Neopterin as an indicator of inflammation in chronic viral hepatitis, liver cirrhosis, and hepatocellular carcinoma

Öz

Background and Aims: Neopterin is a proinflammatory indicator that plays a role in cell-mediated immunity, and elevated concentrations of neopterin indicate the presence of interferon-γ in body fluids. In this study, neopterin concentrations were determined in patients with a virus-induced chronic liver disease (chronic hepatitis, liver cirrhosis, and hepatocellular cancer), inactive hepatitis B virus carriers, and in a healthy control group to assess whether neopterin can be used as a disease marker in patients with virus-induced chronic liver disease. Materials and Methods: A total of 110 subjects (42 females and 68 males, with an average age of 44±8.90 years) were included in this study. Of these patients, 33 had chronic hepatitis; 22, liver cirrhosis; 22, hepatoma; 18, inactive hepatitis B virus carriers; and 15 were included in the healthy control group. Neopterin levels were measured before and after interferon treatment in patients with chronic hepatitis. Data collected among the groups were analyzed statistically using the Mann-Whitney test, considering p < 0.05 as statistically significant. Results: Neopterin concentrations and gender showed no statistically significant correlation. Patients with cirrhosis, hepatocellular cancer, and chronic hepatitis had statistically significantly higher neopterin levels than the healthy control and healthy carrier groups. A positive correlation was observed between neopterin levels and other disease activity indicators such as aspartate transaminase, alanine transaminase, hepatitis B virus deoxyribonucleic acid, hepatitis C virus ribonucleic acid, erythrocyte sedimentation rate, and C-reactive protein levels, and their levels were also high. Although 14 patients, who were also evaluated after interferon treatment, showed good response to the treatment, no statistically significant correlation was observed between their neopterin levels and disease activity indicator levels. Conclusion: Neopterin concentrations were found to be significantly higher in patients with inflammation than in inactive hepatitis B virus carriers who had no ongoing inflammatory activity and in the healthy control group. No correlation was detected between neopterin levels and hepatitis B virus deoxyribonucleic acid and hepatitis C virus ribonucleic acid levels in patients who received interferon treatment and benefitted from it. Although neopterin levels indicate inflammatory activity in cases of chronic hepatitis, liver cirrhosis, and hepatocellular cancer, additional studies are necessary to determine its usefulness in clinical practice.

Anahtar Kelimeler

• Neopterin
• chronic hepatitis
• liver cirrhosis
• hepatocellular cancer

Kronik viral hepatitler, karaciğer sirozu ve hepatosellüler karsinomada inflamasyon göstergesi olarak neopterin

Öz

Giriş ve Amaç: Neopterin hücre aracılı immünitede rol oynayan proinflamatuvar bir belirleyicidir ve  konsantrasyonu vücut sıvılarındaki γ interferonun varlığını gösterir.  Viral etiyolojili karaciğer hastalığı olan kronik hepatit, karaciğer sirozu, hepatosellüler kanserli olgularda, inaktif hepatit B virüsü taşıyıcısı olanlarda neopterin seviyesini saptamak ve kontrol grubu ile karşılaştırarak; viral etiyolojili kronik karaciğer hastalıklarında yeri olabilecek bir belirteç olabileceğini ispatlamak amacıyla bu çalışma planlandı. Gereç ve Yöntem: Çalışmaya toplam 110 kişi (42 kadın, 68 erkek, yaş ortalaması 44±8.90) alındı. Bunlardan 33 hasta kronik hepatit, 22’si karaciğer sirozu, 22’si hepatoma, 18’i inaktif hepatit B taşıyıcısı ve 15’i sağlıklı kontrol grubu olarak belirlendi. Neopterin düzeyleri kronik hepatitli hastalarda interferon tedavisinden önce ve sonra ölçüldü. Gruplar arasındaki ölçümler istatistiksel olarak Mann-Whitney testiyle araştırıldı. p<0,05 istatistiksel olarak anlamlı kabul edildi. Bulgular: Cinsiyet ve neopterin düzeyleri arasında istatistiksel olarak ilişki saptanmadı. Hastalıklar değerlendirildiğinde, neopterin seviyeleri siroz, hepatosellüler kanser, kronik hepatit grubundaki hastalarda sağlıklı taşıyıcı ve sağlıklı kontrol grubundaki hastalara göre istatistiksel olarak anlamlı düzeyde yüksekti. Neopterin düzeyleri, bu hasta gruplarında aktivite göstergeleri olan aspartat aminotransferaz, alanin aminotransferaz, hepatit B virüs deoksiribonükleik asit, hepatit C virüs ribonükleik asit, sedimentasyon ve C-reaktif protein değerleri ile arasında pozitif korelasyon vardı ve yüksek olarak saptandı. İnterferon tedavisi sonrası değerlendirilen 14 hastada ise tedaviye cevap alınmasına rağmen, neopterin düzeyleri ile aktivite belirteçleri arasında anlamlı ilişki saptanmadı. Sonuç: Sonuç olarak neopterin seviyeleri inflamasyonu olan hastalarda sağlıklı kontrol ve inflamasyon aktivitesi beklenmeyen hepatit B taşıyıcılarına göre anlamlı olarak daha yüksekti. İnterferon tedavisi verilen ve tedaviden fayda gören hastalarda hepatit B virüs deoksiribonükleik asit ve hepatit C virüs ribonükleik asit düzeyleri ile neopterin arasında bir korelasyon saptanmadı. Neopterin seviyesi kronik hepatit, karaciğer sirozu ve hepatosellüler kanserli olgularda inflamasyon aktivitesini gösterirken bunun klinik pratikteki yararı konusunda ilave çalışmalara gerek olduğu açıktır.

Anahtar Kelimeler

• Neopterin
• kronik hepatitler
• karaciğer sirozu
• hepatosellüler kanser

Kaynakça

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