| Abstract | Prekomjerna tjelesna težina, šećerna bolest, dislipidemija i arterijska hipertenzija česte su komplikacije nakon transplantacije jetre (TJ). Porijeklo ovih promjena najčešće je multifaktorijalno, a njihova međusobna interakcija doprinosi razvoju postransplantacijskog metaboličkog sindroma (PTMS), koji povisujući kardiovaskularni rizik može značajno utjecati na dugoročni morbiditet i mortalitet transplantiranih bolesnika. Cilj ovog rada bio je odrediti prevalenciju i karakteristike metaboličkog sindroma u bolesnika nakon transplantacije jetre i istražiti njegove komponente tijekom i nakon prve godine od transplantacije. Metabolički sindrom u studiji definiran je temeljem modificiranih NCEP (National Cholesterol Education Program Adult Treatment Panel III) kriterija. U istraživanju analizirano je 98 odraslih bolesnika (prosječne starosti 55,8±9,3 god, 75,5% muškaraca) u sklopu redovitih postTJ kontrola s medijanom praćenja od 20 mjeseci (raspon 1-180). Povećani opseg struka bio je prisutan kod 66,7%, hipertrigliceridemija kod 29,6%, smanjen HDL kolesterol kod 32,7%, arterijska hipertenzija kod 78,6%, hiperglikemija kod 68,4% bolesnika, dok je 70,4% primalo antihipertenzivnu odnosno 29,6% specifičnu dijabetološku terapiju. Prevalencija PTMS u analiziranoj skupini iznosila je 65,3%. Bolesnici s PTMS su bili prosječno stariji (p=0,02), imali veći opseg struka (p <0,001), više vrijednosti triglicerida (p<0,001), niži HDL (p<0,001), viši sistolički tlak (p=0,047), koriste više antihiperteziva (p=0,01) i hipolipemika (p=0,048), ali se nisu razlikovali s obzirom na spol, osnovu bolest jetre (alkohol, virusi) tip imunosupresivne terapije, vrijednosti glikemije, primjenu dijabetološke terapije i dijastoličkog tlaka (n=ns) u odnosu na transplantiranu skupinu bez PTMS. Bolesnici transplantirani unutar godinu dana imali su statistički značajno niže vrijednosti dijastoličkog tlaka (p=0,03) i vrijednosti HDL kolesterola (p=0,03) te koristili manje hipolipemika (p=0,03) u odnosu na ranije transplantirane bolesnike. Visoka prevalencija metaboličkih komplikacija nakon TJ ukazuje na postojanje dodatnih faktora rizika u odnosu na opću populaciju, te upućuje na potrebu aktivnijeg istraživanja kao i pristupa preveneciji i liječenju PTMS i njezinih komponenata s ciljem smanjenja morbiditeta i mortaliteta transplantiranih bolesnika |
| Abstract (english) | Obesity, diabetes, dislipidemia, and arterial hypertension are frequently observed after LT. The origin of these conditions is mostly multifactorial and their interaction leed to the developement of , a posttransplantation metabolic syndrome (PTMS). PTMS increases the risk of cardiovascular events which are the leading causes of morbidity and mortality in longterm transplant recipients.
The aim of this study was to define the prevalence and characteristics of metabolic syndrome in patients after LT and to investigate its components within and after first year of LT. Metabolic syndrome was defined according to the guidelines of the National Cholesterol Education Progam Adult Treatment Panel III (NCEP- ATP III). 98 adult patients after LT (mean age 55,8±9,3 years, 75,5% male) were analysed, with themedian follow up of 20 months (range 1-180). An enlarged waist circumference, hypertriglyceridemia, low HDL cholesterol, high blood pressure and hyperglicerimia were present in 66.7%, 29.6%, 32.7%, 78.6% and 68.4% of cases, respectively. 70.4% patients of patients in the sudy were taking antihypertensive and 29.6% antidiabetic therapy. The prevalence of PTMS was 65.3%. Patients with PTMS were older (p=0,02), had greater waist circumference (p<0,001), higher triglycerides (p<0,001), lower HDL (p<0,001), higher systolic blood pressure (p=0,047), used more antihypertensive (p=0,01) and hypolipemic (p=0,048) drugs. There were no differences among groups in gender, etiology of liver disease (alcohol, HCV, HBV etc.), type of immunosuppressive drugs, antidiabetc therapy and diastolic blood pressure. The patients transplanted within one year had significantly lower diastolic blood pressure (p=0.03), lower HDL (p=0,03) and used less hypolipemic drugs (p=0,03).
A higher prevalence of metabolic complications after LT, compared to the general population is indicative of additional risk factors within this population. Therefore, the need of active research and approach of prevention and treatment of PTMS is necessary, with the aim of decreasing morbidity and mortality of patients after LT. |
