Kronik hepatit B ve B+D kaynaklı sirozda, hepatoselüler karsinom gelişiminin öngörülmesinde ALBI ve PALBI skorlamalarının prediktif değeri

Year 2019, Volume: 7 Issue: 3, 172 - 179, 18.12.2019

Tolga Şahin Alihan Oral

Abstract

Amaç: Hepatoselüler karsinom (HCC), dünya
çapında kanser kaynaklı ölümlerin ikinci en yaygın nedenidir. HCC, çoğu olguda
sirotik karaciğer dokularında gelişir. HCC'nin teşhisinde ve tedavisinde yeni
gelişmeler olmasına rağmen, 5 yıllık sağkalım oranı halen % 12' nin altındadır.
Bu nedenle, erken tanı ve agresif yaklaşım, HCC tedavisi için en önemli nokta
haline gelmiştir. Bu çalışmanın amacı, kronik hepatit B ve kronik hepatit B + D
kaynaklı sirozda HCC gelişiminde albumin-bilirubin indeksi (ALBI) ve Platelet-albumin-bilirubin
indeksinin (PALBI) prediktivitelerinin değerlendirilmesidir.

Materyal
ve Metod: Çalışmaya 2004-2019
yılları arasında Demiroğlu Bilim Üniversitesi Tıp Fakültesi Gastroenteroloji
bölümüne başvuran kronik hepatit B ve kronik hepatit B + D ‘ye bağlı karaciğer
sirozu bulunan 331 hasta dahil edildi. Hastalar HCC olan ve olmayan hastalar olmak
üzere iki ana gruba ayrıldı. Hastaların demografik verileri ve vücut kitle
indeksleri istatistiksel olarak analiz edildi. Hastaların Child ve MELD
skorları ile laboratuvar bulguları gruplar için ayrı ayrı kaydedildi ve incelendi.
Ortalama ALBI ve PALBI değerleri her iki hasta grubu için ayrı ayrı hesaplandı.
Son aşamada HCC gelişimi ile ALBI ve PALBI arasındaki ilişki ve bu skorların
prediktif değerleri değerlendirildi.

Bulgular: Hastaların yaş ortalaması 51.3 ± 9.18,
ortalama ağırlığı 77.7 ± 13.08 kg, ortalama boyu 165 ± 18 cm, ortalama vücut
kitle indeksi (BKİ) ise 30.04 ± 11.65 idi. HCC grubu 115 hastadan ve HCC
olmayan siroz grubu 216 hastadan oluşmaktaydı. Ortalama ALBI ve PALBI skor
değerleri, HCC grubu hastalarda, HCC olmayan sirozlu hasta grubuna göre anlamlı
derecede düşüktü (p <0,001). Receiver operating characteristics (ROC)
analizi yapıldığında, eğri altındaki alan (AUC) ALBI skoru için 0.775 ve PALBI
skoru için 0.733 olarak saptandı.

Sonuç:
ALBI ve PALBI skorları HCC’ li hastalarda sağkalım ve prognozun
öngörülmesi amacı ile geliştirilmiştir. Çalışmamızda, ALBI ve PALBI skorlarının
HCC ‘de sağkalım ve prognoz tahimininin yanısıra, sirozlu hastalarda HCC
gelişimi öngörüsünde de kullanışlı belirteçler olabilecekleri sonucuna varıldı.

Keywords

ALBI, PALBI, Hepatocellular carcinoma, Siroz

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