İ. SÜLEYMANLAR, G. U. KARATAŞ, H. KOÇAK, G. TEKİNALP, G. SÜLEYMANLAR

Possible correlations among viremia, genotypes and liver histology in HCV(+) hemodialysis patients

Amaç: Kronik hepatit C virus (HCV) infeksiyonu, hemodiyaliz hastalarında sık görülen ancak yavaş ilerleyen bir karaciğer hastalığıdır. HCV nin viral yükünün ve genotipinin hastalığın ilerlemesinde rol oynadığı düşündüren kanıtlar vardır. Bu çalışmada, kronik C hepatiti olan hemodiyaliz hastalarında HCV RNA pozitifliği ve HCV genotipleri ile klinikopatolojik bulgular arasındaki ilişkilerin araştırılması amaçlanmıştır. Yöntem ve Gereç: Çalışmaya HCV antikoru pozitif olan yaş ortalaması 47,3 (22-80) yıl, 40 (%55) ı erkek olan 73 kronik hemodiyaliz hastası alınmıştır. Ortalama 10.4±4.4 yıllık hemodiyaliz süresi olan bu hastaların biyokimyasal, virolojik ve histopatolojik verilerinin retrospektif analizi yapılmıştır. Bulgular: ALT düzeyi açısından HCV antikoru pozitif hastaların 50 (%68.5) sinde normal, 18 (%24) inde intermittent yükseklik, 5 (%6,8) inde persistan olarak yüksek seyretmiştir. Yetmiş üç hastanın 42 (57.5%) sinde HCV RNA pozitifliği saptanmıştır. Bu 42 hastanın 29 unda HCV genotipi saptanabilmiştir. Bu hastaların 3 ünde genotip 1a, 26 sında genotip 1b saptanmıştır. HCV-RNA pozitif ve negatif hastalar arasında yaş, cinsiyet, diyaliz süresi, ALT yüksekliği ve albumin düzeyleri açısından fark bulunmamıştır. Karaciğer biyopsisi yapılmış 21 hastada HCV RNA (+) ve genotipleri ile hastalığın histolojik evresi ve derecesi arasında anlamlı ilişki dikkati çekmemiştir. Sonuç: Sonuçlarımız HCV antikoru pozitif kronik hemodiyaliz hastalarında vireminin yüksek, genotip olarak da 1b nin çok daha sık olduğunu, bu viral özelliklerle klinikopatolojik bulgular arasında anlamlı ilişki olmadığını düşündürmektedir. Ancak, bu hasta grubunda virolojik ve klinikopatolojik bulgular arasındaki ilişkilerin belirlenmesi için ileri çalışmalara gereksinim vardır.

HCV(+) hemodiyaliz hastalarında viremi, genotip ve karaciğer histolojisi arasındaki ilişkiler

Aim: The aim of this study was to address whether there were possible correlations between viral load or HCV genotype and clinicopathological features in hemodialysis patients with chronic HCV infection. Material and Methods: Seventy three HCV antibody (+) hemodialysis patients (Mean age: 47.3 ± 15.6 years, Male/ Female: 40/33 ) were enrolled in the study. The biochemical, viral and histological data were analyzed retrospectively in these patients on dialysis (mean duration; 10.4±4.4 years). Results: ALT level was normal in 50 patients (68.5%), intermittently high in 18 patients (24.8%) and persistently high in 5 patients (6.8%). HCV RNA (57, 5 %) was positive in 42 of 73 patients. HCV genotype was determined in 29 patients. HCV genotype 1a was detected in three cases and HCV genotype 1b was detected in 26 patients. There was no difference between HCV RNA positive patients and HCV RNA negative ones with regard to age, gender, duration of dialysis, ALT and albumin levels. A liver biopsy was performed in 21 of 73 patients. It was found that histological features were not different between HCV RNA (+) and HCV RNA (-) patients. Moreover, HAI and fibrosis scores were found to be similar among patients with HCV genotype 1a, HCV genotype 1b and an undetermined genotype. Conclusion: Our results demonstrate that viral load or HCV genotype do not correlate with clinicopathological features in hemodialysis patients with chronic HCV infection. But further studies should be performed to clarify possible clinicopathologic correlations in HCV Ab (+) hemodialysis patients.

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