Çocukluk çağı kronik Hepatit B olgularında uzun süreli izlem, tedavi ve prognoz

Abstract

Amaç: Kronik Hepatit B infeksiyonu tanısı ile tedavisiz en az bes yıl veyatedavi verildikten sonra en az iki yıl süreyle izlenmis olan hastaların aldıkları tedavi,tedaviye yanıtları, tedaviye yanıtta etkili olan faktörler ve hastalıgınkomplikasyonları yönünden retrospektif olarak degerlendirilmesi amaçlandı.Materyal ve metod: Çalısmaya alınan toplam 89 hasta; hepatit B tasıyıcısı,kronik B hepatitli interferon tedavisi alanlar, kronik B hepatitli lamuvidin tedavisialanlar, kronik B hepatitli interferon ve lamuvidin tedavisi alanlar, kronik B hepatitlitedavi almayanlar olarak 5 guruba ayrıldı.Tüm hastalara ait demografik veriler, hastalık süresi, basvuru, biyopsi öncesi,tedavi öncesi, izlemin veya tedavinin 3, 6, 9, 12, 18, 24. aylar, daha uzun süre takipedilenlerde ise 36, 48, 60. aylar ve izlem veya tedavi sonrası ALT degerleri ve HBVbelirleyicileri, baslangıç HA skoru, uygulanan tedavi, tedaviye yanıt durumları vehastalıga ait komplikasyonlar kayıt edildi.Bulgular: Tam viral klirens oranı % 6.7 idi. Tam yanıt oranı IFN grubunda% 53.8, LAM grubunda %39.3, IFN+LAM grubunda %29.4 idi. IFN, LAM, IFNLAMgrupları arasında tedaviye en yüksek yanıt oranı IFN grubundaydı ancakistatistiksel fark olusturmuyordu (p>0.05).Yas ve cinsiyet ile tedaviye yanıt arasında istatistiksel iliski yoktu. Tedaviöncesi ALT degerleri tedaviye tam yanıt veren olgularda daha yüksekti. Basvuruanında HBV DNA düzeyi ile tedaviye yanıt arasında istatistiksel iliski vardı(p<0.05). Baslangıç HA skoru ile tedaviye yanıt arasında istatistiksel iliski yoktu(p>0.05).Bes yıllık izlem sonucu 1 hastada anksiyete bozuklugu, 1 hastada cinselisteksizlik, 1 hastada hepatik yetmezlik, 1 hastada pseudotrombositopeni, 1 hastadaözefagus varisi izlendi.Sonuç: Kronik HBV infeksiyonuna ait komplikasyonlar çocukluk yasgrubunda seyrek olarak görülür. Tedavi için uygun seçilmis olgularda IFN, LAM vebu iki ilacın kombinasyonu kullanılabilir. Tüm tedavi seçeneklerine ragmenhastaların yaklasık yarısında tedaviye tam yanıt elde edilmektedir.Anahtar kelimeler: Kronik Hepatit B, Çocuk, zlem, Tedavi, Prognoz.

Aim: In this study we aimed to retrospectively evaluate the patients, in termsof the treatment applied to them, their responses to the treatment, the factors effectiveon the response to the treatment and of the complications of the disease, who werefollowed up at least five years after they were diagnosed to have chronic hepatitis Binfection or at least two years after they were medically treated.Material and method: A total of 89 patients included in the study weredivided into five groups; those carrying hepatitis B virus, those receiving interferontreatments for chronic hepatitis B, those having the treatment of lavumidin forchronic hepatitis B and those with chronic hepatitis B but not receiving any medicaltreatment for this disease.The demographic data of all the patients, the duration of the disease, thevalues of ALT, HBV, and the scores of HA at the time of diagnosis and at the 3rd,6th, 9th, 12th 18th, 24th months of the therapy, and finally the values of ALT, HBV atthe 36th, 48th, 60th months for the long follow - up patients, their response to thetherapy, and the complications associated with the disease were recorded.Findings: The rate of full viral clearance was 6.7%. The full response ratewas 53.8 % in IFN group, 39.3% in LAM group, and 29.4% in IFN+ LAM group.Among groups IFN, LAM and IFN-LAM, group IFN had the highest response rate tothe treatment, but there was no statistical difference (p>0.05).There was no statistical relationship between the age and the gender and theresponse to the treatment. The values of ALT prior to the treatment were higher inthe patients who had full response to the treatment. There was a statisticalrelationship between HBV DNA level at the time of application and the response tothe treatment (p<0.05). There was not any statistical relationship between the HAscore at the time of application and the response to the treatment (p>0.05).After five year follow- up, it was found that one patient had anxiety disorder,one patient sexual reluctance, one patient hepatic failure, one patientpsodotrombositopeni and one patient esophageal varices.Conclusion: Complications associated with chronic HBV infection are rarelyseen in childhood age group. IFN, LAM and the combination of these two drugs canbe used in patients who are found suitable for the treatment. Despite many treatmentchoices, approximately only half of the patients give full response to the treatment.Key words: Chronic Hepatitis B, Child, Follow-up, Treatment, Prognosis.