Aziz A. HAMİDİ, Serhat KESCİOĞLU, Aslı KARADENİZ

Hepatit B virüsüne bağlı kronik infeksiyon ve kronik hepatit hastalarının klinik ve laboratuvar özelliklerinin irdelenmesi

Amaç: Avrupa Karaciğer Çalışma Derneği 2017 kılavuzunda HBV infeksiyonun eski terminolojideki farklı evreleri, kronik infeksiyon (Kİ) ve kronik hepatit (KH) olarak tanımlanmıştır. Bu çalışmada, Kİ ve KH olan hastalarda, klinik ve laboratuvar özelliklerinin irdelenmesi amaçlanmıştır. Materyal ve Metotlar: Ocak 2019 ile Ocak 2020 tarihleri arasında kronik HBV infeksiyonu tanısıyla polikliniğine başvuran >18 yaş olguların klinik ve laboratuvar özellikleri geriye dönük olarak incelendi. Olgular Kİ ve KH olarak iki gruba ayrıldı. Olguların ultrasonografik sonuçları incelenerek hepatosteatoz bulguları grade 0, 1, 2 ve 3 olarak kaydedildi. Bulgular: Yüz altmış (kadın: 87, erkek: 73) hasta incelenmiştir. Her iki grup arasında yaş ve cinsiyet açısından anlamlı bir fark bulunmadı (sırsıyla p=0.20; p=021). Aspartat aminotransferaz AST) ve alanin aminoteransferaz (ALT) KH grubunda Kİ grubuna göre daha yüksek bulundu (sırasıyla p<0,001, p=0,03). Ortalama trombosit değeri KH grubunda, Kİ grubuna göre daha düşük saptandı (p=0,04). Kİ grubunda evre 2 hepatosteatoz olguların %17’sinde saptanırken KH grubunda olguların %3’ünde saptandı (p=0,003). Sonuç: Kİ ve KH olan hastaların fibroz evresinin ilerlemeden tanı ve tedaviye ulaşması için klinik laboratuvar ve görüntüleme yöntemleriyle yakından izlenmesinin gerekli olduğu kanısına varılmıştır.

Anahtar Kelimeler:

Hepatit B virüsü, kronik hepatit B infeksiyonu, karaciğer fibrozu

Examination of clinical and laboratory features of chronic infection and chronic hepatitis cases due to hepatitis B virus

Purpose: In the European Liver Study Association 2017 guideline, the various stages of HBV infection in the old terminology were defined as chronic infection (CI) and chronic hepatitis (CH). In this study, it was aimed to examine the clinical and laboratory features of patients with CI and CH. Material and Methods: Between January 2019 and January 2020, the clinical and laboratory features of patients aged> 18 years who were admitted to the infectious diseases outpatient clinic with the diagnosis of chronic HBV infection were retrospectively analyzed. The cases were divided into two groups as CI and CH. The ultrasound results of the cases were examined and hepatosteatosis findings were recorded as grade 0, 1, 2 and 3. Results: One hundred and sixty (female: 87, male: 73) cases were examined. There was no significant difference between the two groups in terms of age and gender (respectively p = 0.20; p = 021). Aspartate aminotransferase and alanine aminoteransferase was higher in the CH group then CI group (respectively p <0.001, p = 0.03) .The mean platelet value was lower in the CH group then CI gruop (p = 0.04). Grade 2 hepatosteatosis was detected in 17% of the cases in the CI group, and in 3% of the cases in the CH group (p = 0.003). Conclusion: It was concluded that patients with CI and CH should be closely monitored by clinical laboratory and imaging methods in order to achieve diagnosis and treatment before the fibrosis stage progresses.

Keywords:

Hepatitis B virus, chronic hepatitis B infection, liver fibrosis,

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1. Terrault NA, Lok ASF, McMahon BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018;67(4):1560-1599. doi:10.1002/hep.29800
2. Özkan H. Epidemiology of Chronic Hepatitis B in Turkey. Euroasian J Hepatogastroenterol. 2018;8(1):73-74. doi:10.5005/jp-journals-10018-1264
3. Tozun N, Ozdogan O, Cakaloglu Y, et al. Seroprevalence of hepatitis B and C virus infections and risk factors in Turkey: a fieldwork TURHEP study. Clin Microbiol Infect. 2015;21(11):1020-1026. doi:10.1016/j.cmi.2015.06.028
4. European Association For The Study Of The Liver. EASL clinical practice guidelines: Management of chronic hepatitis B virus infection [published correction appears in J Hepatol. 2013 Jan;58(1):201. Janssen, Harry [corrected to Janssen, Harry L A]]. J Hepatol. 2012;57(1):167-185. doi:10.1016/j.jhep.2012.02.010
5. European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu; European Association for the Study of the Liver. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol. 2017;67(2):370-398. doi:10.1016/j.jhep.2017.03.021
6. Ergunay K, Balaban Y, Cosgun E, et al. Epidemiologic trends in HBV infections at a reference centre in Turkey: an 11-year retrospective analysis. Ann Hepatol. 2012;11(5):672-678.
7. Kumar M, Sarin SK, Hissar S, et al. Virologic and histologic features of chronic hepatitis B virus-infected asymptomatic patients with persistently normal ALT. Gastroenterology. 2008;134(5):1376-1384. doi:10.1053/j.gastro.2008.02.075
8. Kim GA, Lim YS, Han S, et al. High risk of hepatocellular carcinoma and death in patients with immune-tolerant-phase chronic hepatitis B. Gut. 2018;67(5):945-952. doi:10.1136/gutjnl-2017-314904
9. Choi GH, Kim GA, Choi J, Han S, Lim YS. High risk of clinical events in untreated HBeAg-negative chronic hepatitis B patients with high viral load and no significant ALT elevation. Aliment Pharmacol Ther. 2019;50(2):215-226. doi:10.1111/apt.15311
10. Qamar AA, Grace ND, Groszmann RJ, et al. Incidence, prevalence, and clinical significance of abnormal hematologic indices in compensated cirrhosis. Clin Gastroenterol Hepatol. 2009;7(6):689-695. doi:10.1016/j.cgh.2009.02.021
11. Rastogi A, Sakhuja P, Kumar A, et al. Steatosis in chronic hepatitis B: prevalence and correlation with biochemical, histologic, viral, and metabolic parameters. Indian J Pathol Microbiol. 2011;54(3):454-459. doi:10.4103/0377-4929.85074
12. Bondini S, Kallman J, Wheeler A, et al. Impact of non-alcoholic fatty liver disease on chronic hepatitis B. Liver Int. 2007;27(5):607-611. doi:10.1111/j.1478-3231.2007.01482.x