Abstract
Background: It
is reported that approximately 200 million individuals worldwide are infected
with hepatitis B virus (HBV), and about one-fourth of these patients are active
acute viral hepatitis B infections. HBV can lead to chronicization after a mean
incubation period of 180 days, resulting in cirrhosis and liver cancer. In
patients with HBV, the level of some plasma proteins increases or decreases in
acute inflammatory response or in some types of tissue damages. In serum
protein electrophoresis, albumin forms the largest band, the prealbumin band
appears as a pale band just before albumin, and the production or reduction of
these proteins may be affected in patients with HBV. The liver is an important
storage organ for iron. Hepatic injury and dysfunction may disrupt iron
homeostasis. The aim of this study was to determine serum protein
electrophoresis and prealbumin levels in patients with active viral hepatitis B
and to investigate the diagnostic value of these levels.
Materials and Methods: In
our study, 47 viral hepatitis B patients (mean age 45 ± 19.49 years) and 52
healthy controls (mean age 46 ± 18.2 years) were included. Clinical and
serological markers of acute HBV infection were analyzed by ELISA kits and
total protein, albumin, total bilirubin, iron, transferrin, AST, ALT, GGT and
ALP levels were analyzed by autoanalyzer spectrophotometric method while
ferritin levels were measured by immulite chemiluminescent method. Serum
protein electrophoresis was studied manually in the hydrasys device technique.
Statistical analysis was performed using SPSS 15.0 software. Chi-square,
Mann-Whitney U and Pearson correlation analysis tests were used for data
assessment.
Results: In our study,
serum pealbumin levels were significantly lower in the active HBV patients
group (11.07 ± 4.21%) compared to the control group (19.35 ± 7.4%) (p
<0.05). Serum transferin levels were also significantly lower in the active
HBV patients group compared to the normal healthy group, but serum iron and
ferritin levels were significantly higher (p <0.05).
Conclusion: The
decrease in serum prealbumin levels in active HBV patients during the active
phase of the disease is consistent with the changes in other parameters. The
half-life of prealbumin synthesized by the liver is very important in terms of
reflecting sudden changes in the liver. Albumin reflecting an important
function of the liver. It does not reflect sudden changes in acute liver
diseases due to its long half-life. It was concluded that serum prealbumin
assays are a sensitive marker that rapidly reflects functional changes in liver
in active viral hepatitis. Inflammation and damage of the liver of the disease
in active HBV patients is thought to decrease serum prealbumin and transferrin
levels. Ferritin is an intracellular iron storage protein and a marker for iron
stores and may also indicate liver disease.
References
- Tekin Koruk S, Duygu F, Karaağaç L ve ark. Harran Üniversitesi Tıp Fakültesi Hastanesinde 2005-2009 yıllar arasında takip edilen çocuk kronik hepatit B hastaların özelliklerinin incelenmesi. Viral Hepatit Dergisi. 2010;16(3):87-92.
- Wasley A, Grytdal S, Gallagher K. Centers for disease control and prevention (CDC). surveillance for acute viral hepatitis-United States, 2006. MMWR Surveill Summ. 2008; 57(2):1-24.
- Gane EJ, Deray G, Liaw YF, et al. Telbivudine improves renal function in patients with chronic hepatitis B. Gastroenterology. 2014;146(1):138-46.
- Huang JS, Luo X, Yu JX, Liu W, Chen XW, Xie L, et al. Indige-nous and imported low molecular weight heparin in the treatment of chronic hepatitis B and cirrhosis with hepatitis B virus: a pros-pective randomized controlled clinical study. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2007;19(7):408-11.
- Liang TJ. Hepatitis B: The virus and disease. Hepatology. 2009; 49(5):13-21.
- He QY, Lau GK, Zhou Y, Yuen ST, Lin MC, Kung HF, Chiu JF. Serum biomarkers of hepatitis B virus infected liver inflammation: a proteomic study. Proteomics. 2003; 3(5):666-74.
- Kılıçturgay K. Viral hepatitte immünopatogenez. Tekeli E, Balık İ, ed. Viral Hepatit 2003. Ankara: Karakter Color AŞ, 2003; 316-28.
- Franco-Jarava C, Dieli-Crimi R, Vila-Pijoan G, Colobran R, Pujol-Borrell R, Hernández-González M. Serum protein electropho-resis and complement deficiencies: a veteran but very versatile test in clinical laboratories. Clin Chem Lab Med. 2019; 57(8):179-82.
- Hausmann JC, Cray C, Hartup BK. Comparison of serum pro-tein electrophoresis values in wild and captive whooping cranes (Grus americana). J Avian Med Surg. 2015; 29(3):192-9
- Mayer G, Schomerus H. Synthesis rates of albumin and fibri-nogen during and after acute hepatitis. Digestion. 1975;13(5):261-71.
- Tan L, Meng Y, Zeng T, Wang Q, Long T, Wu S, et al. Clinical diagnostic significance of prealbumin, cholinesterase and retinol binding protein in liver cirrhosis combined with encephalopathy. Br J Biomed Sci. 2019;76(1):24-28.
- Volchkova EV, Pak SG, Malov VA, Umbetova KT. Changes in the levels of acute phase proteins in viral hepatitis. Ter Arkh. 2000;72(11):18-21.
- Coffin CS, Zhou K, Terrault NA. New and old biomarkers for diagnosis and management of chronic hepatitis B virus infection. Gastroenterology. 2019;156(2):355-68.
- Gao W, Kong M, Yao J, Wang F, Liu J, Wang D, et al. Chan-ges in prealbumin and body mass index associated with T lymp-hocyte subsets and nutritional status in chronic hepatitis B and HBV-cirrhosis patients. Clin Lab. 2018;64(11) 172-7.
- WeiLin Mao, Ying Hu, Yu Feng Lou, YueMei Chen, and Ju-anWen Zhang. Abnormal serum iron markers in chronic hepatitis B virus infection may be because of liver injury. Eur J Gastroenterol Hepatol. 2015; 27(2):130 – 6.
- Wu J, Chen L, Chen Y, Yang J, Wu D. Serum ferritin concent-ration predicts mortality in patients with hepatitis B virus-related acute on chronic liver failure. Arch Med Res. 2014;45:251– 6.
- Mao W, Hu Y, Lou Y, Chen Y, Zhang J. Abnormal serum iron markers in chronic hepatitis B virus infection may be because of liver injury. Eur J Gastroenterol Hepatol. 2015; 27(2):130-6.
- Mao W, Hu Y, Lou Y, Chen Y, Zhang J. Abnormal serum iron markers in chronic hepatitis B virus infection may be because of liver injury. Eur J Gastroenterol Hepatol. 2015; 27(2):130-6.
- Büyükaşik NS, Nadır I, Akin FE, Cakal B, Kav T, Ersoy O, Büyükaşik Y. Serum iron parameters in cirrhosis and chronic hepa-titis: detailed description. Turk J Gastroenterol. 2011; 22:606–11.
- Bayraktar Y, Köseoğlu T, Somner C, Kayhan B, Temizer A, Uzunalimoğlu B, et al. The use of deferoxamine infusions to en-hance the response rate to interferon-alpha treatment of chronic viral hepatitis B. J Viral Hepat. 1996; 3:129–35.
- Nakano S, Kumada T, Takeda I et al: Clinical significance of serum ferritin determination for hepatocellular carcinoma. Am J Gastroenterol. 1984;79(8):623–7.
- Lin CC, Tsai LY, Huang JF, et al. Selenium, iron, copper and zinc levels and copper-to-zinc ratios in serum of patients at diffe-rent stages of viral hepatic dieases. Biol Trace Elem Res. 2006;109(1):15-24.
- Lv W, Yan F, Zeng M, Zhang J, Yuan Y, Ma J. Value of abdo-minal susceptibility-weighted magnetic resonance imaging for quantitative assessment of hepatic iron deposition in patients with chronic hepatitis B: comparison with serum iron markers. J Int Med Res. 2012;40(3):1005-15.
Abstract
Amaç: Dünyada
yaklaşık 200 milyon bireyin hepatit B virüsü (HBV) ile enfekte olduğu ve bu
hastaların yaklaşık 1/4’ünün aktif viral hepatit B akut enfeksiyonu olduğu
bildirilmektedir. HBV ortalama 180 günlük inkübasyon dönemini takiben
kronikleşmeye yol açabilen ve bunu sonucunda siroz ve karaciğer kanserine yol
açabilir. HBV’lü hastalarda bazı plazma proteinlerinin düzeyi akut yangısal
yanıtta veya bazı tipte doku zedelenmelerinde artar veya azalır. Serum protein
elektroforezinde albümin en büyük bandı oluşturur, prealbümin bandı soluk bir
band şeklinde albüminin hemen önünde görülür ve bu proteinlerin üretimi veya
azalması HBV’lü hastalarda etkilenebilir. Karaciğer demir için önemli bir
depolama organıdır. Hepatik yaralanma ve disfonksiyon demir homeostazını bozabilir.
Bu çalışma aktif viral Hepatit B’li hastalarda serum protein elektroforezi ve
prealbumin düzeylerini saptamak ve bu düzeylerin aktif viral hepatit B’li olan
hastaların tanıdaki değerlerini araştırmak amacıyla yapılmıştır.
Materyal ve Metod: Çalışmamızda
toplam 47 viral hepatit B’li hasta (yaş ortalamaları 45 ±19,49 yıl) ve 52
sağlıklı kontrol grubunun (yaş ortalamaları 46 ± 18,2 yıl) idi. Hastaların akut
HBV enfeksiyonu klinik ve serolojik belirteçleri ELISA kitleri ile ve total
protein, albümin, total bilirubin, demir, transferin, AST, ALT, GGT ve ALP
düzeyleri otoanalizöründe spektrofotometrik yöntemle ve ferritin düzeyleri ise
immulite chemiluminescent yöntemi ile çalışıldı. Serum protein elektroforezi
hydrasys aygıt teknik manuel olarak çalışıldı. İstatistiksel analizler, SPSS
15.0 paket program ile ki-kare, Mann-Whitney U ve Pearson korelasyon analizi
testleri kullanılarak yapıldı.
Bulgular: Çalışmamızda
aktif HBV hasta grubunda serum prealbümin düzeyleri (%11,07 ± %4.21) kontrol
grubu (%19,35 ± %7.4), ile karşılaştırıldığında anlamlı olarak düşük bulundu
(p<0.05). Aktif HBV hasta grubunda serum transferinin düzeyleri, normal
sağlıklı grup ile karşılaştırıldığında anlamlı olarak düşük, ancak serum demir
ve ferritin değerlerinin anlamlı olarak yüksek bulundu (p<0.05).
Sonuç: Aktif
HBV hastalarda hastalığın aktif döneminde serum prealbümin düzeylerinde
saptanan düşme, diğer parametrelerde görülen değişmelerle uyumludur. Karaciğer
tarafından sentez edilen prealbüminin yarılanma ömrünün çok kısa olması,
karaciğerdeki ani değişmeleri yansıtması açısından önem kazanır, karaciğerin
önemli bir fonksiyonunu yansıtan albüminler yarılanma ömürlerinin uzun olması
nedeniyle akut karaciğer hastalıklarındaki ani değişmeleri yansıtmaz. Serum
prealbümin tayinlerinin aktif viral hepatitte karaciğerdeki fonksiyonel
değişimleri hızlı yansıtan, duyarlı bir belirteç olduğu sonucuna varılmıştır.
Aktif HBV hastalarda hastalığın karaciğerin iltihabı ve hasarı serum prealbümin
ve transferin düzeylerinin düşmesi düşünülmektedir. Ferritin, hücre içi bir
demir depolama proteinidir ve demir depolarının bir belirtecidir ve karaciğer
hastalığına da işaret edebilir.
Keywords
References
- Tekin Koruk S, Duygu F, Karaağaç L ve ark. Harran Üniversitesi Tıp Fakültesi Hastanesinde 2005-2009 yıllar arasında takip edilen çocuk kronik hepatit B hastaların özelliklerinin incelenmesi. Viral Hepatit Dergisi. 2010;16(3):87-92.
- Wasley A, Grytdal S, Gallagher K. Centers for disease control and prevention (CDC). surveillance for acute viral hepatitis-United States, 2006. MMWR Surveill Summ. 2008; 57(2):1-24.
- Gane EJ, Deray G, Liaw YF, et al. Telbivudine improves renal function in patients with chronic hepatitis B. Gastroenterology. 2014;146(1):138-46.
- Huang JS, Luo X, Yu JX, Liu W, Chen XW, Xie L, et al. Indige-nous and imported low molecular weight heparin in the treatment of chronic hepatitis B and cirrhosis with hepatitis B virus: a pros-pective randomized controlled clinical study. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2007;19(7):408-11.
- Liang TJ. Hepatitis B: The virus and disease. Hepatology. 2009; 49(5):13-21.
- He QY, Lau GK, Zhou Y, Yuen ST, Lin MC, Kung HF, Chiu JF. Serum biomarkers of hepatitis B virus infected liver inflammation: a proteomic study. Proteomics. 2003; 3(5):666-74.
- Kılıçturgay K. Viral hepatitte immünopatogenez. Tekeli E, Balık İ, ed. Viral Hepatit 2003. Ankara: Karakter Color AŞ, 2003; 316-28.
- Franco-Jarava C, Dieli-Crimi R, Vila-Pijoan G, Colobran R, Pujol-Borrell R, Hernández-González M. Serum protein electropho-resis and complement deficiencies: a veteran but very versatile test in clinical laboratories. Clin Chem Lab Med. 2019; 57(8):179-82.
- Hausmann JC, Cray C, Hartup BK. Comparison of serum pro-tein electrophoresis values in wild and captive whooping cranes (Grus americana). J Avian Med Surg. 2015; 29(3):192-9
- Mayer G, Schomerus H. Synthesis rates of albumin and fibri-nogen during and after acute hepatitis. Digestion. 1975;13(5):261-71.
- Tan L, Meng Y, Zeng T, Wang Q, Long T, Wu S, et al. Clinical diagnostic significance of prealbumin, cholinesterase and retinol binding protein in liver cirrhosis combined with encephalopathy. Br J Biomed Sci. 2019;76(1):24-28.
- Volchkova EV, Pak SG, Malov VA, Umbetova KT. Changes in the levels of acute phase proteins in viral hepatitis. Ter Arkh. 2000;72(11):18-21.
- Coffin CS, Zhou K, Terrault NA. New and old biomarkers for diagnosis and management of chronic hepatitis B virus infection. Gastroenterology. 2019;156(2):355-68.
- Gao W, Kong M, Yao J, Wang F, Liu J, Wang D, et al. Chan-ges in prealbumin and body mass index associated with T lymp-hocyte subsets and nutritional status in chronic hepatitis B and HBV-cirrhosis patients. Clin Lab. 2018;64(11) 172-7.
- WeiLin Mao, Ying Hu, Yu Feng Lou, YueMei Chen, and Ju-anWen Zhang. Abnormal serum iron markers in chronic hepatitis B virus infection may be because of liver injury. Eur J Gastroenterol Hepatol. 2015; 27(2):130 – 6.
- Wu J, Chen L, Chen Y, Yang J, Wu D. Serum ferritin concent-ration predicts mortality in patients with hepatitis B virus-related acute on chronic liver failure. Arch Med Res. 2014;45:251– 6.
- Mao W, Hu Y, Lou Y, Chen Y, Zhang J. Abnormal serum iron markers in chronic hepatitis B virus infection may be because of liver injury. Eur J Gastroenterol Hepatol. 2015; 27(2):130-6.
- Mao W, Hu Y, Lou Y, Chen Y, Zhang J. Abnormal serum iron markers in chronic hepatitis B virus infection may be because of liver injury. Eur J Gastroenterol Hepatol. 2015; 27(2):130-6.
- Büyükaşik NS, Nadır I, Akin FE, Cakal B, Kav T, Ersoy O, Büyükaşik Y. Serum iron parameters in cirrhosis and chronic hepa-titis: detailed description. Turk J Gastroenterol. 2011; 22:606–11.
- Bayraktar Y, Köseoğlu T, Somner C, Kayhan B, Temizer A, Uzunalimoğlu B, et al. The use of deferoxamine infusions to en-hance the response rate to interferon-alpha treatment of chronic viral hepatitis B. J Viral Hepat. 1996; 3:129–35.
- Nakano S, Kumada T, Takeda I et al: Clinical significance of serum ferritin determination for hepatocellular carcinoma. Am J Gastroenterol. 1984;79(8):623–7.
- Lin CC, Tsai LY, Huang JF, et al. Selenium, iron, copper and zinc levels and copper-to-zinc ratios in serum of patients at diffe-rent stages of viral hepatic dieases. Biol Trace Elem Res. 2006;109(1):15-24.
- Lv W, Yan F, Zeng M, Zhang J, Yuan Y, Ma J. Value of abdo-minal susceptibility-weighted magnetic resonance imaging for quantitative assessment of hepatic iron deposition in patients with chronic hepatitis B: comparison with serum iron markers. J Int Med Res. 2012;40(3):1005-15.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Research Article |
| Authors | |
| Publication Date | December 25, 2019 |
| Submission Date | July 10, 2019 |
| Acceptance Date | December 16, 2019 |
| Published in Issue | Year 2019 Volume: 16 Issue: 3 |
Harran Üniversitesi Tıp Fakültesi Dergisi / Journal of Harran University Medical Faculty