Zehra ÖKSÜZ, Mehmet Sami SERİN, Serkan YARAŞ, Enver ÜÇBİLEK, Orhan SEZGİN

İnsan sitomegalovirüs/ epstein-barr virüs koenfeksiyonunun kronik hepatit b hastalarının karaciğer fonksiyonları üzerine olası etkileri

Amaç: İmmünsüprese hastalarda fırsatçı enfeksiyonun yaygın patojenleri olan İnsan Sitomegalovirüs (HCMV) ve Epstein-Barr virüsün (EBV) immünokompetan konakçıda yeniden aktivasyonu genellikle asemptomatiktir, ancak kronik hastalığa neden olan HBV gibi virüslerle koenfeksiyonu hastalığın prognozunu kötü etkileyebilir. Bu çalışmada histolojik aktivite indeksi bilinen kronik HBV hastalarında HCMV/EBV enfeksiyon prevalansının, koenfeksiyonun risk faktörlerinin ve bunların hastaların karaciğer fonksiyonlarına olası etkilerinin belirlenmesi amaçlandı. Yöntem: Çalışmaya 142 kronik HBV (KHB), 20 HBV’ye bağlı siroz ve 4 HBV’ye bağlı hepatosellüler karsinoma (HSK) tanısı alan toplam 166 hasta retrospektif olarak dâhil edildi. HCMV/EBV DNA amplifikasyonu, gerçek zamanlı kantitatif polimeraz zincir reaksiyonu (RT-qPZR) ile hasta serumlarından belirlendi. Bulgular: Çalışmaya dâhil edilen HBV hastalarının %3.01 HCMV tespit edilirken, %6.02 EBV tespit edilmiştir. HCMV ile koenfekte KHB hastalarında alanin aminotransferaz (ALT) düzeyleri koenfeksiyonu olmayan hastalara nazaran daha yüksek bulunmuşken (p<0.05), EBV ile koenfekte hastalar ile olmayanlar arasında ALT seviyesi açısından bir fark bulunamamıştır. HCMV/EBV koenfekte hastaların histolojik aktivite skorları HCMV/EBV koenfeksiyonu olmayanlardan daha yüksek olduğu tespit edilmiştir. Aynı zamanda HCMV/EBV koenfeksiyonu olan hastaların HBV DNA yükleri koenfeksiyonu olmayan hastalara kıyasla daha az bulunmuştur. Sonuç: Bu çalışma immünsüprese KHB hastalarının yanında immünkompetan KHB hastalarında da HCMV/EBV koenfeksiyonunun önemli olabileceğini göstermiştir. Kronik HBV hastalarında HCMV/EBV koenfeksiyonun düşük HBV DNA seviyelerine rağmen histolojik aktivite skorlarının yüksek bulunması karaciğer hasarını arttırdığını ve prognozu kötü etkilediğini göstermektedir. Bu yüzden KHB hastalarının HCMV/EBV enfeksiyonu için yüksek risk grupları olarak kabul edilmesi ve bu enfeksiyonlar yönünden takip edilerek tedavi edilmesi hastalığın kötü prognozunu değiştirmede kritik öneme sahip olacağı görüşündeyiz.

Anahtar Kelimeler:

hepatit B virüs, , İnsan sitomegalovirüs, Epstein-Barr virüs, Fibroz, Gerçek zamanlı PZR

Possible effects of human cytomegalovirus/epstein-barr virus coinfection on the liver functions of chronic hepatitis B patients

Aim: The reactivation of Human Cytomegalovirus (HCMV) and Epstein-Barr Virus (EBV), which are the common pathogens of opportunistic infection in immunosuppressed patients, is usually asymptomatic in the immunocompetent host, but may seriously affect the prognosis of the disease with viruses like HBV, which causes chronic diseases. The purpose of this study was to determine the prevalence of HCMV/EBV infection, the risk factors of coinfection, and their effects on the liver functions of chronic HBV patients whose histological activity index are known. Method: A total of 166 patients, 142 diagnosed with chronic HBV (CHB), 20 with HBV-related cirrhosis and 4 with HBV-related hepatocellular carcinoma (HCC), were retrospectively included in this study. The HCMV/EBV DNA expression was determined from the patient serums with real-time Quantitative Polymerase Chain Reaction (RT-qPCR). Results:It was determined that 3.01% of the HBV patients, who were included in the study, were identified as HCMV, and 6.02% were EBV. The Alanine Aminotransferase (ALT) levels of the CHB patients who were coinfected with HCMV were higher than those who were not infected; and there were no differences in terms of the ALT levels between those who were coinfected with EBV and who were not. Histological activity scores of the patients who were coinfected with HCMV/EBV were higher than those without HCMV/EBV coinfection. Meanwhile, the HBV DNA loads of the patients with HCMV/EBV coinfection were lower than the patients without it. Conclusion: This study showed that HCMV/EBV coinfection may be important in immunocompromised CHB patients as well as in immunosuppressed CHB patients. Despite the low HBV DNA levels in CHB patients with HCMV/EBV coinfection, high histological activity scores show that they increase liver damage and affect prognosis poorly. For this reason, we believe that accepting and treating CHB patients as high risk groups for HCMV/EBV infection and following-up and treating them for these infections will have critical importance in changing the poor prognosis of the disease.

Keywords:

Hepatitis B virus, human cytomegalovirus, epstein-barr virus, fibrosis, real-time PCR,

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