Kronik viral hepatit B ve C'li hastalarda karaciğer fibrozisin noninvaziv değerlendirilmesinde hyaluronik asit, tip IV kollajen, prokollajen tip III amino-terminal peptid düzeyi
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Date
2011
Authors
Irak, Kader
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Kronik hepatitli hastalarda inflamasyon ve fibrozisin derecesini belirlemede karaciğer biyopsisi `altın standart' olarak kabul edilmektedir. Tedavi öncesi yapılmasındaki temel hedef tedaviden fayda görmesi beklenen grubu (orta derecede inflamasyon ve ileri derecede fibrozisli) belirlemektir. Bununla birlikte karaciğer biyopsisinin mortalite ve morbiditeye neden olması, etik nedenlerle takip için uygun olmaması ve karaciğerdeki patolojilerin heterojen dağılımı tanıdaki rolünün tartışılmasına neden olmaktadır.Yapılan çalışmalarda biyopsi yapılmadan fibrozisin evresini belirlemeye imk?n sağlayacak invaziv olmayan biyokimyasal belirleyicilerin histolojik hasarı tespit etme ve fibrozisin ilerlemesinin takibinde yardımcı olabileceği düşünülmektedir.Çalışmamızda kronik hepatit B ve C'li hastalarda karaciğerdeki fibrozisi değerlendirmede noninvaziv belirteçlerden olan hyaluronik asit, tip IV kollajen, prokollajen III aminoterminal peptit düzeyinin karaciğer histopatolojisi ile ilişkisini ortaya koymayı amaçladık.Bu çalışmada 56 kronik hepatit B ile 24 kronik hepatit C hastası incelendi. Hastalar Ishak skorlama sistemi kullanılarak yapılan karaciğer biyopsisinde fibrozis skorlarına göre HA, PIIINP, Tip IV kollajen düzeyleri açısından karşılaştırıldı. Kronik hepatit B'de ciddi fibrozis grubunda tip IV kollajen düzeyleri istatistiksel olarak anlamlı derecede yüksekti (p<0,05). Kronik hepatit C'li hastalarda ise fibrozis skoruna göre ayrılan gruplar arasında noninvaziv belirteçlerin düzeyi ile istatistiksel anlamlılık tespit edilmedi.Dolayısıyla bu çalışmanın sonucuna göre; karaciğer fibrozisinin noninvaziv ölçümünde kullanılabilecek serum belirteçlerinin değerleri gittikçe artıyor olmasına rağmen karaciğer biyopsi örneğinin histopatolojik incelenmesi halen, karaciğer hastalığının evrelemesinde önemini korumaktadır.
Liver biopsy is the `gold standard' for evaluating the degree of inflammation and fibrosis in patients with chronic hepatitis. The aim of liver biopsy is to determine the patients with moderate degree of inflammation and advanced fibrosis who are expected to benefit from treatment. However, the role of biopsy in the diagnosis of liver diseases is controversial because the procedure has the risk of morbidity and mortality, performing recurrent liver biopsies cannot be accepted as an ethical conduct and the obtained specimen may not present the disease due to the heterogeneous nature of liver pathologies.In several studies it is suggested that non-invasive biochemical markers, which allow determining the stage of fibrosis without biopsy, may help to screen histological damage and the progression of fibrosis.In our study, our aim was to evaluate the relation of serum levels of hyaluronic acid, collagen type IV, and procollogen amino-terminal peptide type III which are non-invasive markers of liver fibrosis with the stage of histopathological liver fibrosis in patients with chronic hepatitis B and C.The study included 56 patients with chronic hepatitis B and 24 patients with chronic hepatitis C. The fibrosis in the liver specimens was evaluated according to Ishak scoring system and the results were compared with serum hyaluronic acid, collagen type IV, and procollogen amino-terminal peptide type III levels. For the patients with chronic hepatitis B, serum levels of type IV collagen were significantly correlated with the severity of fibrosis (p<0.05). However for the patients with chronic hepatitis C, there was no correlation between the serum levels of bio markers and histological liver fibrosis.Consequently, the results of this study revealed that even increasing value of the serum markers which can be used for non-invasive measurements of liver fibrosis, histopathologic examination of the liver is still important for determining the severity of liver diseases.
Liver biopsy is the `gold standard' for evaluating the degree of inflammation and fibrosis in patients with chronic hepatitis. The aim of liver biopsy is to determine the patients with moderate degree of inflammation and advanced fibrosis who are expected to benefit from treatment. However, the role of biopsy in the diagnosis of liver diseases is controversial because the procedure has the risk of morbidity and mortality, performing recurrent liver biopsies cannot be accepted as an ethical conduct and the obtained specimen may not present the disease due to the heterogeneous nature of liver pathologies.In several studies it is suggested that non-invasive biochemical markers, which allow determining the stage of fibrosis without biopsy, may help to screen histological damage and the progression of fibrosis.In our study, our aim was to evaluate the relation of serum levels of hyaluronic acid, collagen type IV, and procollogen amino-terminal peptide type III which are non-invasive markers of liver fibrosis with the stage of histopathological liver fibrosis in patients with chronic hepatitis B and C.The study included 56 patients with chronic hepatitis B and 24 patients with chronic hepatitis C. The fibrosis in the liver specimens was evaluated according to Ishak scoring system and the results were compared with serum hyaluronic acid, collagen type IV, and procollogen amino-terminal peptide type III levels. For the patients with chronic hepatitis B, serum levels of type IV collagen were significantly correlated with the severity of fibrosis (p<0.05). However for the patients with chronic hepatitis C, there was no correlation between the serum levels of bio markers and histological liver fibrosis.Consequently, the results of this study revealed that even increasing value of the serum markers which can be used for non-invasive measurements of liver fibrosis, histopathologic examination of the liver is still important for determining the severity of liver diseases.
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Keywords
Karaciğer fibrozisi, Kronik hepatit B, Kronik hepatit C, Noninvaziv belirteç, Liver fibrosis, Chronic hepatitis B, Chronic hepatitis C, Non-invasive marker
Citation
Irak, K. (2011). Kronik viral hepatit B ve C'li hastalarda karaciğer fibrozisin noninvaziv değerlendirilmesinde hyaluronik asit, tip IV kollajen, prokollajen tip III amino-terminal peptid düzeyi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.