Tablo 2. HDV infeksiyonunda serolojik tanı
Klinik HBsAg Anti-HBC IgM HDAg HDV- RNA Anti-HDV IgM Total Anti-HDV Yorum Akut Hepatit +/- + - - - - Akut HBV +/- + + + + + Koinfeksion + - + + + + Süperinfeksiyon Kronik Hepatit + - - - - - Kronik HBV + - +/- + + + Kronik HBV-HDV
Delta ko infeksiyonu Delta süperinfeksiyonu Akut hepatit B’ye benzer
(Hafif-şiddetli fulminan)
Fulminan hepatite ilereyebilen şiddetli akut hepatit tablosuyla seyredebilir.
Koinfeksiyonda kronikleşme riski %2-7 dir %90 oranında kronikleşiyor. Tanı HBsAg, anti-HBc IgM, anti-HDV IgM ve
HDV RNA pozitifliğine göre konur.
Tanı HBsAg, anti-HBc IgG, anti-HDV IgM ve HDV RNA pozitifliğine göre konur.
Geçirilmiş delta hepatit: Düşük titrede anti-delta IgG pozitifliğiyle birlikte anti-HDV IgM negatifliği mevcut.
Süperinfeksiyon sonrası iyileşen az sayıdaki vakada HBV infeksiyonu devam ediyor.
Çoğu delta hepatit’li hasta HBeAg negatif, anti- HBe pozitif ve sıvı hibridizasyyon ile HBV DNA negatiftir.
Tablo 4. Kronik HBV enfeksiyonunun evreleri Enfeksiyon
dönemi
HBsAg HBeAg HBV DNA ALT Karaciğer
biyopsisi İmmun tolerans fazı + + ↑↑↑ N Normal, minimal değişiklikler İmmun yanıt fazı + + (-)* ↑↑ ↑↑↑ Kronik hepatit bulguları İnaktif dönem + - - N Normal
Reaktivasyon + - ↑ N/↑↑↑ Kronik hepatit
bulguları Tablo–1: Kronik HBV enfeksiyonunun evreleri
* Bu evrenin sonlarında hastaların bir kısmında HBeAg (-) olur
Tablo 5. Diyetteki demir emilimini etkileyen faktörler
1-Lümen içi faktörler 2-İntestinal emici hücre faktörleri (Mukozal faktörler)
3-Organizmadaki (Vücut) faktörler
kimyasal sekli *pH *Diyet kompozisyonu intestinal sekresyonlarlaselasyon veya presipitasyonu
-Emici hucrelerin azalması -Bozuk epitel hucreleri -Mukozal hucre yasam suresi *intestinal motilite
*Mukozal demir kalitesi Kimyasal sekli
*Bazı metaller
*Protein sentezini etkileyen ilaclar *Demir turnoveri Eritropoesis -Anabolizma-katabolizma -RES blokajı -Sideroblastik hadiseler "Hipoksi "idiopatik hemokromatozis *Nadir durumlar
Konj. ferroselataz eksikliği
Tablo 6. Spesifik dokularda demir birikimi ve ilişkili hastalıklar--- Dddd
DdDOKU HASTALIK
Alveolar makrofajlar Pulmoner neoplazi ve infeksiyonlar
Aort, karotis ve koroner arterler Ateroskleroz
Kolorektal mukoza Adenom, karsinom
Kalp Aritmiler, kardiyomiyopati
İntestinal sistem Botulizm, salmonelloz
Eklemler Artropati
Karaciğer Viral hepatit, siroz, karsinom
Makrofajlar İntrasellüler infeksiyonlar
Pankreas Asiner ve beta hücre nekrozu, karsinom
Plazma ve lenfa Ekstraselüler infeksiyonlar
İskelet sistemi Osteoporoz
Deri Melanom Yumuşak doku Sarkom Substantia Nigra Parkinson
Tablo 7. Çalışma hastalarının klinik, laboratuar ve histolojik verileri karşılaştırılması Özellikler Delta Hepatit
(n=52)
Hepatit B (n=57)
P
Cinsiyet, Kadın/erkek 22/30 24/33 0.983
Vücut kitle indeksi (kg/m2) 24.1± 2.30 23.70 ± 3.67 0.484 Hemoglobin (g/dl) 14.03 ± 2.19 14.68 ± 1.62 0.85 Lökosit (K/uL) 24.9 ± 127.83 7.17 ± 1.77 0.344 Trombosit (K/uL) 210.28 ± 81.28 234.45 ±50.81 0.069 Protrombin zamanı, Saniye 13.20 ± 1.40 12.29 ± 1.70 0.003 Protrombin zamanı, INR 1.09 ± 0.12 1.04 ± 0.07 0.015 Kan şekeri (mg/dl) 100.27± 29.20 96.66 ± 25.73 0.503 ALT (U/L) 68.10 ± 95.60 70.98 ± 94.149 0.874 AST (U/L) 50.54 ± 47.79 40.96 ± 36.64 0.241 ALP (U/L) 98.96 ±70.05 84.09 ± 30.87 0.163 GGT (U/L) 69.63 ±102.41 25.00 ± 25.82 0.003 Total billirubin (mg/dl) 1.10 ± 1.71 0.77 ± 0.38 0.173 Albumin (g/dl) 4.06 ± 0.54 4.21 ± 0.41 0.111 Globulin (g/dl) 3.75 ± 0.62 3.39 ±0.43 0.001 LDH 180.38 ± 49.07 181.02 ± 32.22 0.937 HBV DNA Log10 2.84 ± 0.70 5.62 ± 1.82 <0.001 AFP (IU/ml) 3.48 ± 3.94 2.43 ± 2.44 0.103 CRP (mg/dl) 0.29 ± 0.23 0.36 ± 1.03 0.673 Demir (mcg/dl) 91.31 ± 55.83 92.64 ± 38.95 0.887 Demir bağlama kapasitesi (mcg/dl) 237.06 ± 110.17 258.09 ±96.61 0.293 Transferin saturasyon indeksi (%) 63.69 ± 96.49 41.53 ± 26.27 0.115 Ferritin (ng/ml) 124.46 ± 159.06 96.36 ± 101.36 0.272 HAI 6.60 ± 3.13 5.68 ± 2.31 0.312 Fibrozis 2 ± 1.61 1.26 ± 1.0 0.95
Tablo 8. Demir ile diğer parametrelerin korelasyonu
Değişkenler R
( Korelasyon katsayısı )
P
( Bulgular, iki başlıklı ) Hemoglobin (g/dl) – Demir
(mcg/dl)
0.52 <0.001
(mcg/dl)
Protrombin zamanı (saniye) – Demir (mcg/dl)
-0.045 0.647
ALP (U/L) –Demir (mcg/dl) 0.041 0.673
Albumin (g/dl) – Demir (mcg/dl) 0.084 0.385 Globulin (g/dl) – Demir (mcg/dl) -0.053 0.589 ALT(U/L) – Demir (mcg/dl) 0.327 0.001
AST (U/L) – Demir (mcg/dl) 0.220 0.022
GGT (U/L) – Demir (mcg/dl) 0.170 0.07
AFP (IU/ml) – Demir (mcg/dl) 0.163 0.092
Vücut kitle indeksi – Demir (mcg/dl) 0.013 0.891 HAI – Demir (mcg/dl) 0.025 0.881 Fibroz – Demir (mcg/dl) -0.270 0.106 HBV DNA – Demir (mcg/dl) 0.056 0.106 HDV RNA – Demir (mcg/dl) 0.032 0.819
Tablo 10. Ferritin ile diğer parametrelerin korelasyonu
Değişkenler R
(Korelasyon katsayısı)
P
(Bulgular, iki başlıklı)
Hemoglobin (g/dl) –TSI (%) 0.299 0.002
Trombosit (K/uL) – TSI (%) 0.030 0.763
Protrombin zamanı (saniye) – TSI (%)
0.121 0.216
ALP (U/L) – TSI (%) 0.093 0.340
Albumin (g/dl) – TSI (%) -0.171 0.079
Globulin (g/dl) – TSI (%) 0.201 0.038
ALT(U/L) – TSI (%) 0.209 0.031
AST (U/L) – TSI (%) 0.293 0.002
GGT (U/L) – TSI (%) 0.306 0.001
AFP (IU/ml) – TSI (%) 0.451 <0.001
Vücut kitle indeksi – TSI (%) 0.035 0.719
Fibroz – TSI (%) 0.188 0.265
HBV DNA – TSI (%) -0.014 0.884
Değişkenler R
( Korelasyon katsayısı )
P
( Bulgular, iki başlıklı ) Hemoglobin (g/dl) - Ferritin
(ng/ml)
0.296 0.002
Trombosit (K/uL) – Ferritin (ng/ml) -0.091 0.350 Protrombin zamanı (saniye) –
Ferritin (ng/ml)
-0.069 0.480
ALP (U/L) – Ferritin (ng/ml) 0.241 0.013
Albumin (g/dl) – Ferritin (ng/ml) -0.044 0.656 Globulin (g/dl) – Ferritin (ng/ml) 0.122 0.209
ALT(U/L) – Ferritin (ng/ml) 0.161 0.098
AST (U/L) – Ferritin (ng/ml) 0.279 0.004
GGT (U/L) – Ferritin (ng/ml) 0.388 <0.001 AFP (IU/ml) – Ferritin (ng/ml) 0.062 0.525 Vücut kitle indeksi – Ferritin
(ng/ml) 0.214 0.027 HAI – Ferritin (ng/ml) 0.117 0.489 Fibroz – Ferritin (ng/ml) -0.034 0.840 HBV DNA – Ferritin (ng/ml) 0.076 0.436 HDV RNA – Ferritin (ng/ml) -0.143 0.321
Şekil 2. Kronik Delta Hepatitli Kronik Hepatit B li hastalarda histolojik aktivite indeksi ve fibrozis
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