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

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.

Anahtar Kelimeler:

Ortalama platelet hacmi, platelet, siroz, trombositopeni

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.

Keywords:

Cirrhosis, mean platelet volume, platelet, thrombocytopenia,

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