Стан гепатобіліарної системи в підлітків з цукровим діабетом 1-го типу

Abstract

Diabetes mellitus type 1 (DMT1) is one of the diseases in which liver lesions such as glycogenic hepatopathy and hepatic steatosis are frequently observed which makes our study appropriate. Purpose - to study the state of the hepatobiliary system in adolescents with DMT1 based on the results of a biochemical blood test, ultrasound examination of the hepatobiliary system and dynamic monitoring. Materials and methods. The study included 173 adolescents (87 girls and 86 boys aged 10 to 18 years who have DMT1 and were in the endocrinology department of the SI «Institute for Children and Adolescents Health Care of the NAMS of Ukraine»). Patients were divided according to the level of glycaemic control targets (GCT): the Group 1 - optimal (glycosylated hemoglobin (HbA1c) <7.0%), the Group 2 - suboptimal (HbA1c = 7.0-9.0%), the Group 3 - high-risk GCT (HbA1c >9.0%). The Control group included 20 healthy adolescents. All patients underwent a biochemical blood test and ultrasound. Results. Most of the examined adolescents had pain, dyspeptic syndromes and an increased size of the liver on ultrasonography regardless of the level of GCT. Ultrasound signs of hepatic steatosis were most often determined in patients with the Group 3. Dynamic observation indicated the absence of positive dynamics in reducing the size of the liver and normalizing the echogenicity of its parenchyma in 50% of patients, even when optimal GCT is reached. The majority of adolescents with DMT1 had hypotension of the gallbladder, and thickening of the gallbladder walls and the presence of biliary sludge were more often observed in patients with Groups 2 and 3. In the Groups 2 and 3 increased activity of alanine aminotransferase was revealed, which against the background of compensation for DMT1, decreased in only half of the patients. Lipidogram parameters were atherogenic in all patients, regardless of the level of GCT. Conclusions. The study revealed a high incidence of hepatopathy in adolescents with DMT1, which requires careful follow-up. The diagnostic algorithm requires the inclusion of non-invasive tests of the hepatobiliary system. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.