Haşim NAR, İDRİS KIRHAN, Hüseyin TAŞKIRAN, ÇİĞDEM CİNDOĞLU, AHMET UYANIKOĞLU, Necati YENİCE

Kronik hepatitli ve karaciğer sirozlu hastaların biyoelektrik impedans yöntemi ile değerlendirilmesi

Giriş ve Amaç: Bu çalışmada, kronik hepatitli, sirozlu ve sağlıklı bireyler arasında biyoelektriksel impedans analiz yöntemi ile fark olup olmadığının araştırılması amaçlanmıştır. Gereç ve Yöntem: Çalışmaya Haziran 2012-2013 tarihleri arasında Harran Üniversitesi Tıp Fakültesi, Gastroenteroloji polikliniğinde takip edilen 31 kronik hepatit B ve kronik hepatit C hastası, 35 karaciğer sirozu ve 38 sağlıklı erişkin alındı. Olgular kronik hepatit, karaciğer sirozu ve sağlıklı kontrol olarak üç gruba ayrıldı. Olguların yaş, cinsiyet, boy, kilo, hematokrit, sodyum, potasyum değerleri ve biyoelektriksel impedans analiz ölçümü sonrası elde edilen değerler kaydedildi ve istatistiksel analiz yapıldı. Bulgular: Siroz grubunun hematokrit ve sodyum değeri anlamlı olarak düşüktü (p <0.05). Vücut kapasitans değeri kronik hepatitli grupta ve siroz grubunda kontrol grubuna göre yüksekti (p <0.05). Kronik hepatitli grupta rezistans kontrol grubuna göre düşüktü (p <0.05). Vücut hücre kitlesi kronik hepatitli grupta kontrol grubuna göre yüksekti (p <0.05). Kronik hepatitli grupta bazal metabolik hız kontrol grubuna göre yüksekti (p <0.05). Kronik hepatitli grubun yağsız vücut kitlesi kontrol grubuna göre yüksekti (p <0.05). Kronik hepatitli grubun intrasellüler sıvı ve total vücut suyu kontrol grubuna göre yüksekti (p <0.05). Faz açısı kronik hepatitli grupta diğer gruplara göre yüksek olsa da istatistiksel olarak anlamlı değildi (p >0.05). Sonuç: Biyoelektriksel impedans analiz ile sirotik grupta, kontrol ve kronik hepatitli grupla karşılaştırıldığında anlamlı bir değişiklik saptanmamasına rağmen kronik hepatitli grupta saptanan değişiklikler biyoelektriksel impedans analiz açısından ilerisi için ümit vericidir.

Anahtar Kelimeler:

Kronik hepatit, biyoelektrik impedans, karaciğer biyopsisi

Evaluation of chronic hepatitis and cirrhotic patients with bioelectrical impedance analysis

Background and Aims: The aim of this study was to investigate whether there was a difference between chronic hepatitis patients, cirrhotic patients, and healthy individuals with bioelectrical impedance analysis method. Materials and Methods: Between June 2012 and June 2013, 31 chronic hepatitis B and C patients, 35 cirrhotic patients who had been followed up in the Gastroenterology outpatient clinic at Harran University Faculty of Medicine and 38 healthy individuals were included in the study. Cases were divided into three groups as chronic hepatitis, liver cirrhosis, and healthy controls. Each patient’s age, sex, height, weight, hematocrit, sodium, potassium values, and values obtained after bioelectrical impedance analysis measurements were recorded and a statistical analysis was performed. Results: The cirrhotic group’s hematocrit and blood sodium level were significantly lower (p < .05). The body capacitance value in the chronic hepatitis and cirrhosis group was higher than that in the control group (p < .05). Resistance in the chronic hepatitis B group was lower than that in the control group (p < .05). The body cell mass value in the chronic hepatitis group was higher than that in the control group (p < .05). The chronic hepatitis group’s basal metabolic rate value was higher than that of the control group (p < .05). The chronic hepatitis group’s lean body mass value was higher than that of the control group (p < .05). The chronic hepatitis group’s intracellular water and total body water values were higher than both of these were in the control group (p < .05). The phase angle was higher in the chronic hepatitis group when compared with other groups, but was not statistically significant (p > .05). Conclusion: Although this study did not find significant changes between cirrhotic patients, chronic hepatitis patients, and control groups with bioelectrical impedance analysis, detecting any changes in patients with chronic hepatitis is promising for the future regarding bioelectrical impedance analysis.

Keywords:

Chronic hepatitis, bioelectrical impedance, liver biopsy,

PDF

___

1. Harrison’s Principles of Internal Medicine 16th Edition 2005;1858-9.
2. Memik F, Dolar E. Karaciğer sirozu. Tabak F, editör. Klinik Gastroenteroloji. I. Baskı, İstanbul; Nobel ve Güneş Tıp Kitapevleri. 2005;626-33.
3. Tabak F, Yurdaydın C, Kaymakoğlu S, et al; Guidelines Study Group VH. Diagnosis, management and treatment of hepatitis B virus infection: Turkey 2017 Clinical Practice Guidelines. Turk J Gastroenterol 2017;28(Suppl 2):73-83.
4. Idilman R, Baykam N, Kaymakoğlu S, et al; Guidelines Study Group VH. Turkey 2017 Clinical Practice Guidelines on recommendations for screening diagnosing and managing hepatitis C virus. Turk J Gastroenterol 2017 Dec;28(Suppl 2):90-93.
5. Ökten A, Mungan Z, Çakaloğlu Y. Karaciğer sirozu: Gastroenterohepatoloji. Nobel Tıp Kitapevi 2001;449-50.
6. Ökten A. Türkiye’de karaciğer sirozunun etiyolojisi. Hepatolojide Güncel Gelişmeler Sempozyumu Kitabı,1998; 67.
7. Quer J, Esteban J. Epidemiology. In: Thomas HC, Lemon S, Zuckerman AJ (eds). Viral hepatitis. Massachusetts, USA. Third Edition. Blackwell Publishing, 2005;407-25.
8. Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Engl J Med 2001;344:495-500.
9. Şahin M, Karayakar F, Erdogan KE, et al. Liver tissue trace element levels in HepB patients and the relationship of these elements with histological injury in the liver and with clinical parameters. J Trace Elem Med Biol 2018;45:70-77.
10. Dienstag JL. The role of liver biopsy in chronic hepatitis C. Hepatology 2002;36(5 Suppl 1):S152-60.
11. Bedossa P, Poynard T. An algorithm fort he grading of activity in chronic hepatitis C. The METAVİR Cooperative Study Group. Hepatology 1996;24:289-93.
12. Silva AM, Matias CN, Nunes CL, et al. Lack of agreement of in vivo raw bioimpedance measurements obtained from two single and multi-frequency bioelectrical impedance devices. Eur J Clin Nutr 2018 Oct 22. [Epub ahead of print]
13. Ruiz-Vargas A, Ivorra A, Arkwright JW. Design, Construction and Validation of an Electrical Impedance Probe with Contact Force and Temperature Sensors Suitable for in-vivo Measurements. Sci Rep 2018;8:14818.
14. Kushner RF. Bioelectrical impedance analysis: a review of principles and applications. J Am Coll Nutr 1992;11:199-209.
15. Baumgartner RN, Chumlea WC, Roche AF. Impedance for body composition. Exerc Sport Sci Rev 1990;18:193-224.
16. Houtkopper LB, Lohman TG, Going SB, Howell WH. Why bioelectrical impedance analysis should be used for estimating adiposity. Am J Clin Nutr 1996;64(3 Suppl):436S-448S.
17. Köksal İ, Yılmaz G, Parlak M, et al; Study Group TCHC. Diagnostic value of combined serum biomarkers for the evaluation of liver fibrosis in chronic hepatitis C infection: A multicenter, non interventional, observational study. Turk J Gastroenterol 2018;29:464-472.
18. Kushner RF, Guidivaka R, Scholler DA. Clinical characteristics influencig bioelectrical impedance analysis measurements. Am J Clin Nutr 1996;64(3 Suppl):423S-427S.
19. Kravetz D, Arderiu MT, Bosch J, et al. Increased plasma volume in two models of portal hypertension in the rat: Cirrhosis of the liver and partial portal vein ligation. Rev Esp Fisiol 1987;43:179-83.
20. Guglielmi FW, Contento F, Laddaga L, et al. Bioelectric impedance analysis: experience with male patients with cirrhosis. Hepatology 1991;13:892-5.
21. Cabré E, de León R, Planas R, et al. Reliability of bioelectric impedance analysis as a method of nutritional monitoring in cirrhosis with ascites. Gastroenterol Hepatol 1995;18:359-65.
22. Runyon BA, Montano AA, Akriviadis EA, et al. The serum ascites albumin gradient is superior to the exudates-transudate concept in the differential diagnosis of ascites. Ann Int Med 1992;117:215-20.
23. Kahraman A, Hilsenbeck J, Nyga M, et al. Bioelectrical impedance analysis in clinical practice: implications for hepatitis C therapy BIA and hepatitis C. Virol J 2010;7:191.
24. Guida B, Laccetti R, Gerardi C, et al. Bioelectrical impedance analysis and agerelated differences of body composition in the elderly. Nutr Metab Cardiovasc Dis 2007;17:175-80.
25. Barbosa-Silva MC, Barros AJ, Wang J, et al. Bioelectrical impedance analysis: population reference values for phase angle by age and sex. Am J Clin Nutr 2005;82:49-52.
26. Selberg O, Selberg D. Norms and correlates of bioimpedance phase angle in healthy human subjects, hospitalized patients, and patients with liver cirrhosis. Eur J Appl Physiol 2002;86:509-16.
27. Pirlich M, Schutz T, Spachos T, et al. Bioelectrical impedance analysis is a useful bedside technique to assess malnutrition in cirrhotic patients with and without ascites. Hepatology 2000;32:1208-15.