Öz
Amaç
Yağlı karaciğer, obezite ve metabolik hastalıklarda safra kesesi taşı görülme riski artmıştır. Hiperinsülinemik-glisemik klemp yöntemi insülin direnci (IR) için “altın standart” bir yöntem olarak kabul edilmektedir, ancak zor ve maliyetlidir. Alternatif bir yöntem olarak daha hızlı ve daha düşük maliyetli biyokimyasal ölçüm olan trigliseride-glukoz (TyG) indeksi, metabolik bozukluklarla ilişkili olan safra kesesi taşı hastalığı tanısında yararlı olabilir. Bu çalışmanın amacı safra kesesi taşı tanısında TyG indeksinin etkinliğini değerlendirmektir.
Yöntemler
Çalışmada, safra kesesi taşı ile takip ve/veya kolesistektomi yapılan 18-75 yaş aralığında olan 1484 olgularda TyG indeksi araştırıldı. Hastaların serum açlık kan glukoz ve trigliserid düzeyleri hastanemiz biyokimya laboratuvarında ölçüldü. Tüm hastaların safra yolları ve safra taşları hastanemiz radyoloji kliniğinde radyologlar tarafından kullanılan Philips Affiniti 50 (The Philips Affiniti 50 Ultrasound; Philips North America Corporation 3000 Minuteman Road M/S 109 Andover, MA 01810, USA) ultrasonografi cihazı ile değerlendirildi. Elde dilen veriler SPSS’de değerlendirildi, p<0,05 anlamlı kabul edildi.
Bulgular
Araştırmaya toplam 1484 (980 kadın ve 504 erkek) hasta alındı. Çalışmamızdaki biyokimyasal parametrelerden açlık safra kesinde taş saptanan olgularda plazma glukoz 124,6±24,5 mg/dL, trigliserid 198,3±36,8 mg/dL, insülin 16,5±5,6 uIU/mL, IR'nin Homeostatik Modeli Değerlendirmesi 4,8±1,2 seviyesi kontrol grubuna göre hepsi istatistiksel olarak anlamlı yüksekti (p=0,001). Bazal TyG indeksi, primer sonlanım noktası safra kesesi taşı insidansı ile önemli ölçüde ilişkili olduğu saptandı. Tek değişkenli analizde, sürekli bir değişken olarak TyG indeksi, risk oranı 1,65 (%95 güven aralığı 1,15-1,98; p<0,001) ile ilişkilendirildi.
Sonuç
Yüksek TyG skorları safra taşı hastalığıyla ilişkilendirilmiştir ve safra taşı hastalığı olan kişileri taramak için tanımlayıcı bir belirteç ve terapötik önlemler için bir gösterge olarak kullanılabilir.
Anahtar Kelimeler: Trigliserid-glukoz indeksi, metabolik hastalıklar, safra taşı
Kaynakça
Acalovschi M. Gallstones in patients with liver cirrhosis: incidence, etiology, clinical and therapeutical aspects. World J Gastroenterol. 2014;20:7277-85.
Saunders KD, Cates JA, Roslyn JJ. Pathogenesis of gallstones. Surg Clin North Am. 1990;70:1197-216.
Abraham S, Rivero HG, Erlikh IV, Griffith LF, Kondamudi VK. Surgical and nonsurgical management of gallstones. Am Fam Physician. 2014;89:795-802.
Fracanzani AL, Valenti L, Russello M, Miele L, Bertelli C, Bellia A, et al. Gallstone disease is associated with more severe liver damage in patients with non-alcoholic fatty liver disease. PLoS One. 2012;7:e41183.
Yki-Järvinen H. Non-alcoholic fatty liver disease as a cause and a consequence of metabolic syndrome. Lancet Diabetes Endocrinol. 2014;2:901-10.
Lee JH, Rhee PL, Lee JK, Lee KT, Kim JJ, Koh KC, et al. Role of hyperinsulinemia and glucose intolerance in the pathogenesis of nonalcoholic fatty liver in patients with normal body weight. Korean J Intern Med. 1998;13:12-4.
Isokuortti E, Zhou Y, Peltonen M, Bugianesi E, Clement K, Bonnefont-Rousselot D, et al. Use of HOMA-IR to diagnose non-alcoholic fatty liver disease: a population-based and inter-laboratory study. Diabetologia. 2017;60:1873-82.
Borai A, Livingstone C, Ferns GA. The biochemical assessment of insulin resistance. Ann Clin Biochem. 2007;44:324-42.
Salgado AL, Carvalho Ld, Oliveira AC, Santos VN, Vieira JG, Parise ER. Insulin resistance index (HOMA-IR) in the differentiation of patients with non-alcoholic fatty liver disease and healthy individuals. Arq Gastroenterol. 2010;47:165-9.
Simental-Mendía LE, Rodríguez-Morán M, Guerrero-Romero F. The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects. Metab Syndr Relat Disord. 2008;6:299-304.
Salazar J, Bermúdez V, Calvo M, Olivar LC, Luzardo E, Navarro C, et al. Optimal cutoff for the evaluation of insulin resistance through triglyceride-glucose index: A cross-sectional study in a Venezuelan population. F1000Res. 2017;6:1337.
Venneman NG, van Erpecum KJ. Pathogenesis of gallstones. Gastroenterol Clin North Am. 2010;39:171-83.
Di Ciaula A, Wang DQ, Portincasa P. An update on the pathogenesis of cholesterol gallstone disease. Curr Opin Gastroenterol. 2018;34:71-80.
Grigor’eva IN. Gallstone Disease, Obesity and the Firmicutes/Bacteroidetes Ratio as a Possible Biomarker of Gut Dysbiosis. J Pers Med. 2020;11:13.
Ma X, Dong L, Shao Q, Cheng Y, Lv S, Sun Y, et al. Triglyceride glucose index for predicting cardiovascular outcomes after percutaneous coronary intervention in patients with type 2 diabetes mellitus and acute coronary syndrome. Cardiovasc Diabetol. 2020;19:31.
No authors listed. Consensus Development Conference on Insulin Resistance. 5-6 November 1997. American Diabetes Association. Diabetes Care. 1998;21:310-4.
Guerrero-Romero F, Simental-Mendía LE, González-Ortiz M, Martínez-Abundis E, Ramos-Zavala MG, Hernández-González SO, et al. The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic-hyperinsulinemic clamp. J Clin Endocrinol Metab. 2010;95:3347-51.
Vasques AC, Novaes FS, de Oliveira Mda S, Souza JR, Yamanaka A, Pareja JC, et al. TyG index performs better than HOMA in a Brazilian population: a hyperglycemic clamp validated study. Diabetes Res Clin Pract. 2011;93:98-100.
Diehl AK. Cholelithiasis and the insulin resistance syndrome. Hepatology. 2000;31:528-30.
Ruhl CE, Everhart JE. Association of diabetes, serum insulin, and C-peptide with gallbladder disease. Hepatology. 2000;31:299-303.
Heaton KW, Braddon FE, Mountford RA, Hughes AO, Emmett PM. Symptomatic and silent gall stones in the community. Gut. 1991;32:316-20.
Chang Y, Sung E, Ryu S, Park YW, Jang YM, Park M. Insulin resistance is associated with gallstones even in non-obese, non-diabetic Korean men. J Korean Med Sci. 2008;23:644-50.
Grundy SM. Cholesterol gallstones: a fellow traveler with metabolic syndrome? Am J Clin Nutr. 2004;80:1-2.
Banim PJ, Luben RN, Bulluck H, Sharp SJ, Wareham NJ, Khaw KT, et al. The aetiology of symptomatic gallstones quantification of the effects of obesity, alcohol and serum lipids on risk. Epidemiological and biomarker data from a UK prospective cohort study (EPIC-Norfolk). Eur J Gastroenterol Hepatol. 2011;23:733-40.
Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation. 2014;129(25 Suppl 2):102-38. Erratum in: Circulation. 201424;129(25 Suppl 2):139-40.
Ståhlberg D, Rudling M, Angelin B, Björkhem I, Forsell P, Nilsell K, et al. Hepatic cholesterol metabolism in human obesity. Hepatology. 1997;25:1447-50.
Mingrone G, Greco AV, Finotti E, Passi S. Free fatty acids: a stimulus for mucin hypersecretion in cholesterol gallstone biles. Biochim Biophys Acta. 1988;958:52-9.
Di Ciaula A, Garruti G, Frühbeck G, De Angelis M, de Bari O, Wang DQ, et al. The Role of Diet in the Pathogenesis of Cholesterol Gallstones. Curr Med Chem. 2019;26:3620-38.
Lee SB, Kim MK, Kang S, Park K, Kim JH, Baik SJ, et al. Triglyceride Glucose Index Is Superior to the Homeostasis Model Assessment of Insulin Resistance for Predicting Nonalcoholic Fatty Liver Disease in Korean Adults. Endocrinol Metab (Seoul). 2019;34:179-86.
Raimi TH, Dele-Ojo BF, Dada SA, Fadare JO, Ajayi DD, Ajayi EA, et al. Triglyceride-Glucose Index and Related Parameters Predicted Metabolic Syndrome in Nigerians. Metab Syndr Relat Disord. 2021;19:76-82.
Wen J, Wang A, Liu G, Wang M, Zuo Y, Li W, et al. Elevated triglyceride-glucose (TyG) index predicts incidence of Prediabetes: a prospective cohort study in China. Lipids Health Dis. 2020;19:226.
Wang K, He G, Zhang Y, Yin J, Yan Y, Zhang Y, et al. Association of triglyceride-glucose index and its interaction with obesity on hypertension risk in Chinese: a population-based study. J Hum Hypertens. 2021;35:232-9.
Fritz J, Bjørge T, Nagel G, Manjer J, Engeland A, Häggström C, et al. The triglyceride-glucose index as a measure of insulin resistance and risk of obesity-related cancers. Int J Epidemiol. 2020;49:193-204.
da Silva A, Caldas APS, Hermsdorff HHM, Bersch-Ferreira ÂC, Torreglosa CR, Weber B, et al. Triglyceride-glucose index is associated with symptomatic coronary artery disease in patients in secondary care. Cardiovasc Diabetol. 2019;18:89.
