Filiz Fusun Bolukbas, Seyda İgnak, Ozlem Unay Demirel, Yavuz Furuncuoglu, Ferhan Mantar, Sercen Cansu Sertel, Filiz Yarimcan Saglam, Cengiz Bolukbas

Alkole bağlı olmayan karaciğer yağlanmasında transient elastografi (Fibroscan) tekniği ile tespit edilen fibrozis skoru ile serum Vitamin B12 arasındaki ilişkinin araştırılması

Amaç: Alkole bağlı olmayan karaciğer yağlanması (NAFLD) en sık rastlanan kronik karaciğer hastalığıdır. NAFLD kompleks bir hastalık oldğu için tanıda kullanılacak spesifik ve duyarlı biyobelirteçler bulmak oldukça güçtür. Çalışmamızda transient elastografi (FibroScan) tekniği ile belirlenen steatoz ve fibrozis skorları ile serum Vitamin B12 düzeyinin NAFLD hastalarında girişimsel olmayan biyobelirteç olarak kullanılabilirliği sorgulanmıştır.Gereç ve Yöntemler: Çalışmamıza toplam 129 NAFLD hastası (45,68±12,9 yaş ve 29 kadın) ve 50 sağlıklı gönüllü (43,44±15,3 yaş ve 21 kadın) dahil edilmiştir. Tüm hastaların yağlı karaciğer yağlanması ve fibrozis evresi FibroScan yöntemiyle belirlenmiştir. Serum Vitamin B12 ve C reaktif protein (CRP) seviyesininin yanı sıra çeşitli karaciğer enzim düzeyleri de saptanmıştır. Bulgular: Yaş ve cinsiyet açısından NAFLD ile kontrol grupları uyumlu bulunmuştır. NAFLD hastalarında serum alanin aminotransferaz, aspartat aminotransferaz, gama-glutamil transferaz ve CRP düzeyleri kontrol grubuna göre anlamlı oranda (p<0.05) yüksek bulunurken, serum Vitamin B12 düzeyleri ise düşük (352,8±125,2pg/mL ile 435.2±134,4 p<0.01) bulunmuştur. Ortalama serum B12 düzeylerinin kontrol (435.2±134,4pg/mL) ve NAFLD fibrozis evre F0-F3 alt grupları (366,17±129,7pg/mL, 285,22±101pg/mL) ile karşılaştırıldığında anlamlı düzeyde (p<0.01) farklılık olduğu görülmüştür. Tartışma ve sonuç: Serum Bitamin B12 düzeyinin NAFLD hasta grubunda kontrol grubuna göre anlamlı oranda düşük olduğu saptanmıştır. Serum Vitamin B12 seviyesindeki bu azalmanın özellikle karaciğer inflamasyonu ve fibrozis evresi yüseldikçe (F0-F3) daha belirgin olduğu ancak daha ileri fibrozis düzeylerinde (F4) anlamlı bir fark görülmediği tespit edilmiştir.

Anahtar Kelimeler:

Alkole bağlı olmayan yağlı karaciğer hastalığı, fibrozis, fibroscan, karaciğer, steatozis, vitamin B12

Relationship between serum Vitamin B12 levels and hepatic fibrosis detected by transient elastography (Fibroscan) in non-alcoholic fatty liver disease

Aim: Non-alcoholic fatty liver disease (NAFLD) is one of the most frequent chronic liver disease. Because NAFLD is a complex disease, finding highly spesific and sensitive biomarkers for diagnosis is very difficult. We investigated the possible relation between staging of steatosis and fibrosis determined by Fibroscan technique and serum vitamin B12 levels as a non-invasive biomarker in NAFLD patients. Materials and Method: A total of 129 patients (45,68±12,9 years and 29F) with NAFLD and 50 healthy subjects (43,44±15,3 years and 21F) were included in this study. Fibroscan is performed in all patients for staging of the fatty liver fibrosis. Liver enzymes are also analyzed in addition to serum vitamin B12 and C-reactive protein (CRP) levels. Results: There was no difference in terms of age and gender in NAFLD and control groups. The serum alanin aminotransferaz, aspartate aminotransferase, gamma-glutamyl transferase and CRP levels were significantly higher in the NAFLD patients than controls (p<0.05). On the contrary, serum vitamin B12 vitamin levels were lower in patients with NAFLD compared with controls (352,8±125,2pg/mL vs. 435.2±134,4 p<0.01). There was a significant difference in mean serum B12 vitamin levels between controls ( 435.2±134,4pg/mL) and NAFLD patients from F0 to F3 subgroups (366,17±129,7pg/mL, 285,22±101pg/mL, p<0.01). Discussion and Conclusion: The serum vitamin B12 levels were found to be significantly low in patients with NAFLD when compared to the control group. The reduction in serum vitamin B12 levels was even more pronounced as hepatic inflammation and fibrosis increases (F0-F3) but not in advanced fibrosis stage (F4).

Keywords:

Non alcoholic fatty liver disease, liver, steatosis vitamin B12, fibrosis, fibroscan, liver, steatosis, vitamin B12,

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