Kronik hepatit B hastalarında karaciğer histolojisi ile platelet parametreleri arasındaki ilişki

Year 2019, Volume: 44 Issue: 4, 1160 - 1166, 29.12.2019

Cihat Çoşgun Alpaslan Karabulut , Barış Yılmaz Hüseyin Köseoğlu Emre Demir

https://doi.org/10.17826/cumj.512080

Abstract

Amaç: Karaciğer fibrozis tanı ve skorunun belirlenmesi için birçok noninvaziv test çalışılmıştır. Bu çalışmada, kronik hepatit B (KHB) olan hastalarda platelet parametrelerinin ve karaciğer fibrozisin evresi arasındaki ilişkiyi araştırmayı amaçladık. 

Gereç ve Yöntem: Çalışmaya toplam 140 biyopsi ile kanıtlanmış naiv KHB olgusu dahiledildi. HBV-DNA düzeyi, karaciğer enzimleri ve fonksiyon testleri, beyaz kan hücresi sayısı, platelet parametreleri, hemoglobin, histolojik aktivite indeksi (HAI) ve diğer rutin biyokimyasal parametreler test edildi. Karaciğer biyopsi örnekleri modifiye Ishak skorlama sistemi kullanılarak incelendi. Hastalar karaciğer fibrosis şiddetine göre modifiye İshak puanlama sistemi ile F0-2 ve F3-6 olarak iki gruba ayrıldı.

Bulgular:  F0-2 ve F3-6 grupları arasında platelet (PLT), ortalama platelet hacmi (MPV), platelet dağılım genişliği (PDW) ve platelecrit (PCT) açısından anlamlı fark yoktu. Bu iki grup arasında HAİ, aspartat transaminaz (AST), gama glutamil transaminaz (GGT), yaş ve lenfosit parametreleri açısından anlamlı fark vardı. Karaciğer fibrozis evresini tahmin etmede kullanılmak üzere birçok farklı kombinasyondan oluşan (AST x Yaş x Lenfosit) /√PLT) formülasyonu araştırıldı. 

Sonuç: Yeni indeksimiz diğer noninvaziv skorlama sistemlerine göre daha sensitivitesi yüksek olmakla birlikte noninvaziv belirteç olarak güvenle kullanılabilmesi için ileri karaciğer fibrozis düzeyine sahip olan hastaların daha fazla olduğu, daha geniş örneklem büyüklüğüne sahip çalışmalara ihtiyaç vardır.

Keywords

Kronik hepatit B, Fibrozis, platelet

Relationship between liver histology and platelet parameters in patients with chronic hepatitis B

Abstract

Purpose: Many noninvasive tests have been studied for the diagnosis and determining the liver fibrosis score. In this study, we aimed to research the correlation of platelet parameters and stage of liver fibrosis in patients with chronic hepatitis B (CHB).

Materials and Methods: A total of 140 biopsy-proven naive CHB cases were included in the study. HBV-DNA level, liver enzymes and function tests, white blood cell count, platelet parametres, hemoglobin, histological activity index (HAI) and other routine biochemical parameters were tested. Patients were divided into two groups as F0-2 and F3-6 with Ishak scoring system according to the severity of liver fibrosis.

Results: There was no significant difference between the groups F0-2 and F3-6 in terms of, platelet (PLT), mean platelet volume (MPV), platelet distribution width (PDW) and plateletcrit (PCT). There was a significant difference between these two groups for HAI, aspartate aminotransferase (AST), gamma glutamyl transpeptidase (GGT), age and lymphocyte (LYM) parameters. The formulation of (AST x Age x LYM) / √PLT)which was formed from many different combinations, was investigated in order to be used in predicting the liver fibrosis stage. 

Conclusion: Although our new index is more sensitivitythan other noninvasive scoring systems, it is needed to have a larger sample size in patients with severe stage liver fibrosis in order to be used safely as a noninvasive marker.

Keywords

Chronic hepatitis B, Fibrosis, Platelet

References

• 1. Ceylan B, Mete B, Fincanci M, et al. A new model using platelet indices to predict liver fibrosis in patients with chronichepatitis B infection. Wien Klin Wochenschr 2013; 125:453–460.
• 2. Zeremski M, Dimova RB, Benjamin S, et al. FibroSURE as a noninvasive marker of liver fibrosis and inflammation in chronic hepatitis B. BMC Gastroenterol 2014; 14: 118.
• 3. Koda M, Matunaga Y, Kawakami M, Kishimoto Y, Suou T, Murawaki Y. Fibroindex: a practical index for predicting significant fibrosis in patients withchronic hepatitis C. Hepatology 2007; 45: 297–306.
• 4. Rossi E, Adams L, Prins A,et al. Validation of the fibrotest biochemical markers score in assessing liver fibrosis in hepatitis C patients. Clin Chem 2003; 49: 450–454.
• 5. Adams LA, Bulsara M, Rossi E, et al. Hepascore: an accurate validated predictor of liver fibrosis in chronic hepatitis C infection. Clin Chem 2005; 51: 1867–1873.
• 6. Wai CT, Greenson JK, Fontana RJ, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology 2003; 38: 518–526.
• 7. Hernaez R, Yeh HC, Lazo M, et al. Elevated ALT and GGT predict all-cause mortality and hepatocellular carcinoma in Taiwanese male: a case-cohort study. Hepatol Int 2013; 7: 1040–1049.
• 8. Yin Z and Chen Y. Prognostic value of Gcglobulin in Chinese patients with acute-onchronic hepatitis B liver failure. J Coll Physicians Surg Pak 2015; 25: 176–180.
• 9. Lai CL, Ratziu V, Yuen MF, Poynard T. Viral hepatitis B. Lancet 2003;362:2089–2094.
• 10. de Franchis R, Hadengue A, Lau G, et al. EASL International Consensus Conference on Hepatitis B. 13–14 September, 2002 Geneva, Switzerland. Consensus statement (long version). J Hepatol 2003;39:S3–S25.
• 11. Cadranel JF, Rufat P, Degos F. Practices of liver biopsy in France: Results of a prospective nationwide survey for the group of epidemiology of the French association for the study of the liver (AFEF). Hepatology 2000;32: 477–481.
• 12. Liaw YF, Leung N, Kao JH, et al. Chronic Hepatitis B Guideline Working Party of the Asian-Pacific Association for the Study of the Liver. Asian-Pacific consensus statement on the management of chronic hepatitis B: a 2008 update. Hepatol Int 2008; 2: 263–283.
• 13. Lee HH, Seo YS, Um SH, et al. Usefulness of non-invasive markers for predicting significant fibrosis in patients with chronic liver disease. J Korean Med Sci 2010;25: 67–74.
• 14. Sterling RK, Lissen E, Clumeck N,et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology. 2006; 43(6): 1317-1325.
• 15. Purnak T, Olmez S, Torun S, et al. Mean platelet volume is increased in chronic hepatitis C patients with advanced fibrosis. Clin Res Hepatol Gastroenterol 2013; 37: 41–46.
• 16. Ekiz F, Yüksel O, Koçak E,et al. Mean platelet volume as a fibrosis marker in patients with chronic hepatitis B. J Clin Lab Anal 2011; 25: 162–165.
• 17. Hakyemez IN, Bolukcu S, Durdu B, Aslan T. Red cell volume distribution width to platelet ratio is an important predictor of liver fibrosis and cirrhosis in chronic hepatitis B. Viral Hepat Derg. 2016; 22(2): 52-57.
• 18. Kim EY, Lee JW, Yoo HM, Park CH, Song KY. The platelet-to-lymphocyte ratio versus neutrophil-to-lymphocyte ratio: Which is better as a prognostic factor in gastric cancer. Ann Surg Oncol. 2015; 22(13): 4363-4370.
• 19. Choi WJ, Cleghorn MC, Jiang H, Jackson TD, Okrainec A, Quereshy FA. Preoperative neutrophil-to-lymphocyte ratio is a better prognostic serum biomarker than platelet-to-lymphocyte ratio in patients undergoing resection for nonmetastatic colorectal cancer. Ann Surg Oncol. 2015; 22(3): 603-613.
• 20. Peng W, Li C, Zhu WJ, et al. Prognostic value of the platelet to lymphocyte ratio change in liver cancer. J Surg Res. 2015; 194(2): 464-470.
• 21. Li X, Chen ZH, Xing YF, et al. Platelet-to-lymphocyte ratio acts as a prognostic factor for patients with advanced hepatocellular carcinoma. Tumor Biol. 2015; 36(4): 2263-2269.