Karaciğer sirozlu hastalarda platelet ve ortalama platelet hacmi düzeylerinin değerlendirilmesi

Amaç: Karaciğer sirozu, fibrozis ile karakterize ve normal karaciğer yapısının diffüz nodül yapısıyla yer değiştirdiği bir süreçtir. Karaciğer sirozunun tanı ve prognoz öngörüsünde farklı laboratuvar değerleri kullanılmaktadır. Karaciğer sirozlu hastalarda platelet ve ortalama platelet hacmi düzeylerini saptamak; platelet veya ortalama platelet hacmi düzeylerinin Child-Pugh sınıflamasına veya siroz etiyolojisine göre değişip değişmediğini görmektir. Yöntemler: Bir eğitim ve araştırma hastanesi iç hastalıkları kliniklerinde 2006 - 2013 yılları arasında yatışı yapılmış veya iç hastalıkları polikliniklerinde takibi yapılmış 201 karaciğer sirozlu hasta, vaka grubuna dâhil edildi. Platelet sayısı < 150000 / µl olması halinde trombositopeni olarak kabul edildi. Trombositopeni yapabilecek hastalığı olanlar, trombositopeni yapabilecek ilaç kullananlar ve psödotrombositopenik hastalar çalışma dışı bırakıldı. Bulgular: Vakalar etiyolojik nedenlerine göre gruplandırıldığında yüzdelik dağılımlar: Grup 1 (alkolik karaciğer hastalığı kökenli siroz olguları) % 16,9, Grup 2 (hepatit - B kökenli siroz olguları) % 25,4, Grup 3 (hepatit - C kökenli siroz olguları) % 23,4, Grup 4 (Kriptojenik siroz olguları) % 34,3 olarak bulundu. Çalışmadaki farklı sirotik etiyolojilerden oluşan dört grubun ortalama platelet değerleri Grup 1 için 130,2 ± 74 x 103 / mikrolitre (µL), Grup 2 için 104,8 ± 56,8 x 103 / µL, Grup 3 için 100,6 ± 44,2 x 103 / µL ve Grup 4 için 104,1 ± 48,7 x 103 / µL olarak hesaplandı. Kontrol grubundaki (Grup 5) ortalama platelet değeri ise 247,7 ± 58,7 x 103 / µL idi. Gruplardaki ortalama platelet hacmi değerleri Grup 1 için 9,19 ± 1,32 femtolitre (fL), Grup 2 için 9,21 ± 1,57 fL, Grup 3 için 8,67 ± 1,25 fL ve Grup 4 için 8,85 ± 1,21 fL olarak saptandı; 5. Gruptaki ortalama platelet hacmi değeri ise 8,05 ± 1 fL idi. Sonuç: Çalışmada sirotik hastalarda platelet değerleri, kontrol grubundan düşük; ortalama platelet hacmi değerleri ise kontrol grubundan yüksek saptandı. Platelet ve ortalama platelet hacmi değerleri, Child-Pugh evresi ya da siroz etiyolojisine göre farklı saptanmadı. Bu nedenle, trombosit sayısı ve MPV'nin kronik karaciğer inflamasyonu üzerindeki etkileri hakkında çelişkili sonuçları netleştirmek için daha geniş ölçekli çalışmalara ihtiyaç vardır.

Evaluation of platelet and mean platelet volume levels in patients with liver cirrhosis

Aim: Liver cirrhosis isa process characterized by fibrosis and normal liver structure is replaced with diffuse nodular structure. Different laboratory values are used for diagnosis and prognosis of liver cirrhosis. To determine platelet and mean platelet volume levels of patients with liver cirrhosis and to find out if platelet or mean platelet volume levels have changed according to Child-Pugh classification or the etiology of cirrhosis. Methods: A total of 201 patients with cirrhosis who have been followed by of an education and research hospital internal medicine out-patient clinic between the years of 2006 and 2013, were included. Platelet count <150,000 / µL was accepted as thrombocytopenia. Individuals with diseases that can cause thrombocytopenia, patients using drugs that can cause thrombocytopenia and who has pseudothrombocytopenia were excluded from the study. Results: The number percantage ratios of patients according to underlying etiology for chronic liver disease were as follows Group 1 (alcoholic liver disease) with rate of % 16.9, Group 2 (hepatitis - B) with rate of % 25.4, Group 3 (hepatitis - C) with rate of % 23.4, Group 4 (cryptogenic) with rate of % 34.3.Average platelet value in the Group 1 was 130.2 ± 74 x 103/ µL, Group 2 was 104.8 ± 56.8 x 103/ µL, Group 3 was 100.6 ± 44.2 x 103/ µL, Group 4 was 104,1 ± 48.7 x 103/ µL;average platelet value in the control group (Group 5) was 247.7 ± 58.7 x 103 / µL. Average mean platelet volume values in the Group 1 was 9.19 ± 1.32 fL, Group2 was 9.21 ± 1.57 fL, Group 3 was 8.67 ± 1.25 fL, Group 4 was 8.85 ± 1.21 fL; average mean platelet volume value in the Group 5 was 8.05 ± 1 fL. Conclusion: In this study, platelet levels of the cirrhotic patients were lower than the control group's platelet levels; MPV levels of the patients with cirrhosis were higher than the control group's mean platelet volume levels. Platelet and MPV values were not different according to Child-Pugh stage or cirrhosis etiology. Therefore, more and larger scaled studies are needed to clarify conflicting conclusions about the impact of platelet number and MPV on chronic liver inflammation.

Kaynakça

1. Heidelbaugh JJ, Bruderly M. Cirrhosis and chronic liver failure: part I. Diagnosis and evaluation. Am Fam Physician 2006; 74: 756-62.

2. Martin TG 3rd, Somberg KA, Meng YG, Cohen RL, Heid CA, de Sauvage FJ et al. Thrombopoietin levels in patients with cirrhosis before and after orthotopic liver transplantation. Ann Intern Med 1997; 127: 285-8.

3. Realdi G, Fattovich G, Hadziyannis S, Schalm SW, Almasio P, Sanchez-Tapias J et al. Survival and prognostic factors in 366 patients with compansated cirrhosis type B: a multicenter study. J Hepatol 1994; 21: 656-66.

4. Bath PM, Butterworth RJ. Platelet size: Measurement, physiology and vascular disease. Blood Coagul Fibrinolysis 1996; 7: 157-61.

5. Endler G, Klimesch A, Sunder-Plassmann H, Schillinger M, Exner M, Mannhalter C et al. Mean platelet volume is an independent risk factor for myocardial infarction but not for coronary artery disease. Br J Haematol 2002; 117: 399-404.

6. Kapsoritakis AN, Koukourakis MI, Sfiridaki A, Potamianos SP, Kosmadaki MG, Koutroubakis IE et al. Mean platelet volume: a useful marker of inflammatory bowel disease activity. Am J Gastroenterol 2001; 96: 776-81.

7. Gasparyan AY, Ayvazyan L, Mikhailidis DP, Kitas GD. Mean platelet volume: A link between thrombosis and inflammation? Curr Pharm Des 2011; 17: 47-58.

8. Arslan N, Makay B. Mean platelet volume in obese adolescents with nonalcoholic fatty liver disease. J Pediatr Endocrinol Metab 2010; 23: 807-13.

9. Pathansali R, Smith N, Bath P. Altered megakaryocyte-platelet haemostatic axis in hypercholesterolaemia. Platelets 2001; 12: 292-7.

10. Papanas N, Symeonidis G, Maltezos E, Mavridis G, Karavageli E, Vosnakidis Tet al. Mean platelet volume in patients with type 2 diabetes mellitus. Platelets 2004; 15: 475-8.

11. Nadar S, Blann AD, Lip GY. Platelet morphology and plasma indices of platelet activation in essential hypertension: Effects of amlodipinebased antihypertensive therapy. Ann Med 2004; 36: 552-7.

12. Wang RT, Li Y, Zhu XY, Zhang YN. Increased mean platelet volume is associated with arterial stiffness. Platelets 2012; 22: 447-51.

13. Qamar AA, Grace ND, Groszmann RJ, Garcia-Tsao G, Bosch J, Burroughs AK et al.Incidence, prevalence, and clinical significance of abnormal hematologic indices in compensated cirrhosis. Clin Gastroenterol Hepatol 2009; 7: 689.

14. Dow RB. The Clinical and laboratory utility of trombosit volume parameters. J Med Sci 1994; 15: 1-15.

15. Bancroft AJ, Abel EW, Mclaren M, Belch JJ. Mean trombosit volume is a useful parameter: a reproducible routine method using a modified Coulter Thrombocytometer. Trombosits 2000; 11: 379-87.

16. Şenaran H, İleri M, Altınbaş A, Koşar A, Yetkin E, Özturk M. et al. Thrombopoietin and mean trombosit volume in coronary artery disease. Clin Cardiol 2001; 24: 405-8.

17. Corrao G. Liver cirrhosis mortality trends in Eastern Europe, 1970- 1989. Analyses of age, period and cohort effects and of latency with alcohol consumption. Addiction Biol 1998; 3: 413-22.

18. Ikejima K, Enomoto N, Iimuro Y, Ikejima A, Fang D, Xu J et al. Estrogen increases sensitivity of Kupffer cells to endotoxin. Am J Physiol 1998; 274: G669-76.

19. Reed T, Page WF, Viken RJ, Christian JC. Genetic predisposition to organ-specific endpoints of alcoholism. Alcohol Clin Exp Res 1996; 20: 1528-33.

20. Colantoni A, Idilman R, De Maria N, La Paglia N, Belmonte J, Wezeman F et al. Hepatic apoptosis and proliferation in male and female rats fed alcohol: Role of cytokines. Alcoholism: Clin Expl Res 2003; 27: 1184-9.

21. Jorgensen B, Fischer E, Ingeberg S, Hollaender N, Ring-Larsen H, Henriksen JH. Decreased blood platelet volume and count in patients with liver disease. Scand J Gastroenterol 1984; 19: 492-6.

22. Adinolfi LE, Giordano MG, Andreana A, Tripodi MF, Utili R, Cesaro G et al. Hepatic fibrosis play a central role in the pathogenesis of thrombocytopenia in patients with chronic viral hepatitis. Br J Hematol 2001; 113: 290-5.

23. Madhotra R, Mulcahy HE, Willner I, Reuben A.Prediction of esophageal varices in patients with cirrhosis. J Clin Gastroenterol 2002; 34: 81-5.

24. Uslu AU, Aydın B, Balta S, Yonem O, Uncu T, Seven D. The effect of standard therapy on mean platelet volume in patients with chronic hepatitis C. Prz Gastroenterol 2016; 11: 200-5.

25. Hu Y, Lou Y, Chen Y, Mao W. Evaluation of mean platelet volume in patients with hepatitis B virus infection. Int J Clin Exp Med 2014; 7: 4207-13.

26. Purnak T, Olmez S, Torun S, Efe C, Sayılır A, Özaslan E et al. Mean platelet volume is increased in chronic hepatitis C patients with advanced fibrosis. Clin Res Hepatol Gastroenterol 2103; 37: 41-6.

27. Kurt M, Onal IK, Sayılır AY, Beyazıt Y, Öztaşş E, Kekilli M et al. The role of mean platelet volume in the diagnosis of hepatocellular carcinoma in patients with chronic liver disease. Hepatogastroenterology 2012; 59: 1580-2.

28. Qi XT, Wan F, Lou Y, Ye B, Wu D. The mean platelet volume is a potential biomarker for cirrhosis in chronic hepatitis B virus infected patients. Hepatogastroenterology. 2014;61:456-459.

29. Karpatkin S, Freedman ML. Hypersplenic Thrombocytopenia Differentiated From Increased Peripheral Destruction by Platelet Volume. Ann Int Med. 1978;89:200.

30. Giannini EG, Moscatelli A, Brunacci M, Zentilin P, Savarino V. Prognostic role of mean platelet volume in patients with cirrhosis. Dig Liver Dis. 2016;48:409-413.

Kaynak Göster

418 226

Arşiv
Sayıdaki Diğer Makaleler

Is the use of intraoperative nerve monitoring an effective method to reduce the rate of permanent recurrent laryngeal nerve paralysis?

Doğan YILDIRIM, Turgut DÖNMEZ, Mikail ÇAKIR, Okan Murat AKTÜRK, ADNAN HUT, Ahmet KOCAKUŞAK, Erdinç ÇEKİÇ, Leyla Zeynep TİGREL, Turgay YILDIZ

Intrauterine interventions with the aid of ultrasonography

BULAT AYTEK ŞIK, Alim ÖZCAN, Serkan KUMBASAR, MURAT FANİ BOZKURT, Sedat BİLECAN

Psödoksantoma elastikum: Üç kardeşten oluşan bir olgu serisi

Mustafa ESEN, İsa AN, İBRAHİM İBİLOĞLU, Adar ASLAN, REMZİ ERTEN

Unilateral ovarian leiomyoma in a 14-year-old adolescent: A rare case report

Aşkı KAYA ELLİBEŞ, Sabri Berkem ÖKTEN, Alper BAŞBUĞ, MEHMET GAMSIZKAN, Ozan DOĞAN, Hasan BAKI

Is there any benefit of harmonic scalpel for hemorrhoidectomy versus conventional diathermy?

Doğan YILDIRIM, Turgut DÖNMEZ, Okan Murat AKTÜRK, Ahmet KOCAKUŞAK, Mikail ÇAKIR, Mustafa Ertuğrul YURTTERİ

Dental materyal ilişkili oral likenoid kontakt reaksiyonun malign dönüşümü: Amalgam çıkarımı sonrası sonuçların ortaya konulduğu bir olgu

Ahu YORULMAZ, BAŞAK YALÇIN, Ayşe BOYVAT, Ömür ATAOĞLU, Önder BOZDOĞAN

Factors affecting the success of conservative management in de Quervain cases

Hasan Hüseyin CEYLAN, Özcan KAYA, BARIŞ ÇAYPINAR, MUHAMMED BEŞİR ÖZTÜRK

Karaciğer sirozlu hastalarda platelet ve ortalama platelet hacmi düzeylerinin değerlendirilmesi

Mustafa Genco ERDEM, Eylem Özgün ÇİL, Tufan TÜKEK, Şerife Ayşen HELVACI

A retrospective analysis of restless legs syndrome in epileptic patients

Gökhan ÖZER, YASEMİN ÜNAL, Gülnihal KUTLU, Yasemin GÖMCELİ BİÇER, Levent Ertuğrul İNAN