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Sirotik Hastalarda ve Spontan Bakteriyel Peritonitte Fekal Calprotectin Düzeylerinde Artış

Amaç: Bu çalışmanın amacı, intestinal inflamasyonun göstergesi olan fekal calprotectin (FC) ile artmış intestinal inflamasyon ve buna bağlı artan bakteriyel translokasyon sonucu meydana gelen sirozun komplikasyonları arasındaki ilişkiyi araştırmaktır.Gereç ve Yöntemler: Hastanemize başvuran 18 ve 80 yaş arası 156 sirotik hastadan, dışlama kriterlerine göre 64’ü çıkartıldı ve toplam 92 hasta ve benzer yaş ve cinsiyette 20 gönüllü kontrol grubu olarak çalışmaya dahil edildi. Başvuru sırasında alınan kan örneklerinden eritrosit sedimantasyon değeri (ESR), c-reaktif protein (CRP) ve beyaz küre sayımı (WBC) çalışıldı. Her hastadan ve kontrol grubundan başvurudan sonraki 24 saat içinde bir adet spot gaita örneği alındı. Çalışma grubu, sirozun evresi ilerledikçe veya komplikasyonlar meydana geldiğinde FC değerlerinin değişip değişmediğini incelemek için beş alt gruba (Child-Pugh Evre-A, Evre-B, Evre-C, hepatiks ensefalopati ve spontan bakteriyel peritonit) ayrıldı.Bulgular: Ortanca FC değerleri sirotik hastalarda 168,8 mg/kg ve kontrol grubunda 9,8 mg/kg idi ve gruplar arasındaki farklılık istatistiksel olarak anlamlıydı (p=0,039). Alt grup incelemesinde, spontan bakteriyel peritonit grubu ile diğer tüm alt gruplar arasındaki farklılıklar istatistiksel olarak anlamlıydı (p=0,002). Sirotik hastalarda FC ile ESR (r=0.439, p=0.545) veya CRP (r=0.403, p=0.321) ya da WBC sayımı (r=0.061, p=0.645) arasında korelasyon saptanmadı.Sonuç: Sirotik hastalarda FC değerleri yükselmektedir ve sistemik inflamasyon belirteçlerinden önce FC değerlerinin erken yükselmesi sayesinde, spontan bakteriyel peritonitte tanısal bir test olarak kullanılabilir.

Anahtar Kelimeler:

calprotectin, siroz, sekonder peritonit

Elevated Levels of Fecal Calprotectin in Cirrhotic Patients and Spontaneous Bacterial Peritonitis

Aim: The aim of this study is to investigate the relationship between fecal calprotectin (FC) which is a marker for intestinal inflammation and complications of cirrhosis which are due to increased bacterial translocation and intestinal inflammation.Material and Methods: Out of 156 cirrhotic patients aged between 18-80 years who are admitted to our hospital, 64 were excluded according to exclusion criteria and a total of 92 patients, and 20 volunteers with similar age and sex as a control group were included in this study. Serum samples were taken at admission to measure erythrocyte sedimentation rate (ESR), c-reactive protein (CRP) and white blood cell count (WBC). All patients and the control group provided a single stool sample within 24 hours after admission. The study group divided into five subgroups (Child-Pugh Grade A, Grade-B, Grade-C, spontaneous bacterial peritonitis and hepatic encephalopathy) to investigate whether FC levels change as the disease progress or complications occur.Results: Median FC levels were 168.8 mg/kg for cirrhotic patients and 9.8 mg/kg for control group, and the difference between the groups was statistically significant (p=0.039). In the subgroup analysis, the differences between spontaneous bacterial peritonitis and all other subgroups were statistically significant (p=0.002). In cirrhotic patients, FC levels were not correlated either with ESR (r=0.439, p=0.545) or CRP (r=0.403, p=0.321) or WBC count (r=0.061, p=0.645).Conclusion: FC levels are increased in cirrhotic patients and early increase in FC levels before the rise of systemic inflammation markers can be used as a diagnostic marker for spontaneous bacterial peritonitis.

Keywords:

calprotectin, cirrhosis, secondary peritonitis,

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