Kilolu ve obez kadınlarda insülin direnci, karaciğer yağlanması, visfatin düzeyi arasındaki ilişkinin değerlendirilmesi
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Date
2012
Authors
Özışık, Seçil
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Publisher
Uludağ Üniversitesi
Abstract
Obezite, vücutta normalden fazla yağ birikmesi ile karakterize olan, genetik ve çevresel faktörlerin etkileşimi sonucu ortaya çıkan kronik bir hastalıktır. Epidemiyolojik çalışmalar, obezitenin ortak özelliği insülin direnci olan pek çok metabolik bozukluk için bir risk faktörü olduğunu ortaya koymuştur. Bu metabolik bozukluklardan biri de non alkolik yağlı karaciğer hastalığı olup, obezitenin artması ile prevalansında dramatik bir artış olmuştur. Ayrıca obezitenin immün sistemde düşük dereceli kronik bir inflamasyona neden olduğu da gösterilmiştir. Adipoz dokuda, artan obezite ile orantılı olarak makrofaj sayısı ve salgılanan proinflamatuvar sitokin miktarı artmaktadır. C-reaktif protein (CRP) bu sitokinlerden biri olup sistemik inflamasyona cevap olarak karaciğerden salgılanmaktadır. Adipoz dokunun kendisi de obeziteye bağlı CRP oluşturabilmektedir. Başlıca enerji deposu olarak bilinmesinin yanında, son yıllarda yapılan çalışmalar adipoz dokunun adipokin adı verilen çeşitli önemli proteinleri salgılayan metabolik olarak aktif bir doku olduğunu göstermiştir. Bu adipokinlerden biri olan visfatin ile insülin direnci, inflamasyon ve non alkolik yağlı karaciğer hastalığı arasındaki ilişkiyi araştıran çalışmalar çelişkili sonuçlar vermiş, bazı araştırmacılar ilişki bulurken, bazıları bulamamıştır. Biz bu çalışmamızda kilolu ve obez kadınlarda insülin direnci, karaciğer yağlanması ve visfatin düzeyi arasındaki ilişkiyi değerlendirmeyi amaçladık.Çalışmaya beden kitle indeksi (BKİ) 25 kg/m2 ve üzerinde olan non-diyabetik 67 kadın hasta dâhil edilmiştir. Olgular BKİ'lerine göre üç gruba ayrılmışlardır. Hastaların antropometrik ve kan basıncı ölçümleri kaydedilmiştir. Biyokimyasal değerleri ve karaciğer ultrasonografi sonuçları dosyalarından elde edilmiştir. Visfatin analizi hastaların plazmalarından `Human Visfatin ELISA Kit' kullanılarak yapılmıştır. Elde edilen verilerin gruplar ile ilişkileri ve kendi aralarındaki korelasyon incelenmiştir.Çalışmamızda obezite derecesi arttıkça boyun, bel, kalça çevresinde ve kan basıncı ölçümlerinde artış olduğunu gördük. Gruplar arasında bel-kalça oranlarında istatistiksel olarak anlamlı fark yoktu. Obez gruplarda kilolu gruba göre insülin ve HOMA-IR değerleri anlamlı derecede yüksekti. BKİ ile CRP düzeyleri arasında korelasyon vardı. Fakat CRP ile HOMA-IR arasında ilişki bulunmadı. Gruplar arasında visfatin düzeyleri arasında anlamlı fark yoktu. Visfatin, obezite ve insülin direnci ile ilişkili bulunmadı. Ancak karaciğer yağlanması olan grupta visfatin düzeyleri belirgin şekilde düşüktü.Sonuç olarak, bulgularımız bize visfatin ile non alkolik yağlı karaciğer hastalığı arasında obeziteden bağımsız bir ilişki olabileceğini düşündürmüştür. Visfatin ile obezite, insülin direnci, CRP ve karaciğer yağlanması arasındaki ilişkiyi değerlendirmek ve daha kesin olarak ortaya koymak için daha geniş hasta popülasyonunun dahil edildiği çalışmalara ihtiyaç vardır.
Obesity is a chronic disease that develops from the interaction between genotype and environmental factors, and is characterized as accumulation of fat more than normal in the body. Epidemiological studies revealed that obesity is a risk factor for many metabolic disturbances associated with insulin resistance. One of these metabolic disturbances is non alcoholic liver disease and there is a dramatic rise in its prevalence with the increase in obesity. Also it was shown that obesity causes a low degree of chronic inflammation in the immune system. In the adipose tissue there is a proportional increase in the amount of macrophage number and secreted proinflammatory cytokines, with the degree of obesity. C-reactive protein (CRP) is one of those cytokines which is released from the liver as a response to systemic inflammation. Besides being known as a major energy reservoir, studies in recent years showed that adipose tissue is a bioactive organ which can secrete a variety of proteins, known as adipokines. The studies investigating the relation between one of these adipokines namely visfatin and insulin resistance, inflammation and non alcoholic fatty liver disease gave conflicting results, some authors found relation, others could not. In our study, we aimed to examine the relationship between, insulin resistance, fatty liver and visfatin in overweight and obese female subjects. Sixty seven non-diabetic female subjects, having a body mass index (BMI) of 25 kg/m2 and over were included. Subjects were divided in three groups according to their BMI. The anthropometric and blood pressure measurements were recorded. Their biochemical values and liver ultrasonography results were provided from the file records. Visfatin analyses were studied from their plasma with the ‘Human Visfatin ELISA Kit’. The relationship between the data and groups, and the correlation with each other were examined. In our study we demonstrated that there was an increase in neck, waist, hip circumferences and blood pressure measurements with the increase in the degree of obesity (p<0.05). There was no difference in waist to hip ratio between groups. Insulin and HOMA-IR levels were significantly higher in obese groups compared to overweight group. There was a correlation between CRP and BMI levels but not with insulin resistance. There was no difference in visfatin levels between groups. Also visfatin was not found to be associated with obesity and insulin resistance. However, in fatty liver group visfatin levels were significantly lower (p=0.05). In conclusion, our findings suggest us that there may be an association between visfatin and non alcoholic fatty liver disease independent of obesity. So, studies that include larger patient populations are needed for the evaluation and clarification of the association between visfatin and obesity, insulin resistance, CRP and fatty liver.
Obesity is a chronic disease that develops from the interaction between genotype and environmental factors, and is characterized as accumulation of fat more than normal in the body. Epidemiological studies revealed that obesity is a risk factor for many metabolic disturbances associated with insulin resistance. One of these metabolic disturbances is non alcoholic liver disease and there is a dramatic rise in its prevalence with the increase in obesity. Also it was shown that obesity causes a low degree of chronic inflammation in the immune system. In the adipose tissue there is a proportional increase in the amount of macrophage number and secreted proinflammatory cytokines, with the degree of obesity. C-reactive protein (CRP) is one of those cytokines which is released from the liver as a response to systemic inflammation. Besides being known as a major energy reservoir, studies in recent years showed that adipose tissue is a bioactive organ which can secrete a variety of proteins, known as adipokines. The studies investigating the relation between one of these adipokines namely visfatin and insulin resistance, inflammation and non alcoholic fatty liver disease gave conflicting results, some authors found relation, others could not. In our study, we aimed to examine the relationship between, insulin resistance, fatty liver and visfatin in overweight and obese female subjects. Sixty seven non-diabetic female subjects, having a body mass index (BMI) of 25 kg/m2 and over were included. Subjects were divided in three groups according to their BMI. The anthropometric and blood pressure measurements were recorded. Their biochemical values and liver ultrasonography results were provided from the file records. Visfatin analyses were studied from their plasma with the ‘Human Visfatin ELISA Kit’. The relationship between the data and groups, and the correlation with each other were examined. In our study we demonstrated that there was an increase in neck, waist, hip circumferences and blood pressure measurements with the increase in the degree of obesity (p<0.05). There was no difference in waist to hip ratio between groups. Insulin and HOMA-IR levels were significantly higher in obese groups compared to overweight group. There was a correlation between CRP and BMI levels but not with insulin resistance. There was no difference in visfatin levels between groups. Also visfatin was not found to be associated with obesity and insulin resistance. However, in fatty liver group visfatin levels were significantly lower (p=0.05). In conclusion, our findings suggest us that there may be an association between visfatin and non alcoholic fatty liver disease independent of obesity. So, studies that include larger patient populations are needed for the evaluation and clarification of the association between visfatin and obesity, insulin resistance, CRP and fatty liver.
Description
Keywords
Visfatin, Obezite, İnsülin direnci, Yağlı karaciğer, Obesity, Insulin resistance, Fatty liver
Citation
Özışık, S. (2012). Kilolu ve obez kadınlarda insülin direnci, karaciğer yağlanması, visfatin düzeyi arasındaki ilişkinin değerlendirilmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.