Karaciğer fibrozisi ile serum hyaluronik asit düzeyi arasındaki ilişki
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Date
2004
Authors
Yalçın, Mustafa
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Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
AMAÇ : Çalışmamızda bag dokusunda yaygın olarak dağılmış, dallanmış bir iskelete sahip büyük molekül ağırlıklı, (1-ß-3)-D-glukoronik asit ve (1-ß-4)-N-asetil-D-glukozaminin tekrarlayan disakkarid ünitelerinden meydana gelmiş bir polisakkarid olan hyaluronik asitin (HA) artmış serum düzeyleri ile karaciğer fibrozisi arasındaki ilişkinin araştırılması amaçlandı. GEREÇ VE YÖNTEM: Uludağ Üniversitesi Tıp Fakültesi İç hastalıkları AD, Gastroenteroloji BD'na başvuran kronik hepatitli ve karaciğer sirozlu 84 hasta çalışmaya alındı. Hastalar önce 2 guruba ayrıldı. Gurup 1; Kronik hepatitli hastalar ki (n: 41) bunlar daha sonra karaciğer biyopsisindeki fibrozis skoruna göre iki alt guruba ayrıldı (fibrozis skoru 0-1 ve 3). Gurup 2; Karaciğer sirozlu hastalar (n:43) bunlar da daha sonra kompanse ve dekompanse sirozlu hastalar olmak üzere iki alt guruba ayrıldı. Ayrıca hastaların başvuru sırasındaki trombosit sayıları, AST, ALT ve protrombin zamanı kaydedildi. Sirozlu hastalara başvuru sırasında Child-Pugh sınıflaması yapıldı. Serum HA düzeyleri Corgenix HA kiti kullanılarak ölçüldü. BULGULAR: Gurup 1'de (kronik hepatit grubu) serum HA düzeyinin 24.3±1.7 ng/mL olduğu, Gurup 2'de (karaciğer siroz grubu) ise serum HA düzeyinin 199.4±26.3 ng/mL olduğu saptandı. Aralarında istatistiksel anlamlı farklılık vardı (p=0001). HA düzeyi karaciğer sirozlu hasta grubunda belirgin artış gösterdi. HA düzeyinin 40 ng/mL üzerindeki değerler siroz tanısı koymak için yüksek spesifite ve sensitiviteye sahipti. Hasta grubumuzu kronik hepatit fibrozis skoru 0-1, 3, kompanse siroz ve dekompanse siroz olarak dort alt gruba ayırdığımızda, serum HA düzeyleri sırasıyla 17.8±2.3 ng/mL, 29±1.8 ng/mL, 106.9±14.3 ng/mL, 296.4±16.8 ng/mL olarak saptandı (p=0.0001). Tüm guruplar arasında istatistiksel olarak anlamlı farklılık vardı. Child-Pugh sınıflamasına göre serum HA düzeylerine bakıldı. Child A sirozlu hastalarda 107.2±15.0 ng/mL, Child B sirozlu hastalarda 242.5±61.9 ng/mL ve Child C sirozlu hastalarda 297.5+49.6 ng/mL olarak tespit edildi. SONUÇ: HA serum seviyeleri, karaciğerin farklı fibrozis evresinde göze çarpan artışlar göstermektedir. Ayrıca karaciğer sirozunun erken tanısında spesifite ve sensitivitesi yüksek bir parametredir. Hyaluronik asit düzeylerinin diğer laboratuvar bulgularıyla kombine kullanılması halinde tanısal etkinliği artmaktadır. Bizim çalışmamız göstermiştir ki serum HA düzeylerinde, fibrozis skorunun artmasıyla progresif artış olmasına rağmen en belirgin artış kronik hepatitten siroza geçişte görülmektedir. Serum HA düzeyi karaciğer sirozlu hastalarda ChiId-Pugh sınıflamasıyla da pozitif korelasyon göstermektedir. Bu sonuçlar desteklemektedir ki serum HA düzeyi fibrozisin primer göstergesi olabilir. Karaciğer biyopsisi fibrozis tespitinde halen altın standarttır. Biyopsi yapılmış hastaların uzun dönem izlemlerinde serum HA düzeyi fibrozisin takibinde kullanılabilir bir parametredir. Bu hastaların serum HA düzeyleri, karaciğer fibrozisinin progresyonunu takip etmede ve gelecekteki biyopsi ihtiyacını belirlemede kullanışlı olabilir. Ayrıca karaciğer biyopsisinin kontrendike olduğu durumlarda fibrozis evresini belirlemede, özellikle de siroz ile kronik hepatit ayrımında kullanılabilir.
OBJECTIVES: The aim of our study is to evaluate the association between the increased serum levels of hyaluronic acid (HA) and hepatic fibrosis. HA is a lineer polysaccharide of repeating disaccharide units of D-glucuronic acid (1-ß-3) and N-acetyl-D-glucosamine (1-ß-4) which has a large molecular weight and it is distributed diffusely in the connective tissue. MATERIAL AND METHODS: Total of 84 patients who were admitted to Uludag University, Faculty of Medicine, Department of Gastroenterology with chronic hepatitis and hepatic cirrhosis were included in this study. The patients were classified into two groups. After that the patients who had chronic hepatitis were divided into two sub groups according to the fibrosis score (fibrosis score 0-1 and 3) in group 1 and the patients who had hepatic cirrhosis were divided into two subgroups as compensated and decompensated patients. The platelet count, AST, ALT and protrombin time values of the patients were also recorded retrospectively. Child-Pugh classification was used for the cirrotic patients at the admission and the serum HA levels were meassured by using Corgenix HA cits. RESULTS: Serum HA levels were found as 24±1.7 ng/ml and 199.4±26.3 ng/ml in group 1 and 2 respectively. There was an statistically significant differance between them. The HA levels showed marked elevation in the hepatic cirrhosis group. The levels of HA over 40 ng/ml had high sensitivity and spesificity for the diagnosis of cirrhosis. When our patients were classified into 4 groups as chronic hepatitis fibrosis score 0-1, 3, compensated and decompensated cirrhosis; the serum HA levels were determined as 17.8±2.3 ng/ml, 29±1.8 ng/ml, 106.9±14.3 ng/ml and 296±16.8 ng/ml respectively. There were significant difference between all the groups. Serum HA levels were also evaluated for Child-Pugh classification. It was found 107.2±15.0 ng/ml in Child A patients, 242.5±61.9 ng/ml in Child B patients and 297.5±49.6 ng/ml in Child C patients. CONCLUSION: The HA levels showed marked increase for the different hepatic fibrosis stages. It has also high specificity and sensitivity for the early diagnosis of hepatic cirrhosis. If HA is used combined with the other laboratuary findings, its diagnostic efficacy has increased. We have shown that serum HA levels were elaveted progresively with the increase in the fibrosis sccire, the most increase was found in the early stages of cirrotic patiens. Serum HA levels also showed positive correlation with the Child-Pugh classification in the cirrhotic patients. The results suggest that serum HA levels can be the primary indicator of the fibrosis. Liver biopsy is still gold standart in the diagnosis of fibrosis. Serum HA levels can be used for the evaluation of fibrosis in the long term follow up of the patients who underwent biopsy. The serum HA levels of these patients can also be used to follow up the progression of hepatic fibrosis. It can also be used to determine the stage of fibrosis and to differantiate cirrhosis and chronic hepatitis in whom liver biopsy is contraindicated.
OBJECTIVES: The aim of our study is to evaluate the association between the increased serum levels of hyaluronic acid (HA) and hepatic fibrosis. HA is a lineer polysaccharide of repeating disaccharide units of D-glucuronic acid (1-ß-3) and N-acetyl-D-glucosamine (1-ß-4) which has a large molecular weight and it is distributed diffusely in the connective tissue. MATERIAL AND METHODS: Total of 84 patients who were admitted to Uludag University, Faculty of Medicine, Department of Gastroenterology with chronic hepatitis and hepatic cirrhosis were included in this study. The patients were classified into two groups. After that the patients who had chronic hepatitis were divided into two sub groups according to the fibrosis score (fibrosis score 0-1 and 3) in group 1 and the patients who had hepatic cirrhosis were divided into two subgroups as compensated and decompensated patients. The platelet count, AST, ALT and protrombin time values of the patients were also recorded retrospectively. Child-Pugh classification was used for the cirrotic patients at the admission and the serum HA levels were meassured by using Corgenix HA cits. RESULTS: Serum HA levels were found as 24±1.7 ng/ml and 199.4±26.3 ng/ml in group 1 and 2 respectively. There was an statistically significant differance between them. The HA levels showed marked elevation in the hepatic cirrhosis group. The levels of HA over 40 ng/ml had high sensitivity and spesificity for the diagnosis of cirrhosis. When our patients were classified into 4 groups as chronic hepatitis fibrosis score 0-1, 3, compensated and decompensated cirrhosis; the serum HA levels were determined as 17.8±2.3 ng/ml, 29±1.8 ng/ml, 106.9±14.3 ng/ml and 296±16.8 ng/ml respectively. There were significant difference between all the groups. Serum HA levels were also evaluated for Child-Pugh classification. It was found 107.2±15.0 ng/ml in Child A patients, 242.5±61.9 ng/ml in Child B patients and 297.5±49.6 ng/ml in Child C patients. CONCLUSION: The HA levels showed marked increase for the different hepatic fibrosis stages. It has also high specificity and sensitivity for the early diagnosis of hepatic cirrhosis. If HA is used combined with the other laboratuary findings, its diagnostic efficacy has increased. We have shown that serum HA levels were elaveted progresively with the increase in the fibrosis sccire, the most increase was found in the early stages of cirrotic patiens. Serum HA levels also showed positive correlation with the Child-Pugh classification in the cirrhotic patients. The results suggest that serum HA levels can be the primary indicator of the fibrosis. Liver biopsy is still gold standart in the diagnosis of fibrosis. Serum HA levels can be used for the evaluation of fibrosis in the long term follow up of the patients who underwent biopsy. The serum HA levels of these patients can also be used to follow up the progression of hepatic fibrosis. It can also be used to determine the stage of fibrosis and to differantiate cirrhosis and chronic hepatitis in whom liver biopsy is contraindicated.
Description
Keywords
Hyaluronik asit, Fibrozis, Karaciger, Hyaluronic acid, Fibrosis, Liver
Citation
Yalçın, M. (2004). Karaciğer fibrozisi ile serum hyaluronik asit düzeyi arasındaki ilişki. Yayınlanmamış tıpta uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.