Birsen AYDEMİR, Tevfik GÜLYAŞAR, H.Oktay SEYMEN, Hasan MAĞIN, Refik DEMİRTUNÇ, Pınar SEYMEN

Anti-hcv pozitif hemodiyaliz hastalarında eritrosit ve serum ferritin düzeyleri ile karaciğer enzim düzeyleri arasındaki ilişkinin değerlendirilmesi

Amaç: Hepatit C enfeksiyonu olan hastalarda, kronik enflamasyona bağlı olarak hepatosellüler depolardan ferritin salınmakta ve bu hepatosellüler hasarın bağımsız bir göstergesi olarak kabul edilmektedir. Serum eritrosit ferritin seviyelerinin, serum ferritin düzeyleri gibi, karaciğer hasarını göstermede aminotransferazlar ile birlikte kullanılıp kullanılamayacağı bilinmemektedir. Çalışmamızda amacımız, anti-HCV pozitif hemodiyaliz hastalarında, karaciğer hasarının göstergesi olan aminotransferaz enzim düzeyleri ile eritrosit ve serum ferritin düzeyleri arasındaki ilişkiyi ortaya koymaktır. Gereç ve yöntem: Beş farklı diyaliz merkezinde diyalize giren, aktif enfeksiyonu, malignitesi ve polisitemisi bulunmayan, kan transfüzyonu yapılmamış, anti- HCV' si pozitif 40 hastada eritrosit ferritin, serum ferritin, CRP, HBsAg, anti-HİV, anti-HCV, ALT (alaninaminotransferaz ) ve AST (aspartat aminotransferaz) düzeylerine bakıldı. SPSS (ver. 12) istatistik programı kullanılarak sonuçlar değerlendirildi. Bulgular: Hastaların 17' si erkek 23'ü kadın olup yaş ortalamaları 54±16 yıl, ALT 25 ±19 IU/L, 20±12 IU/L, eritrosit ferritin değerleri 1,8 ± 1,72 ng/gHb, serum ferritin değerleri 992±424 ng/ml olarak bulundu. Yapılan değerlendirmede, serum aminotransferaz değerleri ile serum ferritin değerleri arasında istatistiksel olarak anlamlı pozitif korelasyon saptandı (p< 0,05), ancak eritrosit ferritin ile aminotransferazlar düzeyleri arasında istatistiksel olarak anlamlı pozitif korelasyon saptanmadı (p> 0,05). Sonuç: Anti-HCV pozitif hastalarda hepatosellüler depolardan salınan serum ferritin seviyeleri aminotransferaz enzimleri ile birlikte karaciğer hasarının göstergelerinden biridir. Yaptığımız çalışmada, aminotransferaz seviyeleri ile serum ferritin düzeyleri arasında anlamlı korelasyon saptandı, ancak eritrosit ferritin düzeyleri ile aminotransferaz seviyeleri arasında anlamlı bir korelasyon saptanamamıştır. Bulgular HCV pozitif hemodiyaliz hastalarında, eritrosit ferritin seviyelerinin karaciğer hasarını göstermede serum ferritin gibi iyi bir belirteç olarak kullanılamayacağını düşündürmektedir.

The evaluation of relationship between erythrocyte and serum ferritin levels with aminotransferase enzyme levels in anti-hcv positive hemodialysis patients

Objective: Serum ferritine level which is released from hepatocellular stores due to chronic inflammation of HCV infection, is accepted as an independent indicator of hepatocellular damage. It is not known whether intra-erythrocyte ferritin could be used as an indicator of hepatocellular damage as with serum ferritin, AST and ALT. In our study, we evaluated the relationship between aminotransferase level with eriythrocyte ferritin level and serum ferritin level in anti-HCV positive hemodialysis patients. Materials and methods: 40 HCV patients, taking hemodalysis therapy at five different hemodialysis center, were included in the study. They had no active inflamation, malignity and policytemia and had not been given blood transfusion. Erythrocyte and serum ferritin, ALT, AST, CRP, HBs-Ag, anti-HCV, anti-HIV levels were detected. The results were evaluated by using SPSS (ver.12) statistics program.Results: 17 male and 23 female patients were taken to study and their average age was 54 ± 16 year. Their alanineaminotransferase values were 25 ± 29 IU/L, their aspartat aminotransferase values 20 ± 12 IU/L, erythrocyte ferritin values 1.8 ± 1.72 ng/gHb and their serum ferritin values were 992 ± 424ng/ml. When the data evaluated, it was found that, there is a statistically significant positive correlation between the serum aminotransferase levels and the serum ferritin levels (p< 0.05), whereas there was no statistically significant pozitif correlation between aminotransferase levels and erythrocyte ferritin levels (p> 0.05).Conclusion: In HCV positive patients, AST, ALT and serum ferritin released from hepatoselluler stores shows liver damage. We found a significant positive correlation between aminotransferase levels and serum ferritin levels, but not with erythrocyte ferritin levels. This finding lead us to a conclusion that, erythrocyte ferritin levels are not a good marker for showing hepatocellular damage as like serum ferritin levels in HCV positive hemodialysis patients.

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