Hepatit B virüsüne bağlı (HBV) kronik aktif hepatit ve siroz sürecindeki hastalarda kemik metabolizması değişiklikleri

Bu çalışmada, HBV'ne bağlı kronik aktif hepatit (KAH) ve sirozlu hastalarda kemik metabolizmasındaki değişiklikleri göstermek amacıyla, HBV'ne bağlı gelişmiş 14 KAH ve 15 siroz hastasında kemik mineralizasyonu belirleyicisi olarak plazma iyonize kalsiyum (Ca), 25 hidroksi vitamin D (25(OH)vitD), paratiroid hormon (PTH) seviyeleri; kemik yapımı belirleyicileri olarak, kemik spesifik alkelen fosfataz (KAP), osteokalsin (OK), tip-1 kolajen propeptid (T-1KP) ve yıkım parametreleri olarak idrarda Ca ve deoksipridinolin (DP) atılımı ile X-ray emisyon absorptiometre (DEXA) yöntemiyle lumbar vertebra ve femur proksimalinin kemik mineral dansiteleri (KMD) çalışıldı. Benzer yaş ve cinsten 20 sağlıklı gönüllü kişi kontrol grubu olarak çalışmaya katıldı. KAH, siroz ve kontrol grubunda plazma iyonize Ca, 25(OH)vitD ve PTH düzeyleri anlamlı bir farklılık göstermedi. L1-L4 vertebra ve femurun değerlendirilen 5 bölgesinde (boyun, trokanter, intertrokanter, Ward's üçgeni, total) her iki hasta grubunda kontrol grubuna göre kemik kitlesinde belirgin kayıp olduğu gösterildi. Plazma OK düzeyinde her iki hasta grubunda kontrole göre istatistiksel olarak anlamlı artış saptandı. Buna karşılık KAP ve T-1KP düzeyleri sadece sirotik evredeki hastalarda kontrollere göre anlamlı yüksek bulundu. Sonuç olarak, beklenenin aksine HBV'ne bağlı gelişen KAH ve siroz hastalarının hiçbirinde osteomalazik bir tablo saptanmazken, her iki hasta grubunda yüksek dönüşüm hızlı osteopeni ve osteoporoz varlığı belirlendi.

Anahtar Kelimeler:

Hepatit B virüsü, Hepatit, kronik, Karaciğer sirozu, Osteomalazi, Osteoporoz, Kemik yoğunluğu

Change of bone metabolism in patients with hepatitis B virus induced chronic active hepatitis and cirrhosis

In this study, we evaluated 15 pts with cirrhosis and 14 pts with CAH due to HBV etiology. 20 healthy volunteers with similar age and sex were admited to study as control. We measured the plasma ionised Ca, 25(OH)Vit D, PTH levels as a marker of bone mineralization; bone spesific alkaline phophatase (BAP), osteocalcin and type-1 collagen propeptide as the marker of bone formation; and urinary calcium and deoxypyridinoline excretion for determination of bone resorption. Bone mineral density of the lumbar spine and proximal part of femur was assesed by dual emission X-ray absorptiometry (DEXA) method. There was no statistically significant difference between cirrhosis, CAH and control groups for plasma ionised Ca, 25(OH)Vit D and PTH levels. Both in CAH and cirrhosis groups significantly increased bone loss were found by measurements of BMD of L1-L4 lumbar spine and 5 different areas of femur (neck, trochanter, intertrochanter, Ward's triangle and total). Plasma osteocalcin level was found significantly higher in both pts groups than controls (p<0.05). On ffie other hand, BAP and type 1 collagen propeptide levels were high only in cirrhosis group.In conclusion, contrary to expection we didn't found the presence of osteomalasia, but high turnover bone loss was displayed in both CAH and cirrhosis group.

Keywords:

Hepatitis B virus, Hepatitis, Chronic, Liver Cirrhosis, Osteomalacia, Osteoporosis, Bone Density,

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