Cengiz BOLUKBAS, Yavuz FURUNCUOGLU, Ferhan MANTAR, Seyda IGNAK, Filiz Fusun BOLUKBAS, Ozlem Unay DEMİREL, Filiz YARIMCAN SAGLAM, Sercen Cansu SERTEL

An Investigation of the Relationship between Serum Vitamin B12 Levels and Hepatic Fibrosis Scores Determined by Transient Elastography (FibroScan) in Nonalcoholic Fatty Liver Disease

Amaç: Alkole bağlı olmayan karaciğer yağlanması (NAFLD) en sık rastlanan kronik karaciğer hastalığıdır. NAFLD kompleks bir hastalık olduğu için tanıda kullanılacak spesifik ve duyarlı biyobelirteçler bulmak oldukça güçtür. Çalışmamızda NAFLD'li hastalarda kullanılabilecek invaziv olmayan bir biyobelirteç olarak transient elastografi (FibroScan) tekniğiyle belirlenen steatozis ve fibrozis skorları ile serum vitamin B12 düzeyleri arasındaki olası ilişki araştırılmıştır.Gereç ve Yöntemler: Çalışmamıza toplam 129 NAFLD hastası (45,68±12,9 yaş, 29 kadın) ve 50 sağlıklı gönüllü (43,44±15,3 yaş, 21 kadın) dahil edilmiştir. Tüm hastaların fibrozis evresi FibroScan yöntemiyle belirlenmiştir. Serum vitamin B12 ve C reaktif protein (CRP) düzeylerinin yanı sıra çeşitli karaciğer enzimleri de incelenmiştir. Bulgular: Yaş ve cinsiyet açısından NAFLD ile kontrol grupları uyumlu bulunmuştur. NAFLD hastalarında serum alanin aminotransferaz, aspartat aminotransferaz, gama-glutamil transferaz ve CRP düzeyleri kontrol grubuna göre anlamlı oranda (p

Alkole Bağlı Olmayan Karaciğer Yağlanmasında Transient Elastografi (FibroScan) Tekniğiyle Belirlenen Fibrozis Skoru ile Serum Vitamin B12 Arasındaki İlişkinin Araştırılması

Aim: Non-alcoholic fatty liver disease (NAFLD) is the most frequent chronic liver disease. Because NAFLD is a complex disease, finding highly specific and sensitive biomarkers for diagnosis is very difficult. We investigated the possible relation between steatosis and fibrosis stages determined by FibroScan technique and serum vitamin B12 levels as a non-invasive biomarker in patients with NAFLD. Materials and Methods: A total of 129 patients (45.68±12.9 years of age, 29 females) with NAFLD and 50 healthy subjects (43.44±15.3 years of age, 21 females) were included in this study. FibroScan was performed in all patients for the staging of fatty liver fibrosis. Liver enzymes were also analyzed in addition to serum vitamin B12 and C-reactive protein (CRP) levels. Results: There was no difference with respect to age and gender between NAFLD and control groups. The serum alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, and CRP levels were significantly higher in the patients with NAFLD than the controls (p

PDF

___

1. Abd El-Kader SM, El-Den Ashmawy EM. Non-alcoholic fatty liver disease: The diagnosis and management. World J Hepatol. 2015; 7(6):846–58.
2. Baffy G, Brunt EM, Caldwell SH. Hepatocellular carcinoma in non-alcoholic fatty liver disease: an emerging menace. J Hepatol. 2012;56(6):1384–91.
3. de Carvalho SC, Muniz MT, Siqueira MD, Siqueira ER, Gomes AV, Silva KA, et al. Plasmatic higher levels of homocysteine in non-alcoholic fatty liver disease (NAFLD). Nutr J. 2013;12:37.
4. Buzzetti E, Pinzani M, Tsochatzis EA. The multiplehit pathogenesis of non-alcoholic fatty liver disease (NAFLD). Metabolism. 2016;65(8):1038–48.
5. Sanal MG. Biomarkers in nonalcoholic fatty liver disease-the emperor has no clothes? World J Gastroenterol. 2015;21(11):3223–31.
6. Farrell GC, Chitturi S, Lau GK, Sollano JD. Guidelines for the assessment and management of non-alcoholic fatty liver disease in the Asia-Pacific region: executive summary. J Gastroenterol Hepatol. 2007;22(6):775–7.
7. Loria P, Adinolfi LE, Bellentani S, Bugianesi E,Grieco A,Fargion S, et al. Practice guidelines for the diagnosis and management of nonalcoholic fatty liver disease. A decalogue from the Italian Association for the Study of the Liver (AISF) Expert Committee. Dig Liver Dis. 2010;42(4):272–82.
8. Hashemi SA, Alavian SM, Gholami-Fesharaki M. Assessment of transient elastography (FibroScan) for diagnosis of fibrosis in non-alcoholic fatty liver disease: a systematic review and meta-analysis. Caspian J Intern Med. 2016;7(4):242–252.
9. Osawa H, Mori Y. Sonographic diagnosis of fatty liver using a histogram technique that compares liver and renal cortical echo amplitudes. J Clin Ultrasound. 1996;24(1):25–9.
10. el-Hassan AY, Ibrahim EM, al-Mulhim FA, Nabhan AA, Chammas MY. Fatty infiltration of the liver: analysis of prevalence, radiological and clinical features and influence on patient management. Br J Radiol. 1992;65(777):774–8.
11. Wong VW, Vergniol J, Wong GL, Foucher J,Chan HL,Le Bail B, et al. Diagnosis of fibrosis and cirrhosis using liver stiffness measurement in nonalcoholic fatty liver disease. Hepatology. 2010;51(2):454–62.
12. Thampanitchawong P, Piratvisuth T. Liver biopsy: complications and risk factors. World J Gastroenterol. 1999;5(4):301–4.
13. Saadeh S, Younossi ZM, Remer EM, Gramlich T, Ong JP, Hurley M, et al. The utility of radiological imaging in nonalcoholic fatty liver disease. Gastroenterology. 2002;123(3):745–50.
14. Roldan-Valadez E, Favila R, Martínez-López M, Uribe M, Méndez-Sánchez N. Imaging techniques for assessing hepatic fat content in nonalcoholic fatty liver disease. Ann Hepatol. 2008;7(3):212–20.
15. Castéra L, Foucher J, Bernard PH, Carvalho F, Allaix D, Merrouche W, et al. Pitfalls of liver stiffness measurement: a 5-year prospective study of 13,369 examinations. Hepatology. 2010;51(3):828–35.
16. Wong GL. Update of liver fibrosis and steatosis with transient elastography (FibroScan). Gastroenterol Rep (Oxf). 2013;1(1):19–26.
17. de Lédinghen V, Wong VW, Vergniol J, Wong GL, Foucher J, Chu SH, et al. Diagnosis of liver fibrosis and cirrhosis using liver stiffness measurement: comparison between M and XL probe of FibroScan®. J Hepatol. 2012;56(4):833–9.
18. Wong VW, Vergniol J, Wong GL, Foucher J, Chan AW, Chermak F, et al. Liver stiffness measurement using XL probe in patients with nonalcoholic fatty liver disease. Am J Gastroenterol. 2012;107(12):1862–71.
19. Shipton MJ, Thachil J. Vitamin B12 deficiency - a 21st century perspective. Clin Med. 2015;15(2):145–50.
20. Andrès E, Serraj K, Zhu J, Vermorken AJ. The pathophysiology of elevated vitamin B12 in clinical practice. QJM. 2013;106(6):505–15.
21. Ermens AA, Vlasveld LT, Lindemans J. Significance of elevated cobalamin (vitamin B12) levels in blood. Clin Biochem. 2003;36(8):585–90.
22. Joske RA. The vitamin B12 content of human liver tissue obtaıned by aspiration biopsy. Gut. 1963;4:231–5.
23. Holdsworth CD, Atkinson M, Dossett JA, Hall R. Assessment of the diagnostic and prognostic value of serum vitamin B12 levels in liver disease. Gut. 1964;5:601–6.
24. Catena C, Colussi G, Nait F, Capobianco F, Sechi LA. Elevated homocysteine levels are associated with the metabolic syndrome and cardiovascular events in hypertensive patients. Am J Hypertens. 2015;28(7):943–50.
25. Leach NV, Dronca E, Vesa SC, Sampelean DP, Craciun EC, Lupsor M, et al. Serum homocysteine levels, oxidative stress and cardiovascular risk in non-alcoholic steatohepatitis. Eur J Intern Med. 2014;25(8):762–7.
26. Uchihara M, Izumi N. High-sensitivity C-reactive protein (hs-CRP): a promising biomarker for the screening of non-alcoholic steatohepatitis (NASH). Nihon Rinsho. 2006;64:1133–8.
27. Wieckowska A, Papouchado BG, Li Z, Lopez R, Zein NN, Feldstein AE. Increased hepatic and circulating interleukin-6 levels in human nonalcoholic steatohepatitis. Am J Gastroenterol. 2008;103(6):1372–9.
28. Yoneda M, Mawatari H, Fujita K, Iida H, Yonemitsu K, Kato S, et al. High-sensitivity C-reactive protein is an independent clinical feature of nonalcoholic steatohepatitis (NASH) and also of the severity of fibrosis in NASH. J Gastroenterol. 2007;42:573–82.
29. Marchesini G, Marzocchi R, Agostini F, Bugianesi E. Nonalcoholic fatty liver disease and the metabolic syndrome. Curr Opin Lipidol. 2005;16(4):421–7.
30. Gulsen M, Yesilova Z, Bagci S, Uygun A, Ozcan A, Ercin CN, et al. Elevated plasma homocysteine concentrations as a predictor of steatohepatitis in patients with nonalcoholic fatty liver disease. J Gastroenterol Hepatol. 2005;20(9):1448–55.
31. Koplay M, Gulcan E, Ozkan F. Association between serum vitamin B12 levels and the degree of steatosis in patients with nonalcoholic fatty liver disease. J Investig Med. 2011;59(7):1137–40.
32. Polyzos SA, Kountouras J, Patsiaoura K, Katsiki E, Zafeiriadou E, Zavos C, et al. Serum vitamin B12 and folate levels in patients with non-alcoholic fatty liver disease. Int J Food Sci Nutr. 2012;63(6):659–66.
33. Amer RM, Amin MA, Sabry D, Abd Elaziz A. Impact of serum level of vitamin B12 on response to combined interferon and ribavirin therapy for chronic HCV Infection. Med. J. Cairo Univ. 2016;84(1):529–35