Jetrene komplikacije šećerne bolesti tipa 1

doctoral thesis

• Title (english): Hepatic complications in type 1 diabetes mellitus
• Author: Marina Natalija Aničić
• Mentor: Jurica Vuković (mentor)
• Committee member: Rajko Ostojić (predsjednik povjerenstva)
• Committee member: Sanja Kolaček (član povjerenstva)
• Committee member: Miroslav Dumić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2021-04-20, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine
• Universal decimal classification (UDC): 616 - Pathology. Clinical medicine

Abstract

U loše reguliranih bolesnika sa šećernom bolesti tipa 1 (ŠB1) sporadično je primijećena pojava
jetrenih komplikacija od kojih se izdvajaju dva entiteta: glikogenska hepatopatija (GH) i
nealkoholna steatoza jetre (NAFLD)/steatohepatitis (NASH).
Cilj istraživanja bio je utvrditi prevalenciju jetrenih komplikacija u djece i adolescenata sa ŠB1,
otkriti o kojim se komplikacijama radi te vidjeti postoji li poveznica s kroničnim komplikacijama
ili pridruženim autoimunim bolestima. Također jedan od ciljeva bio je pokušati utvrditi mogu li se
GH i NAFLD razlikovati neinvazivnom metodom poput MR-a.
Pacijentima koji boluju od ŠB1 duže od godinu dana učinili smo laboratorijski i ultrazvučni probir
na prisustvo jetrene bolesti. Onima s detektiranim promjenama učinili smo daljnju laboratorijsku
obradu radi isključivanja drugih potencijalnih uzroka jetrene lezije. Izabranim pacijentima učinili
smo MR jetre i biopsiju. Utvrdili smo značajno veću prevalenciju povišenih transaminaza te
patoloških ultrazvučnih nalaza od dosad opisanog u literaturi: 9,7% imalo je klinički utvrđenu
hepatomegaliju, 18,8% povišene transaminaze, 21,7% ultrazvučno povećanu jetru te 27,3%
promijenjenu ehogenost. MR jetre pokazao je dobru korelaciju s histološkim nalazom te bi mogao
poslužiti kao neinvazivna metoda za razlikovanje nakupljanja masti od nakupljanja glikogena.
Prema histološkim nalazima 8 pacijenata imalo je GH, a samo jedan NAFLD što pokazuje da je
GH daleko najučestalija jetrena bolest u pacijenata sa ŠB1. Nismo utvrdili povezanost jetrenih
komplikacija s kroničnim komplikacijama niti pridruženim autoimunim bolestima. Zaključno
jetrene komplikacije u pacijenata sa ŠB1 su daleko češće nego se mislilo. Moramo ih aktivno tražiti
združenim laboratorijskim i ultrazvučnim probirom te tijekom dugoročnog praćenja utvrditi njihov
značaj u cjelini.

Abstract (english)

In poorly regulated patients with type 1 diabetes mellitus (DM1), hepatic complications were
sporadically observed and two entities were most commonly found: glycogen hepatopathy (GH)
and non-alcoholic fatty liver disease (NAFLD) / steatohepatitis (NASH).
The aim of the study was to determine the prevalence of hepatic complications in children and
adolescents with DM1 and detect them, and to investigate if there is a correlation with chronic
complications or associated autoimmune diseases. Also, one of the goals was to determine if GH
and NAFLD could be differentiated non-invasively with MRI.
We performed laboratory and ultrasound screening for the presence of liver disease in patients
suffering from DM1 for more than a year. In those with detected changes, we performed further
laboratory testing to rule out other potential liver disease. We performed liver MRI and biopsy in
selected patients. We found a significantly higher prevalence of elevated transaminases and
pathological ultrasound findings than previously described in the literature: 9.7% had clinically
established hepatomegaly, 18.8% elevated transaminases, 21.7% ultrasound-enlarged liver and
27.3% changes in echogenicity. Liver MRI showed a good correlation with pathohistological
findings and could be used as a non-invasive method to distinguish fat from glycogen
accumulation. According to histological findings, 8 patients had GH, and only one NAFLD, which
confirms that GH is by far the most common liver disease in patients with DM1. We did not
establish correlation of hepatic complications with chronic complications or associated
autoimmune diseases. In conclusion, hepatic complications in patients with DM1 are more common than previously thought. We must actively search for them by combined laboratory and
ultrasound screening and try to determine their significance during long-term monitoring.

• Keywords: šećerna bolest tipa 1; jetrene komplikacije; djeca i adolescenti; autoimune bolesti
• Keywords (english): type 1 diabetes; liver complications; children and adolescents; autoimmune diseases
• Language: croatian
• URN:NBN: urn:nbn:hr:105:481044
• Study programme: Title: Biomedicine and Health Sciences; Study programme type: university; Study level: postgraduate; Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstvo (doktor/doktorica znanosti, područje biomedicine i zdravstvo)
• Type of resource: Text
• Extent: 91 str.
• File origin: Born digital
• Access conditions: Open access
• Created on: 2021-06-24 10:59:07