Are Serum Vitamin E Levels Associated with Severe Histological Features in Patients with Autoimmune Hepatitis?,

Yıl 2019, , 37 - 43, 30.04.2019

Eylem Karatay , Kebire Karakuş Deniz Öğütmen Koç Rahime Özgür

https://doi.org/10.24938/kutfd.469275

Öz

Objective: Autoimmune
hepatitis is an inflammation of the liver characterized by the presence of
peri-portal hepatitis, hypergammaglobulinemia, and the serum autoantibodies. 

Vitamin E has
anti-oxidant and anti-fibrotic
properties and may potentially be effective for suppressing inflammation and
liver fibrosis. Our aim is to determine vitamin E levels in patients, whose
autoimmune liver diseases have been detected clinically and progression of
fibrosis have been detected with liver biopsy samples, as well as toinvestigate
the relationship between the vitamin E levels and fibrosis.

Material and Method: Sixty-three subjects aged
between 19-75 were observed by prospective method
with control. Serum samples of thirty-three patients
with autoimmune liver disease, whose liver fibrosis levels were assessed by
histopathology, and of 30 healthy controls were collected and Vitamin E
levels were detected using a commercial vitamin E ELISA kit.

Results: This study was carried out with a total
of 33 autoimmune hepatitis cases (27 female, 6 male) and 30 healthy controls
(21 female and 9 male). The mean age of the patient and control group were 50.18±10.71
and 50.22 ± 10.03 years respectively. Mean
vitamin E level was found to be 45.55±39.92 nmol/ml. Vitamin E levels of the patient
group were significantly low compared to the control group (p<0.05). No statistically significant relationship
was found between the fibrosis phase of the patient group and the vitamin E levels
(p>0.05).

Conclusion: While vitamin E level of patients
with autoimmune liver disease was significantly lower compared to the control
group, there was no significant correlation between vitamin E level and fibrosis
phases. As a conclusion, this study showed that vitamin E levels can not be
used as a potential biomarker for the prediction of autoimmune liver
diseases and it can not be involved in the treatment.

Anahtar Kelimeler

Vitmain E, autoimmune liver diseases, fibrosis

OTOİMMÜN HEPATİT TANILI HASTALARDA SERUM E VİTAMİNİ SEVİYELERİ HİSTOLOJİK AKTİVİTE ŞİDDETİ İLİŞKİLİ MİDİR?

Öz

Amaç: Otoimmun hepatit karaciğerde histopatolojik
olarak periportal hepatitle giden serumda hipergammaglobulinemi ve otoantikor
pozitifliğinin eşlik ettiği karaciğer inflamasyonudur. Anti-oksidan ve anti-fibrotik özelliklere sahip olan vitamin E’nin
inflamasyonu ve karaciğer fibrozisi baskılamada etkili olduğunu bidiren
çalışmalar yayınlanmıştır. Bu
çalışmanın amacı, otoimmün karaciğer hastalığı tespit edilmiş ve fibrozis
oluşumu karaciğer biyopsi örnekleri ile belirlenmiş olgularda vitamin E
düzeyini tespit etmek ve vitamin E düzeyleri ile fibrozis arasındaki ilişkiyi
ortaya koymaktır.

Gereç ve Yöntem: Yaşları 19-75 arasında olan 63 vaka
kontrollü prospektif metot ile incelendi. Karaciğer
fibrozis dereceleri histopatoloji ile belirlenmiş olan 33 otoimmün hepatit hastası
ve karaciğer hastalığı olmayan karaciğer biyopsisi yapılmamış 30 sağlıklı
bireyin serumları toplandı ve bu serumlarda vitamin E düzeyleri ticari bir
vitamin E ELISA kiti ile tespit edildi.

Bulgular: Bu çalışma, 27 kadın, 6 erkek
toplam 33 otoimmun hepatit olgusu ve 21 kadın, 9 erkek toplam 30 sağlıklı kontrol
grubu ile yapılmıştır. Hasta grubunun yaş
ortalaması 50.18±10.71, sağlıklı kontrol grubunun yaş ortalaması 50.22±10.03
yıl olarak saptandı. Olguların vitamin E
değerlerinmin ortalaması 45.55±39.92 nmol/ml olarak saptanmıştır. Hasta grubunun
vitamin E değeri, kontrol grubuna göre istatistiksel olarak düşük saptanmıştır (p<0.05).
Hasta grubunun fibrozis evresi ile vitamin E değerleri arasında
istatistiksel olarak anlamlı ilişki saptanmamıştır (p>0.05).

Sonuç: Otoimmün karaciğer hastalarının
vitamin E değeri, kontrol grubu olgulara göre,
istatistiksel olarak anlamlı düzeyde düşük saptandığı halde, vitamin E seviyesiyle fibrozis evreleri arasında
anlamlı bir korelasyonun olmadığı saptanmıştır. Dolayısıyla bu
çalışma; vitamin E’nin, otoimmün karaciğer hastalıklarının değerlendirilmesinde
potansiyel bir biyolojik belirteç olamayacağını ve tedavide yer alamayacağını ortaya
koymuştur. Aynı zamanda vitamin E seviyesi ile bu hastalarda meydana gelen fibrozis
evreleri arasında anlamlı bir ilişki yoktur.

Anahtar Kelimeler

Vitamin E, otoimmün hepatit, fibrozis

Kaynakça

• 1. Krawitt EL. Autoimmune hepatitis. N Engl J Med. 2006;354(1):54-66.
• 2. Krawitt EL. Autoimmune hepatitis: classification, heterogeneity, and treatment. Am J Med. 1994;96(1A):23-6.
• 3. Traber MG, Stevens JF. Vitamins C and E: beneficial effects from a mechanistic perspective. Free Radic Biol Med. 2011;51(5):1000-13.
• 4. Brigelius-Flohe R, Traber MG. Vitamin E: function and metabolism. FASEB J. 1999;13(10):1145-55.
• 5. Trachootham D, Lu W, Ogasawara MA, Nilsa RD, Huang P. Redox regulation of cell survival. Antioxid Redox Signal. 2008;10(8):1343-74.
• 6. Zingg JM. Vitamin E: an over view of major research directions. Mol Aspects Med. 2007;28(5-6):400-22.
• 7. Factor V M, Laskowska D, Jensen MR, Woitach JT, Popescu NC, Thorgeirsson SS. Vitamin E reduces chromosomal damage and inhibits hepatic tumor formation in a transgenic mouse model. Proc Natl Acad Sci USA. 2000;97(5):2196-201.
• 8. Kakizaki S, Takagi H, Fukusato T, Toyoda M, Horiguchi N, Sato K et al. Effect of alpha-tocopherol on hepatocarcinogenesis in transforming growth factor-alpha (TGF-alpha) transgenic mice treated with diethylnitrosamine. Int J Vitam Nutr Res. 2001;71(5):261-7.
• 9. Herbay AV, Stahl W, Niederau C, Sies H. Vitamin E improves the aminotransferase status of patients suffering from viral hepatitis C: a randomized, double-blind, placebo-controlled study. Free Radic Res. 1997;27(6):599-605.
• 10. Mahmood S, Yamada G, Niiyama G, Kawanaka M, Togawa K, Sho M et al. Effect of vitamin E on serum aminotransferase and thioredoxin levels in patients with viral hepatitis C. Free Radic Res. 2003;37(7):781-5.
• 11. Miyanishi K, Hoki T, Tanaka S, Kato J. Prevention of hepatocellular carcinoma: Focusing on antioxidant therapy. World J Hepatol. 2005;7(3):593-9.
• 12. Mohamed S, Waffa MI, Mohamed H, Mai ME. Effect of alpha-tocopherol on tissue transglutaminase and reversibility of thioacetamide-ınduced liver fibrosis in rats. Turk J Biochem. 2005;31(1):13-20.
• 13. Yano M, Kishida E, Iwasaki M, Kojo S, Masuzawa Y. Docosahexaenoic acid and vitamin E can reduce human monocytic U937 cell apoptosis induced by tumor necrosis factor. J Nutr. 2000;130(5):1095-101.
• 14. Takagi H1, Kakizaki S, Sohara N, Sato K, Tsukioka G, Tago Yet al. Pilot clinical trial of the use of alpha-tocopherol for the prevention of hepatocellular carcinoma in patients with liver cirrhosis. Int J Vitam Nutr Res. 2003;73(6):411-5.
• 15. Yeoman AD, Westbrook RH, Al-Chalabi T, Carey I, Heaton ND, Portmann BC et al. Diagnostic value and utility of the simplified International Autoimmune Hepatitis Group (IAIHG) criteria in acute and chronic liver disease. Hepatology. 2009;50(2):538-45.
• 16. Czaja AJ. Performance parameters of the diagnostic scoring systems for autoimmune hepatitis. Hepatology. 2008;48(5):1540-8.
• 17. Gatselis NK, Zachou K, Papamichalis P, Koukoulis GK, Gabeta S, Dalekos GN et al. Comparison of simplified score with the revised original score for the diagnosis of autoimmune hepatitis: a new or a complementary diagnostic score? Dig Liver Dis. 2010;42(11):807-12.
• 18. Campbell MS, Reddy KR. The evolving role of liver biopsy. Aliment Pharmacol Ther. 2004;20(3):249-59.
• 19. Cadranel JF, Rufat P, Degos F. Practices of liver biopsy in France: Results of a prospective nationwide survey. For the Group of Epidemiology of the French Association for the Study of the Liver (AFEF). Hepatology. 2000;32(3):477-81.
• 20. Blanc JF, Bioulac-Sage P, Balabaud C, Desmoulière A. Investigation of liver fibrosis in clinical practice. Hepatol Res. 2005;32(1):1-8.
• 21. Yoshikawa T, Takemura S, Kondo M. Alpha-tocopherol level in liver diseases. Acta Vitaminol Enzymol. 1982;4(4):311-8.
• 22. Ngu JH, Gearry RB, Frampton CM, Stedman CAM. Predictors of poor outcome in patients w ith autoimmune hepatitis: a population-based study. Hepatology. 2013;57(6):2399-406.
• 23. Floreani A. Baragiotta A, Martines D, Naccarato R, D'odorico A. Plasma antioxidant levels in chronic cholestatic liver diseases. Aliment Pharmacol Ther. 2000;14(3):353-8.
• 24. Kline K, Yu W, Sanders BG. Vitamin E and breast cancer. J Nutr. 2004;134(12 Suppl):3458-62S.
• 25. Gopalakrishna R, Gundimeda U. Antioxidant regulation of protein kinase C in cancer prevention. J Nutr. 2002;132(12):3819-23S.
• 26. Rockey DC. Antifibrotic therapy in chronic liver disease. Clin Gastro Hep. 2005;3(2):95-107.
• 27. Yadav D, Hertan HI, Schweitzer P, Norkus EP, Pitchumoni CS. Serum and liver micronutrient antioxidants and serum oxidative stress in patients with chronic hepatitis C. Am J Gastroenterol. 2002;97(10):2634-9.