Relationship Between Serum GGT Levels and Liver Fibrosis in Chronic Hepatitis B Patients

Öz

Objective: The aim of this study was to evaluate the relationship between serum GGT levels and liver fibrosis among patients with chronic hepatitis B in Fırat University Medical School. Materials and Methods: In Gastroenterology Clinics of Fırat University Medical School, data regarding 140 chronic hepatitis B patients and laboratory results were analysed retrospectively. All patients had undergone liver biopsies and according to histopathological stages of fibrosis (Knodell's classification), they were classified as mild (stage 0-2) and severe (stage 3-4) fibrosis groups. The groups were compared to each other in terms of serum GGT levels. Results: When compared to severe fibrosis group, mild fibrosis group had no statistical difference in terms of serum fasting glucose, bilirubin, ALP, T.protein, PT, Hb, HBsAg titer and HBV DNA levels. On the other hand there were statistically significant differences between groups in terms of age, AST, ALT, platelets and albumin levels. Mild fibrosis group had a mean GGT level of 39.33±26.01 while severe fibrosis group had a mean GGT level of 66.19±67.69. The difference between groups in terms of GGT levels was significant (p=0.002). Conclusion: In chronic hepatitis B patients high serum GGT levels seem to be related to higher stages of fibrosis in liver biopsies. Elevetad GGT level in our patients is in parallel to older age, high ALT and AST, low platelets and albumin. GGT may be a non invasive marker of fibrosis in chronic hepatitis B patients.

Anahtar Kelimeler

• -

Kronik Viral Hepatit B Tanısı Olan Hastalarda Serum GGT Düzeyi İle Karaciğer Fibrozu İlişkisi

Öz

Amaç: Bu çalışmada Fırat Üniversitesi Tıp Fakültesi Gastroenteroloji Kliniği'nde takip edilmekte olan kronik hepatit B tanılı hastalarda serum GGT düzeyinin karaciğer biyopsisi sonucunda ortaya konulan fibrozis skoru ile olan ilişkisini değerlendirmek amaçlanmıştır. Gereç ve Yöntemler: Fırat Üniversitesi Tıp Fakültesi Gastroenteroloji Kliniği'nde 2006-2009 yılları arasında kronik viral hepatit B tanısı ile takip edilen ve karaciğer biyopsisi yapılan 140 hasta retrospektif olarak değerlendirildi. Tüm hastaların hepatit belirteçleri, HBV DNA düzeyi, tam kan sayımı, biyokimya tetkikleri, serum GGT düzeyleri gözden geçirildi. Karaciğer histolopatolojisine (Knodell sınıflaması ile) göre hastalar düşük (evre 0-2) ve yüksek (evre 3-4) fibrozis grubu olarak ikiye ayrıldı. Gruplar kendi aralarında serum GGT düzeyleri temel alınarak karşılaştırıldı. Bulgular: Düşük fibrozis skoru olan hasta grubu ile yüksek fibrozis skoru olan hasta grubu arasında AKŞ, T.Bil, ALP, Tprot, PTZ, Hb, HbsAg titresi, HBV DNA düzeyleri açısından istatistiksel olarak anlamlı fark saptanmadı. Bununla birlikte iki grup arasında yaş, AST, ALT, plt, alb düzeyleri açısında istatistiksel olarak anlamlı farklar görüldü. Düşük fibrozis skoru olan hasta grubunun ortalama serum GGT düzeyi 39.33±26.01 iken yüksek fibrozis skoru olan hasta grubunun ortalama serum GGT düzeyi 66.19±67.69 idi, aradaki fark istatistiksel olarak anlamlı bulundu (p=0.002). Sonuç: Kronik hepatit B hastalarımızda serum GGT düzeyinin artması ilerlemiş yaş, yüksek AST, yüksek ALT, düşük alb düzeyi ve yüksek fibrozis ile birliktelik göstermektedir. Kronik viral hepatit B tanısı olan hastalarda yüksek serum GGT düzeyi ileri evre fibrozisin bir göstergesi olabilir.

Anahtar Kelimeler

• Kronik hepatit B, GGT, karaciğer fibrozu

Kaynakça

1. 1. Perz JF, Armstrong GL, Farrington LA, Hutin YJ, Bell BP. The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide J Hepatol 2006; 4: 529-538.
2. 2. Mahoney FJ. Update on diagnosis, management and prevention of hepatitis B virus infection. Clin Microbiol Rev 1999; 12: 351-366.
3. 3. Lee WM. Hepatitis B infection. N Eng J Med 1997; 337: 1733-1745.
4. 4. Fattovich G, Brollo L, Giustina G, et al. Natural history and prognostic factors for chronic hepatitis type B. Gut 1991; 32: 294-298.
5. 5. McGill DB, Rakela J, Zinsmeister AR, Ott BJ. A 21-year experience with major hemorrhage after percutaneous liver biopsy. Gastroenterology 1990; 99: 1396-1400.
6. 6. Regev A, Berho M, Jeffers LJ, et al. Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection. Am J Gastroenterol 2002; 97: 2614-2618.
7. 7. Ter Borg F, Ten Kate FJ, Cuypers HT, et al. Relation between laboratory test results and histological hepatitis activity in individuals positive for hepatitis B surface antigen and antibodies to hepatitis B e antigen. Lancet 1998; 351: 1914- 1918.
8. 8. Giustina G, Fattovich G, De Paoli M, et al. Serum procollagen type III peptide in chronic hepatitis B. Relationship to disease activity and response to interferon-alpha therapy. Int J Clin Lab Res 1996; 26: 33-36.

9. 9. Pontinha N, Pessegueiro H, Barros H. Serum hyaluronan as a marker of liver fibrosis in asymptomatic chronic viral hepatitis B. Scand J Clin Lab Invest 1999; 59: 343-347.
10. 10. Murawaki Y, Ikuta Y, Idobe Y, Kawasaki H. Serum matrix metalloproteinase-1 in patients with chronic viral hepatitis. J Gastroenterol Hepatol 1999; 14: 138-145.
11. 11. Murawaki Y, Nishimura Y, Ikuta Y, et al. Plasma transforming growth factor-beta 1 concentrations in patients with chronic viral hepatitis. J Gastroenterol Hepatol 1998; 13: 680-684.
12. 12. Nakanishi N, Suzuki K, Tatara K. Serum gamma-glutamyltransferase and risk of metabolic syndrome and type 2 diabetes in middle-aged Japanese men. Diabetes Care 2004; 27: 1427-1432.
13. 13. Lee DH, Jacobs DR Jr, Gross M, et al. Gamma-glutamyltransferase is a predictor of incident diabetes and hypertension: the coronary artery risk development in young adults (CARDIA) study. Clin Chem 2003; 49: 1358-1366.
14. 14. Lok ASF, McMahon BJ. AASLD Practice Guidelines: chronic hepatitis B. Hepatology 2001; 34: 1225-1241.
15. 15. Giannini E, Risso D, Testa R. Transportability and reproducibility of the AST/ALT ratio in chronic hepatitis C patients. Am J Gastroenterol 2001; 96: 918-919.
16. 16. Wai C T, Greenson J K, Fontana R J, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology 2003; 38: 518-526.
17. 17. Silva IS, Ferrazs Mlrez RM, Lanzoni VP, Figueiredo VM, Silva E. Role of gamma-glutamyl transferase activity in patients with chronic hepatitis C virus infection. J Gastroenterol Hepatol 2004; 19: 314-318.
18. 18. Hwang SJ, Luo JC, Lai CR, et al. Clinical, virologic and pathologic significance of elevated serum gamma-glutamyl transpeptidase in patients with chronic hepatitis C. Zhonghua Yi Xue Za Zhi 2000; 63: 527-535.
19. 19. Rosenberg WM, Voelker M, Thiel R, et al. European Liver Fibrosis Group. Serum markers detect the presence of liver fibrosis: a cohort study. Gastroenterology 2004; 127: 1704- 1713.
20. 20. Chrysanthos NV, Papatheodoridis GV, Savvas S, et al. Aspartate aminotransferase to platelet ratio index for fibrosis evaluation in chronic viral hepatitis. Eur J Gastroenterol Hepatol 2006; 18: 389-396.
21. 21. Zeng MD, Lu LG, Mao YM, et al. Prediction of significant fibrosis in HBeAg-positive patients with chronic hepatitis B by a noninvasive model. Hepatology 2005; 42: 1437-1445.
22. 22. Mohamadnejad M, Montazeri G, Fazlollahi A, et al. Noninvasive markers of liver fibrosis and inflammation in chronic hepatitis B-Virus related liver disease. Am J Gastroenterol 2006; 101: 2537-2545.
23. 23. Lu LG, Zeng MD, Mao YM, et al. Relationship between clinical and pathologic findings in patients with chronic liver diseases. World J Gastroenterol 2003; 9: 2796-2800.
24. 24. Lacobellis A, Fusilli S, Mangia A, et al. Ultrasonographic and Biochemical parameters in the non-invasive evaluation of liver fibrosis in hepatitis C virus chronic hepatitis. Aliment Pharmacol Ther 2005; 22: 769-774.
25. 25. Lu LG, Zeng MD, Mao YM, et al. Granding and staging of hepatic fibrosis, and its relationship with noninvasive diagnostic parameters. World J Gastroenterol 2003; 9: 2574- 2578.