Kronik Hepatit B enfeksiyonlu hastalarda görülen, akut hepatik alevlenmelerin demografik, klinik, biyokimyasal ve virolojik özellikleri
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Tarih
2012
Yazarlar
Dergi Başlığı
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Cilt Başlığı
Yayıncı
Dicle Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Hepatit B virüsünün doğal seyri viral replikasyon ve konakçının immün yanıtı arasındaki etkileşim ile belirlenir. Serum aminotransferaz düzeylerinde ani artış olarak kendini gösteren akut hepatik alevlenme, kronik hepatit B enfeksiyonunun doğal seyri sırasında sık görülen bir durumdur. Bu çalışmada kronik hepatit B enfeksiyonu olan hastalarda meydana gelen akut hepatik alevlenmelerin demografik, klinik, biyokimyasal, virolojik ve etyolojik özelliklerinin incelenmesi amaçlanmıştır.Metod: Çalışma retrospektif ve prospektif olarak dizayn edildi. 2005-2012 yılları arasında Gastroenteroloji kliniğimize, akut hepatik alevlenme ile başvuran kronik hepatit B enfeksiyonlu hastalar, çalışmaya dahil edildi. Hastaların demografik, klinik, biyokimyasal ve virolojik bulguları önceden hazırlanmış formlar kullanılarak kaydedildi.Bulgular: Çalışmaya 125 hasta alındı. Yaş ortalaması 34.08 ± 12.68 ve erkek (%69.6) kadın (%30.4) oranı 2.28 bulundu. Ailesinde hepatit B enfeksiyon hikayesi olan hasta sayısı 58 (%46.4) bulundu. 117 hastada (%93.6) en az bir semptom mevcuttu. En sık görülen semptomlar halsizlik (%81.6), iştahsızlık (%64), sarılık (%60) ve bulantı (%52) idi.Çalışmaya alınan 108 hastada (%86.4) serum transaminaz düzeyleri normalin üst sınırına göre 10 kat artış göstermekteydi. Serum GGT, bilirubin, ferritin, LDH, AFP ve ALP düzeyleri sırasıyla, hastaların %84, %76.8, %76, %74.4, %42.4 ve %36.8 yüksek saptandı. Ferritin ve transaminaz düzeyleri arasında pozitif korelasyon mevcuttu (p<0.001).Anti-HBc IgM antikoru 24 hastada (%19.2) saptandı ve ALT (p = 0.002) ve ferritin (p= 0.004) düzeyleri ile pozitif korelasyon gösteriyordu. Serum HBV DNA 107 hastada (%85.6) pozitif olup ortalama HBV DNA log10 düzeyi 5.8 ± 2:07 IU bulundu. Alevlenmelerin en sık nedeni spontan hepatik alevlenmeler idi (%80.8).Sonuç: Çalışmamızın sonuçlarına göre akut hepatik alevlenme daha çok ailesinde hepatit B virüs infeksiyon öyküsü olan genç erkeklerde görülmektedir. Hastalık genellikle non-spesifik semptomlarla prezente olmakta ve sarılık hastalarda en sık görülen bulgudur. Bu hastalarda ferritin, hepatoselüler hasarın ve yoğun inflamasyonun bir belirtisi olarak yüksek seyertmektedir. Serum HBV-DNA ve anti-HBc IgM pozitifliği ile birlikte AFP yüksekliği akut hepatik alevlenmede sık karşılaşılan bulgulardır.
Background and Aim: The natural history of hepatitis B virus is determined by the interaction between viral replication and the host's immune response. Acute hepatitic flares as abrupt increases in serum aminotransferases are often observed during the natural course of chronic hepatitis B infection. In this study, we aimed to investigate demographic, clinical, biochemical, virological and etiological characteristics of patients with acute hepatic exacerbations.Methods: Study was designed as a retrospective and prospective manner. Chronic hepatitis B patients with acute hepatic flares, admitted to the Department of Gastroenterology between 2005-2012 years, were enrolled into the study. Demographic, clinical, biochemical and virological findings were recorded via pre-prepared forms.Results: There were 125 patients conducted into this study. The mean age was 34.08 ± 12,68 and male (69,6%) to female (30,4%) ratio was found to be 2,28. Family history of hepatitis B infection was found in 58 (46,4%) patients. 117 patients (93,6%) had at least one symptom. The most common symptoms were fatigue (81,6%), loss of appetite (64%), jaundice (60%) and nausea (52%).Transaminase levels were more than 10 times the upper limit of normal in 108 patients (86,4%). The elevated levels of serum GGT, bilirubin, ferritin, LDH, AFP and ALP was detected in 84%, 76,8%, 76%, 74,4%, 42,4% and 36,8% of patients, respectively. There was a positive correlation between ferritin and transaminase levels (p<0.001).Anti-HBc IgM antibody was detected in 24 patients (19,2%) and was positively correlated with ALT (p = 0.002) and ferritin (p = 0.004). Serum HBV DNA was positive in 107 (85,6%) patients and mean level of HBV DNA log10 was 5,8 ± 2,07 IU. The most common cause of exacerbations was spontaneous hepatic flare (80,8%).Conclusion: According to the results of our study, acute hepatic exacerbations are more commonly seen in young men with a family history of hepatitis B virus infection. The disease usually presents with non-specific symptoms and jaundice is the most common finding. As a sign of intensive inflammation and hepatocellular injury, serum ferritin levels seem to be high. Serum HBV DNA and anti-HBc IgM positivity together with AFP elevation are presenting features in acute hepatic exacerbations.
Background and Aim: The natural history of hepatitis B virus is determined by the interaction between viral replication and the host's immune response. Acute hepatitic flares as abrupt increases in serum aminotransferases are often observed during the natural course of chronic hepatitis B infection. In this study, we aimed to investigate demographic, clinical, biochemical, virological and etiological characteristics of patients with acute hepatic exacerbations.Methods: Study was designed as a retrospective and prospective manner. Chronic hepatitis B patients with acute hepatic flares, admitted to the Department of Gastroenterology between 2005-2012 years, were enrolled into the study. Demographic, clinical, biochemical and virological findings were recorded via pre-prepared forms.Results: There were 125 patients conducted into this study. The mean age was 34.08 ± 12,68 and male (69,6%) to female (30,4%) ratio was found to be 2,28. Family history of hepatitis B infection was found in 58 (46,4%) patients. 117 patients (93,6%) had at least one symptom. The most common symptoms were fatigue (81,6%), loss of appetite (64%), jaundice (60%) and nausea (52%).Transaminase levels were more than 10 times the upper limit of normal in 108 patients (86,4%). The elevated levels of serum GGT, bilirubin, ferritin, LDH, AFP and ALP was detected in 84%, 76,8%, 76%, 74,4%, 42,4% and 36,8% of patients, respectively. There was a positive correlation between ferritin and transaminase levels (p<0.001).Anti-HBc IgM antibody was detected in 24 patients (19,2%) and was positively correlated with ALT (p = 0.002) and ferritin (p = 0.004). Serum HBV DNA was positive in 107 (85,6%) patients and mean level of HBV DNA log10 was 5,8 ± 2,07 IU. The most common cause of exacerbations was spontaneous hepatic flare (80,8%).Conclusion: According to the results of our study, acute hepatic exacerbations are more commonly seen in young men with a family history of hepatitis B virus infection. The disease usually presents with non-specific symptoms and jaundice is the most common finding. As a sign of intensive inflammation and hepatocellular injury, serum ferritin levels seem to be high. Serum HBV DNA and anti-HBc IgM positivity together with AFP elevation are presenting features in acute hepatic exacerbations.
Açıklama
Anahtar Kelimeler
Kronik hepatit B enfeksiyonu, Hepatik alevlenme, Hepatit B virüsü, Chronic hepatitis B infection, Hepatic exacerbation, Hepatitis B virus
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Beştaş, R. (2012). Kronik Hepatit B enfeksiyonlu hastalarda görülen, akut hepatik alevlenmelerin demografik, klinik, biyokimyasal ve virolojik özellikleri. Yayımlanmamış uzmanlık tezi, Dicle Üniversitesi, Diyarbakır.
