Gender peculiarities of hepatopathy manifestation in adolescents with type 1 diabetes

Abstract

The incidence of diabetes mellitus is steadily increasing worldwide, including in the pediatric population. Type 1 diabetes is a disease that is often accompanied by liver damage in the form of glycogenosis, steatosis, and fibrosis. However, there is paucity of research devoted to this problem. Objective — to determine the gender characteristics of the clinical course of hepatopathy in adolescents with type 1 diabetes. Materials and methods. The study included 86 boys and 87 girls aged 8 to 18 years (school-age children in the period of hormonal puberty adjustment), suffering from type 1 diabetes. Clinical and anamnestic, laboratory and instrumental examinations were carried out in accordance with the current standards. Blood biochemistry examinations included determining the levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase, total bilirubin and its fractions, total cholesterol, triglycerides, high density lipoprotein, β­lipoproteins. According to the results of ultrasound examinations, adolescents with type 1 diabetes were divided into groups based on the liver size. Results and discussion. The groups did not differ significantly by the nature of dyspeptic complaints. During ultrasound examinations, an increase in the liver size was determined more often in boys; the frequency of steatosis signs did not depend on gender. Absence of positive dynamics of these signs was established in 50 % of patients, regardless of the state of glycemic control. Regardless of gender, functional disorders of the biliary tract were found in almost all of them. The indicators of the lipid panel in girls were slightly higher than in boys, and the difference in β­lipoproteins level was significant. In most adolescents, levels of high density lipoprotein were within the normal ranges, but the frequency of its decrease in boys with enlarged liver was higher compared to girls. ALT activity significantly increased only in girls with enlarged liver, and in boys it only tended to increase; the frequency of increased ALT activity in girls with enlarged liver was 1.5 times higher compared to boys. The AST/ALT ratio in every fifth patient, regardless of gender and liver size, was ≥ 1.3 (a marker of fibrosis formation). Conclusions. The performed investigation revealed the gender peculiarities of clinical, ultrasound and biochemical manifestations of hepatopathy in adolescents with type 1 diabetes, which can be the basis for the administration of patient oriented therapeutic, preventive and rehabilitation measures.