Kronik hepatit B hastalarının irdelenmesi ve tedaviyi kesme kriterlerinin değerlendirilmesi
Yükleniyor...
Dosyalar
Tarih
2020
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Selçuk Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Kronik hepatit B enfeksiyonu tüm dünyada ve Türkiye'de siroz ve HCC'nin önde gelen nedenlerinden biridir. Çalışmamızda Ocak 2009-Ağustos 2018 tarihleri arasında Selçuk Üniversitesi Tıp Fakültesi Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Polikliniği'nde takip edilen Faz 2 ve Faz 4 KHB tanısı ile tedavi alan 245 hastanın dosyası retrospektif olarak tarandı. Olgular fibrozis açısından değerlendirildiğinde 8 hastada fibrozis olmadığı (%3.3), 177 hastanın (%72.2) hafif fibrozis, 52 hastanın (%21.2) orta fibrozis olduğu, 8 hastanın (%3.3) ise ileri fibrozis olduğu saptandı. Hastaların karaciğer biyopsi evrelerinin ortalaması 2.14±1.09 tespit edildi. Hastalara yapılan karaciğer biyopisisi HAİ sonuçları incelendiğinde 36 hastanın (%14.7) minimal iltihabi aktivite, 145 hastanın (%59.2) hafif iltihabi aktivite, 57 kişinin (%23.3) orta iltihabi aktivite ve 7 kişinin (%2.8) de ağır iltihabi aktivite skoru olduğu tespit edildi. Hastaların karaciğer biyopsi HAİ ortalaması 6.84±2.45 tespit edildi. Hastaların almakta oldukları tedaviler incelendiğinde 124 hastanın (%50.6) tenofovir disoproksil fumarat kullandığı, 99 hastanın (%40.4) entekavir tedavisi aldığı görüldü. Çalışmamızda bulunan hastalardan kaç kişinin ne kadar süredir HBV DNA düzeyinin baskılı ve ALT-AST düzeylerinin normal olduğu saptandı. Hastaların bir kısmının almakta oldukları tedavilerinin kesilmesi planlandı. Bu hastalar içerisinde 2 yıldan uzun süredir HBV DNA düzeyi baskılı ve ALT düzeyi normal seyreden ve siroz evresinde olmayan 118, 3 yıldan uzun süredir HBV DNA düzeyi baskılı ve ALT düzeyi normal seyreden ve siroz evresinde olmayan 87 ve 5 yıldan uzun süredir HBV DNA düzeyi baskılı ve ALT düzeyi normal seyreden ve siroz evresinde olmayan 38 hastamızın tedavilerinin kesilebileceği düşünüldü. Şu anda bu konu ile ilgili kesin kriterler olmaması, etkinliği ve güvenilirliği kanıtlanmış kesin testler bulunmaması, tedavileri kesilen hastaların takibi ile ilgili sorunlar bulunması nedeniyle hastaların tedavileri sonlandırılamadı. Bu çalışmanın devamı olarak HBsAg titresi bakılması için Bilimsel Araştırma Projeleri'ne başvurulması ve tedavi kesilmesi açısından bu hastaların HBsAg titresi ile beraber tekrar değerlendirilmesi planlandı.
Chronic hepatitis B is the leading cause of cirrhosis and HCC in Turkey and around the globe. In our study, we retrospectively reviewed the charts of 245 patients diagnosed with Phase 2 and Phase 4 CHB and received treatment in Selcuk University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, between January 2009-August 2018. When patients were evaluated for fibrosis, 8 patients did not have fibrosis (3.3%), 177 patients were found to have mild fibrosis (72.2%), 52 patients had moderate fibrosis (21.2), 8 patients had advanced fibrosis (3.3%). Average stage of liver biopsies of these patients were found to be 2.14±1.09. When liver biopsy Hepatic Activity Index scores of the patients were evaluated, minimal inflammatory activity was detected in 36 patients (14.7%), mild inflammatory activity in 145 patients (59.2%), moderate inflammatory activity in 57 patients (23.3%) and severe inflammatory activity in 7 patients (2.8%). Average Hepatic Activity Index score was found to be 6.84±2.45. When treatments received by the patients were examined, 124 patients (50.6%) used tenofovir disoproxil fumarate, 99 patients (40.4%) received entecavir. How many of the patients in our study had suppression of HBV DNA levels and normal ALT-AST values and for how long, was determined. Withdrawal of treatment was planned for some patients. 118 patients with suppressed HBV DNA levels, normal ALT values and not in cirrhotic stage for longer than 2 years, 87 patients with suppressed HBV DNA levels, normal ALT values and not in cirrhotic stage for longer than 3 years, and 38 patients with suppressed HBV DNA levels, normal ALT values and not in cirrhotic stage for longer than 5 years were thought to be among the treatment withdrawal ones. However, treatment withdrawal plan was unable to be implemented due to lack of clear criteria, absence of tests with strong reliability and problems with monitoring of the patients with treatment withdrawal. As a follow up to this study, it was planned to apply for Scientific Research Projects to obtain HBsAg levels and re-assess these patients for treatment withdrawal with HBsAg levels available.
Chronic hepatitis B is the leading cause of cirrhosis and HCC in Turkey and around the globe. In our study, we retrospectively reviewed the charts of 245 patients diagnosed with Phase 2 and Phase 4 CHB and received treatment in Selcuk University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, between January 2009-August 2018. When patients were evaluated for fibrosis, 8 patients did not have fibrosis (3.3%), 177 patients were found to have mild fibrosis (72.2%), 52 patients had moderate fibrosis (21.2), 8 patients had advanced fibrosis (3.3%). Average stage of liver biopsies of these patients were found to be 2.14±1.09. When liver biopsy Hepatic Activity Index scores of the patients were evaluated, minimal inflammatory activity was detected in 36 patients (14.7%), mild inflammatory activity in 145 patients (59.2%), moderate inflammatory activity in 57 patients (23.3%) and severe inflammatory activity in 7 patients (2.8%). Average Hepatic Activity Index score was found to be 6.84±2.45. When treatments received by the patients were examined, 124 patients (50.6%) used tenofovir disoproxil fumarate, 99 patients (40.4%) received entecavir. How many of the patients in our study had suppression of HBV DNA levels and normal ALT-AST values and for how long, was determined. Withdrawal of treatment was planned for some patients. 118 patients with suppressed HBV DNA levels, normal ALT values and not in cirrhotic stage for longer than 2 years, 87 patients with suppressed HBV DNA levels, normal ALT values and not in cirrhotic stage for longer than 3 years, and 38 patients with suppressed HBV DNA levels, normal ALT values and not in cirrhotic stage for longer than 5 years were thought to be among the treatment withdrawal ones. However, treatment withdrawal plan was unable to be implemented due to lack of clear criteria, absence of tests with strong reliability and problems with monitoring of the patients with treatment withdrawal. As a follow up to this study, it was planned to apply for Scientific Research Projects to obtain HBsAg levels and re-assess these patients for treatment withdrawal with HBsAg levels available.
Açıklama
Anahtar Kelimeler
Kronik Hepatit B, Tedavi Kesilmesi, Aile Öyküsü, Bulaş Yolları, Chronic Hepatitis B, Treatment, Discontinuation, Ffamily History, Tedavi, Routes of Transmission
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Çiftci, Ş. (2020). Kronik hepatit B hastalarının irdelenmesi ve tedaviyi kesme kriterlerinin değerlendirilmesi. (Uzmanlık Tezi). Selçuk Üniversitesi, Tıp Fakültesi, Konya.
