Kronik Hepatit-B hastalarında hematolojik parametrelerin karaciğer inflamasyonu ve fibrozu ile ilişkisi

Abstract

Amaç: Bu çalışmada, kronik hepatit B (KHB) hastalarında karaciğerdeki enflamasyonun ve fibrozisin derecesini öngörebilecek hematolojik parametrelerin değerlendirilmesi amaçlanmaktadır. Yöntem: Hastanemiz iç hastalıkları ve gastroenteroloji polikliniğinde KHB tanısıyla takip edilen ve karaciğer biyopsisi yapılan 237 hasta çalışmaya alındı. Karaciğer biyopsisi yapılmadan hemen önceki Nötrofil/Lenfosit, Platelet/Lenfosit, MPV, MPV/Platelet ve MPV/Lenfosit değerleri hesaplandı. Bu parametrelerin viral serolojik bulgular, karaciğer fibrozisi (Kİ) ve histolojik aktivite indeksi (HAİ) ile arasındaki ilişki araştırıldı. Bulgular: 101’i (%43) kadın, 136’sı (%57) erkek 237 hastanın yaş ortalaması 42.56±11.7 yıl idi. MPV/Platelet, MPV/Lenfosit, HBeAg, HBV-DNA değerleri ile HAİ arasında pozitif yönde istatistiksel olarak anlamlı korelesyon bulundu (P<0.05). Ek olarak HBV-DNA düzeyi ile Kİ arasında da pozitif yönde istatistiksel olarak anlamlı korelasyon saptandı (p<0.05). HAİ <6 ile HAİ ≥6 olmak üzere iki grup karşılaştırıldığında; HAİ ≥6 olan grubun MPV, MPV/Platelet, MPV/Lenfosit, HBV-DNA düzeyleri daha yüksekti. (p<0.05). Hastalar HBeAg (+) ve (-) olarak iki gruba ayrılıdığında; HBeAg (+) grupta Kİ, HAİ ve HBV-DNA düzeyindeki yükseklik istatistiksel olarak da anlamlıydı. (p<0.05). Sonuç: MPV/Lenfosit, MPV/Platelet değerleri; KHB enfeksiyonunda karaciğer fibrozisini değerlendirmekten ziyade, karaciğerdeki histolojik enflamasyonu değerlendirebilen yardımcı bir parametre olabilir.

Keywords

• Hepatit B
• MPV
• Lenfositler
• MPV/Lenfosit
• Plateletler
• MPV/Platelet

Relationship of hematological parameters with liver inflammation and fibrosis in patients with chronic Hepatitis B

Abstract

Objective: This study aims to evaluate the hematological parameters that can predict the inflammation and degree of fibrosis in the liver in chronic hepatitis B patients. Method: 237 patients who were followed up with the diagnosis of Chronic Hepatitis B in the internal medicine and gastroenterology outpatient clinics of our hospital and underwent liver biopsy were included in the study. Neutrophil/Lymphocyte, Platelet/Lymphocyte, MPV, MPV/Platelet, and MPV/Lymphocyte values were calculated just before liver biopsy. These parameters were compared with viral serological findings, liver fibrosis, and histological activity scores. Results: Among 237 patients, 101 (43%) female and 136 (57%) male, the mean age was 42.56±11.7. A statistically significant positive correlation was found between MPV/Platelet, MPV/Lymphocyte, HBeAg, HBV-DNA values, and HAI (P<0.05). In addition, a statistically significant positive correlation was found between the HBV-DNA level and the degree of Chronicity Index (p<0.05). When the patients were grouped regarding the HAI<6 or ≥6; MPV, MPV/Platelet, MPV/Lymphocyte, HBV-DNA values were statistically higher in the group with HAI≥6 (p<0.05). When the patients were divided into two groups as HBeAg (+) and (-); in the HBeAg (+) group, chronicity index, HAI, and HBV-DNA levels were found to be statistically significantly higher (p<0.05). Conclusion: MPV/Lymphocyte and MPV/Platelet ratios; In CHB infection, it may be an auxiliary parameter that can evaluate histological inflammation in the liver rather than assessing liver fibrosis.

Keywords

• Hepatitis B
• MPV
• Lymphocytes
• MPV/Lymphocyte
• Platelets
• MPV/Platelet

References

1. Fattovich G, Bortolotti F, Donato F. Natural history of chronic hepatitis B: special emphasis on disease progression and prognostic factors. J Hepatol 2008;48(02): 335-352. https://doi.org/10.1016/j.jhep.2007.11.011
2. European Association For The Study Of The Liver; European Organisation For Research And Treatment Of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 2012;56(04): 908-943. https://doi.org/10.1016/j.jhep.2011.12.001
3. World Health Organization. Hepatitis B. Available at: https:// www.who.int/news-room/fact-sheets/detail/hepatitis-b. Accessed July 18, 2019.
4. Wu JP, Mao W, Li X. Mean Platelet Volume/Lymphocyte Ratio as a Prognostic Indicator for HBV-Related Decompensated Cirrhosis. Gastroenterol Res Pract. 2020. https://doi. org/10.1155/2020/4107219
5. Ding QM, Zhou WQ, Mao ML, Zhang JF. Mean Platelet Volume/ Platelet Count Ratio as a Predictor of 3-Month Mortality in HBV-Related Decompensated Cirrhosis Patients. Clin Lab. 2020;66(3). https://doi.org/10.7754/Clin.Lab.2019.190635
6. Liberski PS, Szewczyk M, Krzych LJ. Haemogram-Derived Indices for Screening and Prognostication in Critically Ill Septic Shock Patients: A Case-Control Study. Diagnostics (Basel). 2020;10(9):638. https://doi.org/10.3390/diagnostics10090638
7. Mao W, Wu J. Haematologic indices in hepatitis B virus-related liver disease. Clin Chim Acta. 2020;500: 135-142. https://doi. org/10.1016/j.cca.2019.10.007
8. Qin B, Ma N, Tang Q, Wei T, Yang M, Fu H et al. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were useful markers in assessment of inflammatory response and disease activity in SLE patients. Mod Rheumatol. 2016;26(3):372-6. https://doi.org/10.3109/14397595.2015.109 1136

9. Celikbilek M, Dogan S, Gursoy S, Zararsız G, Yurci A, Ozbakır O et al. Noninvasive assessment of liver damage in chronic hepatitis B, World. J. Hepatol. 2013;5: 439-445. https://doi.org/10.4254/wjh.v5.i8.439
10. Huang R, Wang G, Tian C, Liu Y, Jia B, Wang J. Gamma-glutamyl-transpeptidase to platelet ratio is not superior to APRI, FIB-4and RPR for diagnosing liver fibrosis in CHB patients in China, Sci. Rep. 2017;7: 8543. https://doi.org/10.1038/s41598- 017-09234-w
11. Yilmaz B, Aydin H, Can G, Şentürk Z, Üstüner B, Yilmaz H et al. The relationship between fibrosis level and blood neutrophil to lymphocyte ratio in inactive hepatitis B carriers, Eur. J. Gastroenterol. Hepatol. 2014;26: 1325-1328. https://doi. org/10.1097/MEG.0000000000000204
12. Kekilli M, Tanoglu A, Sakin YS, Kurt M, Ocal S, Bagci S, Is the neutrophil to lymphocyte ratio associated with liver fibrosis in patients with chronic hepatitis B? World. J. Gastroenterol. 2015;21: 5575-5581. https://doi.org/10.3748/wjg.v21.i18.5575
13. Rodak AP, Kiciak S, Tomasiewicz K. Neutrophil-lymphocyte ratio and mean plateletvolume as predictive factors for liver fibrosis and steatosis in patients with chronic hepatitis B. Annals of Agricultural and Environmental Medicine 2018;25:690-692. https://doi.org/10.26444/aaem/99583
14. Gong J, Liang Y.L, Zhou W, Jie Y, Xiao C, Chong Y et al. Prognostic value of neutrophil-to-lymphocyte ratio associated with prognosis in HBV-infected patients, J. Med. Virol. 2018;90: 730-735. https://doi.org/10.1002/jmv.25015
15. Zhao Z, Liu J, Wang J, Xie T, Zhang Q, Feng S et al. Platelet to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) are associated with chronic hepatitis B virus (HBV) infection. Int Immunopharmacol. 2017;51:1-8. https://doi.org/10.1016/j.intimp.2017.07.007