Vukobrat-Bijedic Zora, Husic-Selimovic Azra, Mehinovic Lejla, Junuzovic Dzelaludin, Bijedic Nina, Sofic Amela, Bjelogrlic Ivana, Mehmedovic Amila
Gastroenterohepatology department, Clinical Center of Sarajevo, University Sarajevo, Bosnia and Herzegovina.
Pathology Department, Clinical Center of Sarajevo, University Sarajevo, Bosnia and Herzegovina.
Med Arch. 2014 Jun;68(3):159-62. doi: 10.5455/medarh.2014.68.159-162. Epub 2014 May 31.
Various complications occur in patients with advanced stages of liver diseases. Renal dysfunction, a parameter included in the MELD score, is the most important prognostic factor. There is a strong need in clinical practice to estimate the GFR in this patients.
The aim of our study was to detect differences in renal function among patients with different stages of chronic liver diseases caused by HBV and HCV, also to determine the impact of viral etiology and gender on the values of eGFR and renal function.
This was an observational cross-sectional study performed on patients with HBV and HCV chronic hepatitis, cirrhosis and HCC caused by these viruses hospitalized during period 2009-2014 in the Clinic of Gastroenterohepatology, Clinical Center University of Sarajevo. The estimated GFR (eGFR) was evaluated by the MDRD4 method. For the processing of data SPSS 21.0 statistical software was used. Statistical methods used in this study where: analysis of variance test (ANOVA test), Student's t-test for independent samples and Pearson coefficient of correlation. The level of significance was p <0.05.
Among this three groups of patients there was a statistically significant difference in eGFR (F= 18.79, p<0.05), i.e. increase of degree of liver damage was related with increase of renal impairment, as reflected by a significant reduction in estimated glomerular filtration rate. Gender had no significant effect on eGFR and renal function (p>0.05), except in group of patients with HCC (p<0.05). Etiology had no significant effect on eGFR and renal (p>0.05). There was statistically significant inverse correlation between glomerular filtration rate and liver enzymes AST (-.184) and GGT (-.181).
By calculation of GFR, we determined the existence of a significant reduction of kidney function through progression of liver damage from HBV and HCV chronic hepatitis, liver cirrhosis to HCC caused by these viruses, which drawing attention to the importance of the assessment of renal function in patients with this liver pathologies. Gender and etiology had no significant effect on eGFR and impairment of renal function. Given the statistically significant inverse correlation between eGFR and AST and GGT this liver enzymes may have important role as marker for both renal and hepatic injury.
晚期肝病患者会出现各种并发症。肾功能不全是终末期肝病模型（MELD）评分中的一项参数，是最重要的预后因素。临床实践中迫切需要评估这类患者的肾小球滤过率（GFR）。
我们研究的目的是检测由乙肝病毒（HBV）和丙肝病毒（HCV）引起的不同阶段慢性肝病患者的肾功能差异，同时确定病毒病因和性别对估算肾小球滤过率（eGFR）值及肾功能的影响。
这是一项观察性横断面研究，研究对象为于2009年至2014年期间在萨拉热窝大学临床中心胃肠肝病科住院的由HBV和HCV引起的慢性肝炎、肝硬化及肝癌患者。采用肾脏疾病饮食改良公式4（MDRD4）法评估估算肾小球滤过率（eGFR）。使用SPSS 21.0统计软件处理数据。本研究采用的统计方法有：方差分析检验（ANOVA检验）、独立样本t检验及Pearson相关系数。显著性水平为p<0.05。
在这三组患者中，eGFR存在统计学显著差异（F = 18.79，p<0.05），即肝损伤程度的增加与肾功能损害的增加相关，这表现为估算肾小球滤过率的显著降低。除肝癌患者组外（p<0.05），性别对eGFR和肾功能无显著影响（p>0.05）。病因对eGFR和肾功能无显著影响（p>0.05）。肾小球滤过率与肝酶天门冬氨酸氨基转移酶（AST，-.184）和γ-谷氨酰转移酶（GGT，-.181）之间存在统计学显著负相关。
通过计算GFR，我们确定了随着肝损伤从HBV和HCV慢性肝炎、肝硬化发展至由这些病毒引起的肝癌，肾功能显著降低，这提醒人们重视对这类肝病患者肾功能评估的重要性。性别和病因对eGFR及肾功能损害无显著影响。鉴于eGFR与AST和GGT之间存在统计学显著负相关，这些肝酶可能作为肾损伤和肝损伤的标志物具有重要作用。
