Prognostic Signs of Hepatopathy Formation in Adolescents With Type 1 Diabetes Mellitus

Abstract

Introduction. The incidence of diabetes mellitus in the world among children is steadily increasing. The main striking factor in type 1 diabetes mellitus (T1DM) is hyperglycemia, which affects the formation of liver complications such as glycogenic hepatopathy and non-alcoholic fatty liver disease (NAFLD).
 The aim of the study is to determine the prognostic signs of hepatopathy formation in adolescents with type 1 diabetes mellitus.
 Materials and methods. Clinical-anamnestic and laboratory-instrumental examination: glycosylated hemoglobin (HbA1c), aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin and its fractions, lipidogram. According to the results of ultrasound of the hepatobiliary system, girls and boys with T1DM were divided into groups taking into account the size of the liver. The study included 87 girls and 86 boys aged 8-18 years. Methods of mathematical statistics, system-information analysis, Wald’s heterogeneous sequential statistical procedure with Kulbak’s information measure were used.
 Results. A comprehensive examination of adolescents with T1DM revealed that 70% of patients had digestive system disorders in the form of pain and dyspeptic syndromes. In 88% of boys and 68% of girls, palpation and ultrasound revealed liver enlargement (χ2 < 0,05). Atherogenic orientation of lipidogram was determined in all adolescents with T1DM. In girls, the difference in β-lipoprotein level and atherogenicity coefficient reached statistical significance compared with boys. In most adolescents, the content of high-density lipoprotein cholesterol was within normal limits, but the frequency of its decrease in boys with liver enlargement was greater compared with girls with liver enlargement (32% and 24%, respectively, χ2 < 0,05). ALT activity significantly exceeded the upper limit of normal only in the group of girls with liver enlargement. Increased ALT activity in girls with enlarged liver appeared 1.5 times more often than in boys of the similar group (respectively 68% and 43%, χ2 < 0,05).
 Conclusions. In boys with T1DM, significant informative prognostic factors for the formation of hepatopathy are the duration of the disease, increased levels of HbA1c, atherogenic lipoprotein fractions, and ALT activity. In girls with T1DM, the most significant prognostic factor was an increase in ALT activity; the overall informativeness of lipid profile parameters in girls was three times lower compared with boys. The duration of the disease and the degree of compensation were less significant for the formation of hepatopathy in girls.