Sirozlu hastalarda Child-Pugh evresine göre Hepatit B Virüs DNA seviyeleri

Öz

Amaç: Hepatit B virüsü nedeniyle siroz gelişen hastalarda Child-Pugh evresine göre HBV DNA düzeylerini karşılaştırmak. Gereç ve Yöntem: Retrospektif olarak yapılan bu çalışmaya hepatit B enfeksiyonu nedeniyle yeni siroz tanısı alan hastalar dahil edildi. Hepatit B virus DNA, albümin, bilirübin ve uluslararası normalleştirilmiş oran düzeyleri Child-Pugh Skorlarına göre karşılaştırıldı. Bulgular: Çalışmaya ortalama yaşları 52.22±9.42 olan 90 hasta (60 erkek, 30 kadın) dahil edildi. Her grup 30 hastadan oluşuyordu. Hepatit DNA seviyesi, Grup A'da Grup B ve C'ye kıyasla anlamlı derecede düşüktü (p=0.031). Gruplar arasında Child-Pugh skorları, albümin, bilirübin ve uluslararası normalleştirilmiş oran düzeyleri açısından anlamlı fark bulundu (p=0.0001). Grup B ve C’de albümin düzeyleri daha düşüktü ve uluslararası normalleştirilmiş oran düzeyleri daha yüksekti (p <0.05). Asit ve ensefalopati 42 (%46,7) ve 79 (%87,8) hastada tespit edildi. C grubunda hem asit hem de ensefalopati daha sık görüldü. Sonuç: Hepatit B enfeksiyonu nedeniyle HBV DNA seviyesi sirozun erken evrelerinde belirgin olarak daha düşüktü ve albümin ve bilirübin düzeyleri nispeten normaldi. Ancak, kronik hepatit B'nin sonraki evrelerinde (Child-Pugh B ve C) asit ve ensefalopati daha sıktır, bilirübin ve hepatit B düzeyleri artmakta ve albümin seviyeleri azalmaktadır. 

Anahtar Kelimeler

• Hepatit B virüsü DNA,siroz,karaciğer yetmezliği,albümin,bilirübin,Child-Pugh Skoru

Hepatitis B Virus DNA levels according to the Child-Pugh stage in patients with cirrhosis

Öz

Objective: To compare hepatitis B virus DNA levels according to Child-Pugh stage in patients who developed cirrhosis due to hepatitis B virus. Materials and Methods: This study was conducted as retrospectively. Patients who were newly diagnosed with cirrhosis due to hepatitis B virus infection were included. hepatitis B virus DNA, albumin, bilirubin, and international normalization rate levels were compared according to the Child-Pugh Scores. Results: A total of 90 patients (60 males, 30 females) with a mean age of 52.22±9.42 years were included in this study. Each group consisted of 30 patients. Hepatitis B virus DNA level was significantly lower in the Group A compared with the Group B and C (p=0.031). A significant difference was observed between the groups in terms of Child-Pugh scores, albumin, bilirubin, and international normalization rate levels (all p=0.0001). Albumin levels were lower and international normalization rate levels were higher in the Group B and C (all p<0.05). Ascites and encephalopathy were detected in 42 (%46,7) and 79 (87,8) patients, respectively. Both ascites and encephalopathy were more common in the Group C. Conclusion: Hepatitis B virus DNA level was significantly lower and albumin and bilirubin levels were relatively normal in the early stages of cirrhosis due to hepatitis B virus infection. By contrast, ascites and encephalopathy were more common, bilirubin and international normalization rate levels were elevated, and albumin levels were lower in the later stages (Child-Pugh B and C) of chronic hepatitis B.

Anahtar Kelimeler

• Hepatitis B virus DNA,cirrhosis,liver failure,albumin,bilirubin,Child-Pugh Score

Kaynakça

1. 1. Kim SE. Quantitative hepatitis B surface antigen predicts the antiviral response and hepatocellular carcinoma development in patients with chronic hepatitis B. Korean J Int Med. 2017; 32: 631-633.
2. 2. Polish Group of Experts for HBV, Flisiak R, Halota W, et al. Recommendations for the treatment of hepatitis B in 2017. Clin Exp Hepatol. 2017; 3: 35-46.
3. 3. Chen CJ, Iloeje UH, Yang HI. Long-term outcomes in hepatitis B: the REVEAL-HBV study. Clin Liver Dis 2007; 11: 797–816.
4. 4. Chen CJ. Global elimination of viral hepatitis and hepatocellular carcinoma: opportunities and challenges. Gut. 2018 doi: 10.1136/gutnl-2017-315407.
5. 5. Ringehan M, McKeating JA, Protzer U. Viral hepatitis and liver cancer. Philos Transac R Soc Lond B Biol Sci. 2017; 372: 20160274.
6. 6. Gür G. Karaciğer Transplantasyonu. In:Özden A, Şahin B, Yılmaz U, Soykan İ. Gastroenteroloji 1. basım. Türk Gastroenteroloji Vakfı 2002; 672-3
7. 7. Lu LG, Zeng MD, Mao YM, Li JQ, Qiu DK, Fang JY et al. Relationship between clinical and pathologic findings in patients with chronic liver diseases. World J Gastroenterol 2003; 9: 2796-800.
8. 8. Mohamadnejad M, Montazeri G, Fazlollahi A, Zamani F, Nasiri J, Nobakht H et al. Noninvasive markers of liver fibrosis and inflammation in chronic hepatitis B-Virus related liver disease. Am J Gastroenterol 2006; 101: 2537 45.

9. 9. Afdhal NH, Nunes D. Evaluation of liver fibrosis: a concise review. Am J Gastroenterol 1999; 6: 1160 74.
10. 10. Halfon P, Bourlière M, Pénaranda1 G, Deydier R, Renou C, Fridlund DB et al. Accuracy of hyaluronic acid level for predicting liver fibrosis stages in patients with hepatitis C virus. Comp Hepato 2005; 11: 1-7.
11. 11. Schmilovitz-Weiss H, Tovar A, Halpern M., Sulkes J, Braun M, Rotman Y. et al. Predictive value of serum globulin levels for the extent of hepatic fibrosis in patients with chronic hepatitis B infection. J Viral Hepat 2006; 13: 671 7.
12. 12. Hui AY, Chan HL-Y, Wong VW-S, Liew C-T, Chim AM-L, Chan FK-L et al. Identification of chronic hepatitis B patients without significant liver fibrosis by a simple noninvasive predictive model. Am J Gastroenterol. 2005; 100: 616-23.