuç: Non-alkolik steatohepatite sekonder siroz gelişen

hastalar HCC, varis kanaması, assit ve ensefalopati gelişimi

açısından dikkatli takip edilmelidir.

Anahtar Kelimeler

Non-alkolik steatohepatit, Siroz, Mortalite

The evaluation of complications and mortality in non-alcoholic steatohepatitis-related cirrhosis

Öz

Objectives: Cirrhosis is seen in 4-8% of patients with nonalcoholic

fatty liver disease (NAFLD), and death occurs in 1-5%

of them due to hepatocellular carcinoma (HCC). The aim of this

study was to determine the factors associated with complications

and mortality in patients with cirrhosis secondary to non-alcoholic

steatohepatitis (NASH).

Materials and Methods: The patients with cirrhosis due to

NASH diagnosed between 2008 and 2018 in our clinic formed

the study population. Patients with diabetes, obesity, or insulin

resistance and those with cirrhosis due to other causes were

excluded. The patients were enrolled and followed up prospectively.

Results: A total of 185 patients were included in the study.

The survival was 94.6% at the 1st year and 57.0% at the 5th year.

Median survival duration was 5.83 years. The rate of HCC

development was 0.7% at the 1st year and 9.7% at the 5th year. In

the multivariate Cox analysis, age (OR: 1.12, 95% CI: 1.04-1.21;

P = 0.003), creatinine (OR: 24.4, 95% CI: 2.32-257.8; P= 0.008)

and encephalopathy (OR: 24.49, 95% CI: 1.06-19.6; p = 0.042)

were found as independent predictors of mortality. Development

of ascites occurred in 46.9%, variceal bleeding in 21.9% and

encephalopathy in 18% of patients at the 5th year.

Conclusion: Patients with NASH-related cirrhosis should

be carefully monitored for HCC development, variceal bleeding,

ascites, and encephalopathy.

Anahtar Kelimeler

Non-alcoholic steatohepatitis, Cirrhosis, Mortality

Kaynakça

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