Kronik Delta hepatitlerin genel özellikleri
General charecteristics of chronic delta hetatitis
Yazar: ALİ ÖZTÜRK
Danışman: PROF. DR. ULUS SALİH AKARCA
Ege Üniversitesi / Tıp Fakültesi / İç Hastalıkları Ana Bilim Dalı / Gastroenteroloji Bilim Dalı
Derece: Tıpta Uzmanlık, 2010
Konu: Gastroenteroloji = Gastroenterology
Dizin: Hepatit D virüsü = Hepatitis D virus ; İnterferonlar = Interferons

Özet:
Hepatit delta virusu (HDV) ülkemizde önemli siroz nedenlerinden biridir. Biz bu çalışmamızda 1990 ve 2009 yılları arasında kliniğimizde takip ettiğimiz 213 Kronik Hepatit D (KHD) hastasının klinik ve labaratuvar özelliklerini, bu hastalara kliniğimizde uyguladığımız tedavi yöntemlerini, hastaların bu tedavilere verdikleri yanıtları ve yine hastaların klinik seyir ve prognozlarını araştırdık.Çalışmaya dahil edilen hastaların yaş ortalaması 42.2 ± 12.4 (17-76)'dır. Ortalama takip süresi 40.0 ± 38.1 aydır. Hastalar aldıkları tedavilere göre 6 grupta değerelendirildi. Birinci grupta tedavisiz izlenenler, ikinci grupta Nükleozit Anoloğu (NA) alanlar, üçüncü grupta interferon (IFN) alanlar, dördüncü grupta pegile interferon (PEG IFN) alanlar, beşinci grupta IFN + NA alanlar, altıncı grupta da PEG IFN + NA alanlar yer almaktaydı. IFN alan 12 hastada tedavi sonu virolojik yanıt %33 iken, tedavi sonrası 1. yılda bu oran %16.6''dır. Bu oranlar sırasıyla PEG IFN alan 26 hastada %53 ve %30.7, IFN + NA alan 24 hastada %42 ve %16.6, PEG IFN + NA alan 5 hastada %0 ve %0, tedavisiz izlenen 20 hastada %0 ve %0 ve NA alan 59 hastada %0 ve %0'dır. ALT düşme bakımından IFN grubunda istatistiksel anlamlı düşüş mevcutken, HBV DNA düşmesi bakımından NA grubunda anlamlı düşüş mevcuttur.HDV ileri evrelerde yakalanan bir hastalık olup, bu nedenle HBsAg pozitif olan hastaların izlemi önemlidir. KHD tedavisinde tek etkili ajanlar IFN ve PEG IFN'lardır.

Abstract:
Hepatitis delta virus (HDV) is one of the important causes of chirrhosis in our country. In this study, we investigated clinical and laboratory features in 213 patients with chronic hepatitis D (CHD) who were followed in our clinic between 1990-2009. Treatments, their treatment responses, their clinic course and prognosis were also investigated.Mean age of studied patients is 42.2 ± 12.4 (17-76). Mean follow-up period is 40.0 ± 38.1 months. Patients were evaluated in 6 groups according to their treatment orders. First group included no treated patients, second group included patients who were treated with nucleoside analogs (NA), third group included patients who were treated with interferon (IFN), forth group included patients who were treated with peg-interferon (PEG IFN), fifth group included patients who were treated with IFN + NA, and sixth group included patients who were treated with PEG IFN+NA. In 12 patients who were treated with IFN, end of treatment response 33% and sustained virological response was 16.6% after the treatment the end of the first year. These rates were 53% and 30.7% in 26 patients who were treated with PEG-İFN, 42% and 16.6% in 24 patients who were treated with IFN+NA, 0% and 0% in 5 patients who were treated with PEG-IFN, %0 and %0 in no treated 20 patients, %0 and %0 in 59 patients who were treated with NA respectively. In patients who were treated with IFN there was a statistically significant decrease in ALT levels. In patients who were treated with NA there was a statistically significant decrease in HBV-DNA levels.HDV is a disease which is diagnosed usually in advanced phases. So, follow up the of patients with HBsAg is very important. Only effective agents in treatment are IFN and PEG-IFNs of CHD.