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

Öz

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.

Anahtar Kelimeler

• 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

Öz

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.

Anahtar Kelimeler

• Hyperhomocysteinemia
• vitamin B12
• metaplasia

Kaynakça

1. Nygård O, Nordrehaug JE, Refsum H, Ueland PM, Farstad M, Vollset SE. Plasma homocysteine levels and mortality in patients with coronary artery disease. N Engl J Med. 1997;337(4):230-236. doi:10.1056/NEJM199707243370403
2. Gospodarczyk A, Marczewski K, Gospodarczyk N, Widuch M, Tkocz M, Zalejska Fiolka J. Homocysteine and cardiovascular disease - a current review. Wiad Lek. 2022;75(11 pt 2):2862-2866. doi:10.36740/WLek202211224
3. Dinis Ribeiro M, Areia M, de Vries AC, et al. Management of precancerous conditions and lesions in the stomach (MAPS): guideline from the European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter Study Group (EHSG), European Society of Pathology (ESP), and the Sociedade Portuguesa de Endoscopia Digestiva (SPED). Endoscopy. 2012;44(1):74-94. doi:10.1055/s-0031-1291491
4. Kösekli MA. Is Helicobacter pylori prevalence associated with the family population? Exp Biomed Res. 2022;5(2):217-224.
5. de Gonzalo Calvo D, de Luxán Delgado B, Rodríguez González S, et al. Interleukin 6, soluble tumor necrosis factor receptor I and red blood cell distribution width as biological markers of functional dependence in an elderly population: a translational approach. Cytokine. 2012;58(2):193-198. doi:10.1016/j.cyto.2012.01.005
6. Nishizaki Y, Yamagami S, Suzuki H, et al. Red blood cell distribution width as an effective tool for detecting fatal heart failure in super-elderly patients. Intern Med. 2012;51(17):2271-2276. doi:10.2169/internalmedicine.51.7938
7. He Y, Liu C, Zeng Z, Ye W, Lin J, Ou Q. Red blood cell distribution width: a potential laboratory parameter for monitoring inflammation in rheumatoid arthritis. Clin Rheumatol. 2018;37(1):161-167. doi:10.1007/s10067-017-3871-7
8. Kutluana U, Simsek I, Akarsu M, Kupelioglu A, Karasu S, Altekin E. Is there a possible relation between atrophic gastritis and premature atherosclerosis?. Helicobacter. 2005;10(6):623-629. doi:10.1111/j.1523-5378.2005.00356.x

9. Kutluana U, Kilciler AG. Is there a possible relationship between gastric intestinal metaplasia and systemic arterial stiffness?. Rev Esp Enferm Dig. 2019;111(7):500-506. doi:10.17235/reed.2019.5945/2018
10. Dixon MF, Genta RM, Yardley JH, Correa P. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol. 1996;20(10):1161-1181. doi:10.1097/00000478-199610000-00001
11. Shah SC, Piazuelo MB, Kuipers EJ, Li D. AGA Clinical Practice Update on the Diagnosis and Management of Atrophic Gastritis: Expert Review. Gastroenterology. 2021;161(4):1325-1332.e7. doi:10.1053/j.gastro.2021.06.078
12. Abosamra M, Bateman AC, Jalal M. Chronic atrophic gastritis - An overlooked association with severe vitamin B12 deficiency: A case report and rapid review of literature. J R Coll Physicians Edinb. 2023;53(3):176-178. doi:10.1177/14782715231180965
13. Kapadia CR. Gastric atrophy, metaplasia, and dysplasia: a clinical perspective. J Clin Gastroenterol. 2003;36(5 Suppl):29-36;discussion 61-62. doi:10.1097/00004836-200305001-00006
14. Parsons BN, Ijaz UZ, D'Amore R, et al. Comparison of the human gastric microbiota in hypochlorhydric states arising as a result of Helicobacter pylori-induced atrophic gastritis, autoimmune atrophic gastritis and proton pump inhibitor use. PLoS Pathog. 2017;13(11):e1006653. doi:10.1371/journal.ppat.1006653
15. Yang GT, Zhao HY, Kong Y, Sun NN, Dong AQ. Correlation between serum vitamin B12 level and peripheral neuropathy in atrophic gastritis. World J Gastroenterol. 2018;24(12):1343-1352. doi:10.3748/wjg.v24.i12.1343
16. Sohouli MH, Almuqayyid F, Alfardous Alazm A, et al. A comprehensive review and meta-regression analysis of randomized controlled trials examining the impact of vitamin B12 supplementation on homocysteine levels. Nutr Rev. 2024;82(6):726-737. doi:10.1093/nutrit/nuad09
17. Zaric BL, Obradovic M, Bajic V, Haidara MA, Jovanovic M, Isenovic ER. Homocysteine and Hyperhomocysteinaemia. Curr Med Chem. 2019;26(16):2948-2961. doi:10.2174/0929867325666180313105949
18. Dholakia KR, Dharmarajan TS, Yadav D, Oiseth S, Norkus EP, Pitchumoni CS. Vitamin B12 deficiency and gastric histopathology in older patients. World J Gastroenterol. 2005;11(45):7078-7083. doi:10.3748/wjg.v11.i45.7078
19. Kwan CP, Tytgat GN. Antral G-cell hyperplasia: a vanishing disease? Eur J Gastroenterol Hepatol. 1995;7(11):1099-1103. doi:10.1097/00042737-199511000-00014
20. Kutluana U, Kilciler AG, Mizrak S, Dilli U. Can neopterin be a useful immune biomarker for differentiating gastric intestinal metaplasia and gastric atrophy from non-atrophic non-metaplastic chronic gastritis? Gastroenterol Hepatol. 2019;42(5):289-295. doi:10.1016/j.gastrohep.2019.01.005
21. Turgut S, Kösekli MA. Gastrik intestinal metaplazi anemiye yol açar mı? YÖK Başkanlığı Tez Kurumu 906237/2024