Gastrik intestinal metaplazi ve atrofik gastrit olgularında hiperhomosisteinemi ve eritrosit dağılım genişliği (RDW) ilişkisini araştıran karşılaştırmalı bir çalışma

Abstract

Amaç: Hiperhomosisteinemi, genellikle vitamin B12 ve folat eksiklikleri ile ilişkilendirilen ve kardiyovasküler hastalıklar için bağımsız bir risk faktörü olarak kabul edilen bir durumdur. Atrofik gastrit (AG) ve gastrik intestinal metaplazi (GIM), kronik mide mukozası hasarının farklı histolojik formları olup, her ikisi de vitamin B12 emilimini olumsuz etkileyebilir. Bu çalışmanın amacı, GIM, AG ve atrofik olmayan, metaplazik olmayan kronik gastritli hastalarda serum homosistein düzeylerini ve bunların vitamin B12, folat konsantrasyonları ve Eritrosit Dağılım Genişliği (RDW) ile ilişkilerini karşılaştırmaktır. Gereç ve yöntem: Toplam 110 hasta çalışmaya dahil edildi: GIM (n=46), AG (n=31) ve kontrol grubu olarak atrofik ve metaplazik olmayan kronik gastritli hastalar (n=33). Serum vitamin B12, folat, RDW ve homosistein düzeyleri ölçüldü. Bilinen kardiyovasküler risk faktörleri olan ve vitamin takviyesi kullanan hastalar çalışmadan çıkarıldı. Bulgular: GIM (11,49±4,95 μmol/L) ve AG (9.37±3.87 μmol/L) gruplarında homosistein seviyeleri, kontrollerden anlamlı şekilde yüksek bulundu (7,03±6,64 μmol/L; sırasıyla p<0,01 ve p=0,042). Vitamin B12 düzeyleri GIM (253,88±95,78 pmol/L) ve AG (251,83±63,70 pmol/L) gruplarında kontrol grubuna göre anlamlı derecede düşüktü (363,69±123,41 pmol/L; p<0,01). Folat düzeyleri de GIM grubunda kontrole göre anlamlı oranda azaldı (p=0,02). RDW, GIM ve AG gruplarında hafifçe yüksekti ancak bu artış istatistiksel olarak anlamlı değildi (sırasıyla 16,11±2,72, 16,23±2,32, 15,17±2,27; p=0,069). Lojistik regresyon analizinde erkek cinsiyet ve GIM veya AG varlığı hiperhomosisteinemi için bağımsız belirleyiciler olarak saptandı. Sonuç: AG gibi, GIM de muhtemelen vitamin B12 emilimindeki bozukluk nedeniyle serum homosistein düzeylerinde artışla ilişkilidir. Bu sonuçlar, özellikle geleneksel kardiyovasküler risk faktörleri bulunmayan hastalarda, GIM’nin vitamin B12’ye bağlı metabolik sorunlarda potansiyel bir etken olarak değerlendirilmesi gerektiğini göstermektedir.

Keywords

• Hiperhomosisteinemi
• vitamin B12
• metaplazi

A comparative study investigating the relationship between hyperhomocysteinemia and red cell distribution width (RDW) in cases of gastric intestinal metaplasia and atrophic gastritis

Abstract

Purpose: Hyperhomocysteinemia is a recognized independent risk factor for cardiovascular diseases, often linked to vitamin B12 and folate deficiencies. Atrophic gastritis (AG) and gastric intestinal metaplasia (GIM) represent distinct histological patterns of chronic gastric mucosal damage, both implicated in impaired vitamin B12 absorption. This study aimed to evaluate and compare serum homocysteine levels and their relationships with vitamin B12, folate and Red Cell Distribution Width (RDW) in patients diagnosed with GIM, AG, and non-atrophic, non-metaplastic chronic gastritis. Materials and methods: The study enrolled 110 individuals categorized into three groups: GIM (n=46), AG (n=31), and control subjects with chronic gastritis without atrophy or metaplasia (n=33). Biochemical measurements included vitamin B12, folate, RDW and homocysteine. Participants with known cardiovascular risks or vitamin supplementation were excluded to reduce confounding factors. Results: Both GIM (11.49±4.95 μmol/L) and AG (9.37±3.87 μmol/L) groups exhibited significantly elevated homocysteine levels compared to controls (7.03±6.64 μmol/L; p<0.01 and p=0.042, respectively). Vitamin B12 concentrations were considerably lower in GIM (253.88±95.78 pmol/L) and AG (251.83±63.70 pmol/L) patients versus controls (363.69±123.41 pmol/L; p<0.01 for both). Folate levels were significantly diminished in the GIM group compared to controls (p=0.02). RDW showed a slight, non-significant increase in the GIM and AG groups compared to controls (16.11±2.72, 16.23±2.32, 15.17±2.27, respectively; p=0.069). Logistic regression identified male gender and presence of GIM or AG as independent predictors of hyperhomocysteinemia. Conclusion: Similar to AG, GIM is linked to increased serum homocysteine levels likely due to compromised vitamin B12 absorption. These findings highlight GIM as a potential metabolic risk factor for vitamin B12-related abnormalities, especially in patients lacking traditional cardiovascular risk factors.

Keywords

• Hyperhomocysteinemia
• vitamin B12
• metaplasia

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