Prevalência e estadiamento da doença hepática gordurosa não alcoólica em pacientes com síndrome dos ovários policísticos em centro de referência do Hospital das Clínicas da UFMG

Abstract

Polycystic ovarian syndrome (PCOS) is a common endocrinopathy in reproductive age women and is a recognized risk factor for nonalcoholic fatty liver disease (NAFLD). The aims of this study were to investigate the prevalence and associated factors to NAFLD in women with PCOS and to evaluate fibrosis satge by non-invasive methods in patients with PCOS and NAFLD. Method: This cross-sectional prospective study evaluated patients with PCOS and women without PCOS as controls. NAFLD was diagnosed by abdominal ultrasonography followed by the exclusion of alcohol consumption, viral or autoimune liver disease. Anthropometric, clinical and metabolic variables, FIB-4, NAFLD score and transient elastography (TE) by Fibroscan® were performed in subsets of PCOS and NAFLD patients. Results: Eighty-seven PCOS patients were included (mean age: 34.4±5.7 years, mean body mass index [BMI]: 34.7±4.7 Kg/m2); 67 (77.0%) had NAFLD vs. 21/40 (52.5 %) patients in control group (p=0.005). PCOS women with liver steatosis had higher BMI, waist circumference (WC), triglycerides, total cholesterol, alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamaglutamyltransferase (GGT) than PCOS women with normal ultrasonography, (35.7 ± 4.1 vs. 31.2 ± 5.2 Kg/m2, p=0.001; 103 [88128] vs. 95 [67-115] cm, p<0.001; 140 [56-373] vs. 92 [49-173] mg/dL, p=0.003; 195 [134 – 288] vs. 177 [127-228] mg/dL, p=0.01; 36 [11-81] vs. 25 [13-37] U/L, p=0.001; 24 [9-48] vs. 18 [11-31] U/L, p=0.001; 37 [14-234] vs. 29 [11-68], p=0,04, respectively). Women with PCOS and NAFLD presented higher frequencies of obesity, metabolic syndrome and insulin resistance (91% vs. 70%, p=0.02; 58.2% vs. 20.0%, p=0.007; and 91.0% vs. 55.0%, p=0.001, respectively). On multivariate analysis, the associated factors with NAFLD in patients with PCOS were WC, triglycerides and ALT (OR [IC 95%] = 1.013 [1.002-1.024], p=0.025; 1.002 [1.0-1.003], p=0.049; and 1.007 [1.0-1.013], p=0.047, respectively). FIB-4 was compatible with absent advanced fibrosis (<1.3) in 45/45 patients (100%). NAFLD score was compatible with absent advanced fibrosis (<1.455) in 7/26 (27%), was indeterminated (≥-1.455 and ≤0.676) in 18/26 (69%) and compatible with advanced liver fibrosis (>0.676) in 1/26 patients (4%). TE was performed in 25 patients with PCOS and NAFLD and was <7.0 kPa, between 7.0 and 9.5 kPa and between 9.5 and 12.5 kPa in 15 (60%), 7 (28%) and 3 (12%) patients, respectively. Conclusion: Women with PCOS have a high risk of NAFLD, which is associated with central obesity, dyslipidemia, insulin resistance and metabolic syndrome in this population. Low rates of hepatic fibrosis in this series were observed.