Kronik hepatit-c hastalarında plazma prohepcidin ve demir parametreleri arasındaki ilişki
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Date
2009
Authors
Ölmez, Ömer Fatih
Journal Title
Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
Kronik hepatit C hastalarında karaciger hasarının gelisimindeki fizyopatolojik süreçte demir merkezi bir rol almaktadır. Bu vakalarda plazma ve karaciger demir miktarında artma gösterilmistir. Kronik hepatit C hastalarındaki bu demir birikiminin fizyopatogenezi açık degildir. Son zamanlarda karacigerden sentez edilip salınan hepcidinin demir metabolizması üzerindeki düzenleyici rolü üstüne çalısmalar yapılmaktadır. Hepcidin ekspresyonu inflamasyon ve enfeksiyon durumlarında artmaktadır. Biz çalısmamızda kronik hepatit C (KHC) vakalarındaki plazma prohepcidin seviyesi ve demir parametreleri arasındaki iliskiyi, kronik hepatit B (KHB) ve kontrol grubu ile kronik hepatit C grubu arasındaki farklılıkları ortaya koymayı amaçladık. Çalısmaya 35 kronik hepatit C'li, 27 kronik hepatit B'li hasta ve 21 saglıklı gönüllü dahil edildi. Çalısmaya katılan hastalarda plazma prohepcidin seviyesi ile demir parametreleri, hepatik aktivite indeksleri, fibrozis ve gruplar arası farklılıklar analiz edildi. Kronik hepatit C ve kontrol grubunda plazma prohepcidin seviyesi ile demir parametreleri arasında negatif korelasyon olmasına ragmen bu anlamlı düzeyde degildi (p>0,05). Kronik hepatit B ile plazma prohepcidin seviyesi arasında da anlamlı iliski saptanmadı (p>0,05). KHC grubunda hepatik aktivite indeksi ile plazma prohepcidin seviyesi arasında negatif iliski anlamlı düzeyde iken tüm gruplar analiz edildiginde fibrozis ile plazma prohepcidin seviyesi arasında anlamlı negatif iliski bulundu (p<0,05). Plazma demir ve ferritin seviyesi en yüksek KHB grubunda ve en düsük kontrol grubunda saptandı ve fark anlamlı düzeyde idi (p<0,05). Her üç grup arasında plazma prohepcidin seviyeleri karsılastırıldıgında, kadınlarda prohepcidin seviyesi her üç gruptada erkeklere göre daha yüksek bulundu. Plazma prohepcidin seviyesi en düsük KHB grubunda iken en yüksek kontrol grubunda tespit edildi ve fark istatistiki olarak anlamlı idi (p<0,05). KHC grubundaki prohepcidin seviyesi kontrol grubuna gore daha düsük tespit edildi ancak istatistiki anlamlılık saptanmadı. KHB ve KHC grubundaki prohepcidin seviyesinin kontrol grubuna gore düsük olması kronik hepatit vakalarındaki hepcidin salınım bozukluguna isaret etmektedir. Özellikle KHC vakalarındaki artmıs serbest oksijen radikallerinin hepcidinin bozulmus regülasyonundaki yeri literatür tarafından ortaya koyulmaya baslanmıstır. Sonuç olarak asırı demir birikiminin kronik hepatit sürecindeki karacigerde yol açtıgı hasar bilinmektedir. Plazma demirinin negatif düzenleyici faktörü olan hepcidinin asırı demir birikimindeki rolünü açıga çıkarmak için çok merkezli, randomize ve hasta sayısı fazla olan çalısmalara ihtiyacı vardır.
Iron plays a central role in the physiopathological process of liver damage development in patients with chronic hepatitis C (CH-C). It has been showed that the amount of plasma and hepatic iron load is increased in these cases. Physiopathogenesis of iron accumulation in CH-C patients is not clear. In recent years, studies have been conducted on the regulatory role of hepcidin in iron metabolism. In this study we aimed to show the relationship between plasma prohepcidin levels and iron parameters in CH-C patients and the difference between the CH-C group and chronic hepatitis B (CH-B) and control groups. Totally, 35 CH-C patients, 27 CH-B patients and 21 healthy volunteers were included in the study. The associations between plasma prohepcidin levels and iron parameters, hepatic activity index, fibrosis were analyzed, and intergroup differences were assessed. Although it is not significant, there was a negative correlation between plasma prohepcidin levels and iron parameters in CH-C and control groups (p>0.05). There was no significant correlation between iron parameters and plasma prohepcidin levels in CH-B patients (p>0.05). While a negative significant correlation was observed between hepatic activity index and plasma prohepcidin level in CH-C group also a negative correlation was detected between fibrosis and plasma prohepcidin levels, when all groups were taken into analysis (p<0.05). The highest plasma iron and ferritin levels were detected in CH-B group and the lowest levels were detected in control group and the differences were found to be significant (p<0.05). It has been noted that the plasma prohepcidin levels were significantly high in all women in all 3 groups. It was statistically significant that the lowest plasma prohepcidin levels were in CH-B group and the highest levels were in control group (p<0,05). The prohepcidin levels found lower than control group but it wasn't statistically significant. Lower levels of prohepcidin in CH-B and CH-C groups compared with the control group indicated the defective release of hepcidin in the cases of chronic hepatitis. The importance of increased free oxygen radicals in the regulation of the defective release of hepcidin, especially in CH-C cases, has been revealed with clinical trials. In conclusion, excess iron accumulation is known to lead to liver damage in chronic hepatitis course. Multicenter, randomized studies with larger patient groups are required to reveal the role of the hepcidin, which is a negative regulatory factor of the plasma iron, in iron over accumulation.
Iron plays a central role in the physiopathological process of liver damage development in patients with chronic hepatitis C (CH-C). It has been showed that the amount of plasma and hepatic iron load is increased in these cases. Physiopathogenesis of iron accumulation in CH-C patients is not clear. In recent years, studies have been conducted on the regulatory role of hepcidin in iron metabolism. In this study we aimed to show the relationship between plasma prohepcidin levels and iron parameters in CH-C patients and the difference between the CH-C group and chronic hepatitis B (CH-B) and control groups. Totally, 35 CH-C patients, 27 CH-B patients and 21 healthy volunteers were included in the study. The associations between plasma prohepcidin levels and iron parameters, hepatic activity index, fibrosis were analyzed, and intergroup differences were assessed. Although it is not significant, there was a negative correlation between plasma prohepcidin levels and iron parameters in CH-C and control groups (p>0.05). There was no significant correlation between iron parameters and plasma prohepcidin levels in CH-B patients (p>0.05). While a negative significant correlation was observed between hepatic activity index and plasma prohepcidin level in CH-C group also a negative correlation was detected between fibrosis and plasma prohepcidin levels, when all groups were taken into analysis (p<0.05). The highest plasma iron and ferritin levels were detected in CH-B group and the lowest levels were detected in control group and the differences were found to be significant (p<0.05). It has been noted that the plasma prohepcidin levels were significantly high in all women in all 3 groups. It was statistically significant that the lowest plasma prohepcidin levels were in CH-B group and the highest levels were in control group (p<0,05). The prohepcidin levels found lower than control group but it wasn't statistically significant. Lower levels of prohepcidin in CH-B and CH-C groups compared with the control group indicated the defective release of hepcidin in the cases of chronic hepatitis. The importance of increased free oxygen radicals in the regulation of the defective release of hepcidin, especially in CH-C cases, has been revealed with clinical trials. In conclusion, excess iron accumulation is known to lead to liver damage in chronic hepatitis course. Multicenter, randomized studies with larger patient groups are required to reveal the role of the hepcidin, which is a negative regulatory factor of the plasma iron, in iron over accumulation.
Description
Keywords
Kronik hepatit C, Kronik hepatit B, Demir, Prohepcidin, Histopatoloji, Chronic hepatitis C, Chronic hepatitis B, Iron, Prohepcidin, Histopathology
Citation
Ölmez, Ö. F. (2009). Kronik hepatit-c hastalarında plazma prohepcidin ve demir parametreleri arasındaki ilişki. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.