Karaciğer sirozlu hastalarda hepatik osteodistrofi
Hepatic osteodistrophy in patient of liver cirrhosis
Yazar: MEHMET ŞİMŞEK
Danışman: PROF. DR. VEDAT GÖRAL
Dicle Üniversitesi / Tıp Fakültesi / İç Hastalıkları Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2009
Konu: Endokrinoloji ve Metabolizma Hastalıkları = Endocrinology and Metabolic Diseases ; Gastroenteroloji = Gastroenterology
Dizin: Karaciğer sirozu = Liver cirrhosis ; Osteoporoz = Osteoporosis

Özet:
Giri ve amaç: Hepatik osteodistrofi, karaci er sirozu olan hastalarda görülen önemli birproblemdir. Bu çal mada 55 sirozlu hasta ve 30 kontrol grubunu kar la t rarak osteoporozlaili kisini ara t rmay amaçlad k.Olgular ve yöntemler: Hasta ve kontrol grubunun kemik mineral dansitesi DEXA yöntemi ileölçüldü. Çal maya dahil edilen kad nlar premenopozaldi. Kemik y k m mark rlarolarakdeoksipiridinolin, piridinolin, idrarda Ca, kemik yap m mark r olarak ALP, osteokalsin, IGF-1ölçüldü. Ayr ca IL-1, IL-6, TNF- , D3 vitamini, direkt biluribin, albumin, kortizol, PTH ölçüldü.Her iki grubun kar la t rmas nda independent t testi ve ki-kare testi kullan ld . Korelasyonanalizleri için Pearson korelasyon testi kullan ld .Bulgular: Sirozlu grupta lumbal total T-skoru ( s ras yla -1,6±1,2; -0,25±1,3g/cm 2 ;p 0,001), lumbal total Z-skoru (s ras yla -1,2±1,23; -0.6±1,3 g/cm²; p<0,001), total femur T-skoru(s ras yla 0,05±1; -0,6±0,9g/cm²; p=0,003) ve total femur Z-skoru (s ras yla -0,08±1,5; 0,7±0,9g/cm²; p=0,003) kontrol grubuna göre istatistiksel olarak dü ük saptand . Kan ALP düzeyi(s ras yla 109,2±57; 62,6±32,5 U/L; p<0,001), IL-6 düzeyi (s ras yla 27,9±51,6; 3,3±3,1 pg/ml; p=0,01), TNFdüzeyi(s ras yla 42,6±33,2; 25,3±12,3 pg/ml; p =0,007), direkt biluribin (s ras yla0,9±0,7; 0,3±0,2; p<0,001) kontrol grubuna göre istatistiksel olarak yüksekti. IGF-1 düzeyi(s ras yla 47,7±26,2; 143,4±53,2 ng/ml; p<0,001), osteokalsin (s ras yla 1,05±2,5; 7,0±13 ng/ml;p=0,002), 24 st.lik idrarda Ca (s ras yla 169,6±227,2; 287±168,6 mgr/dl; p=0,003) kontrolgrubuna göre anlaml olarak dü üktü. Üriner deoksipiridinolin/kreat. (s ras yla 9,4±9,9; 8,1±5,3pmol / ?mol; p=0,51), üriner piridinolin/kreat (s ras yla 51,3±66,6; 29±25,8 pmol/ ?mol; p=0,08),kanIL-1düzeyi3,4±8,8;1,6±3,5pg/ml; p=0,29), Vit D3 düzeyi (s ras yla 18,6±13,3;18,4±8,9?g/l,p= 0,95), kortizol düzeyi (s ras yla 11,1±4,8; 12,6±4,3 ?g/dl; p=0,15), PTH düzeyi(s ras yla 42,7±38;34,8±10,9 ?g/dl; p=0,27) kontrol grubuna göre istatistiksel olarak anlams zd .Sonuçlar:1-Sirozlu hastalarda kemik mineral dansitesinde azalma vard r. Bunun sebebi azalmkemik yap m olabilir.2-Sirozlu hastalarda artm IL-6, TNF- , direkt biluribin ve azalm IGF-1, osteokalsinkemik mineral dansitesinde azalmadan sorumlu olabilir.3- Hepatik osteodistrofi karaci er sirozunun önemli bir komplikasyonudur. Hastalar buaç dan da takip edilmelidir.

Abstract:
Background and aim: Hepatic osteodistrophy is an important problem that is seen inpatient of liver cirrhosis. We intented to search the relation of osteoporosis between 55cirrhosis patients and 30 control group by comparing, in this study .Material and methods: The bone mineral dansity of patient and the group of control ismeasured by DEXA method. The women in this study are premenoposal. It is measured thatdeoxipyridinolin, pyridinolin at urine Ca++ as markers of bones ruin; IGF- 1, osteocalcine, ALPas markers of bone anabolism; moreover IL-1, IL-6, TNF-, D3 vitamin, direct biluribin,albumin, cortisol, PTH are measured. It is used that Chi-square and independent T test in bothtwo groups when compared. Pearson correlation method is used for analysis of the study.Results: At cirrhosis group lumbal total T-score (in respectively -1,6±1,2; -0,25±1,3g/cm² ; p<0,001), lumbal total Z-score (in respectively -1,2±1,23; -0.6±1,3 g/cm²; p<0,001), totalfemur T-score (in respectively 0,05±1; -0,6±0,9g/cm²; p=0,003) and total femur Z-score (inrespectively, -0,08±1,5; 0,7±0,9 g/cm²; p=0,003), this values are low according to the controlgroup. The level of blood ALP (in respectively 109,2±57; 62,6±32,5 U/L; p<0,001), IL-6 level (inrespectively 27,9±51,6; 3,3±3,1 pg/ml; p= 0,01), TNF- level (in respectively 42,6±33,2;25,3±12,3 pg/ml; p =0,007) , direct bilurubin (in respectively 0,9±0,7; 0,3±0,2; p<0,001) it ishigh according to control group, as statistical. IGF-1 level (in respectively 47,7±26,2;143,4±53,2 ng/ml; p<0,001), osteocalcine (in respectively 1,05±2,5; 7,0±13 ng/ml; p=0,002), 24hours at urine Ca (in respectively 169,6±227,2; 287±168,6 mgr/dl; p=0,003) It is low asmeaningful according to control group . Urinary deoxipyridinolin/creat. (in respectively 9,4±9,9;8,1±5,3 pmol / ?mol; p=0,51), urinary pyridinolin/creat (in respectively 51,3±66,6; 29±25,8pmol/ ?mol; p=0,08), blood IL-1 level 3,4±8,8; 1,6±3,5pg/ml; p=0,29), Vit D3 level (inrespectively 18,6±13,3; 18,4±8,9?g/l , p= 0,95), cortisol level (in respectively 11,1±4,8; 12,6±4,3?g/dl; p=0,15), PTH level (in respectively 42,7±38; 34,8±10,9 ?g/dl; p=0,27) was not differentaccording to control group.Conclusion:1- The mineral density is decreasing in patient with liver cirrhosis. The reason isdecreasing of bone anabolism.IX2- The responsible factors are decreasing of IGF-1 and osteocalcine, and increasing of IL-6, TNFinpatients with liver cirrhosis. Also, the high biluribinemia has inhibitor effect forbone anabolism in patients with liver cirrhosis.3- Hepatic osteodistrophy is an important complication of liver cirrhosis. For this reason,the patients of liver cirrhosis should be checked and followed-up for hepatic osteodistrophy.