Differences of Accumulated Heavy Metal Levels in End-Stage Liver Disease, Wilson’s Disease, and Other Etiologies

yumrutaş, önder; CEVIK, MUHAMMER OZGUR; Yilmaz, Sezai; IŞIK, Ali; Dirican, Abuzer; Ates, Mustafa; hatipoglu, sinan

doi:10.4274/iksstd.2021.82712

Differences of Accumulated Heavy Metal Levels in End-Stage Liver Disease, Wilson’s Disease, and Other Etiologies

Sinan HATİPOĞLU, (Adıyaman Üniversitesi, Tıp Fakültesi, Genel Cerrahi Ana Bilim Dalı, Adıyaman, Türkiye)

Abuzer DİRİCAN, (İnönü Üniversitesi, Tıp Fakültesi, Genel Cerrahi Ana Bilim Dalı, Malatya, Türkiye)

Mustafa ATEŞ, (İnönü Üniversitesi, Tıp Fakültesi, Genel Cerrahi Ana Bilim Dalı, Malatya, Türkiye)

Muhammer Özgür ÇEVİK, (Adıyaman Üniversitesi, Tıp Fakültesi, Tıbbi Genetik Ana Bilim Dalı, Adıyaman, Türkiye)

Önder YUMRUTAŞ, (Adıyaman Üniversitesi, Tıp Fakültesi, Tıbbi Biyoloji Ana Bilim Dalı, Adıyaman, Türkiye)

Muhammet Ali IŞIK, (Adıyaman Üniversitesi, Tıp Fakültesi, Genel Cerrahi Ana Bilim Dalı, Adıyaman, Türkiye)

Sezai YILMAZ (İnönü Üniversitesi, Tıp Fakültesi, Genel Cerrahi Ana Bilim Dalı, Malatya, Türkiye)

İstanbul Kanuni Sultan Süleyman Tıp Dergisi

3 0

Yıl: 2021 Cilt: 13 Sayı: 3 Sayfa Aralığı: 184 - 193 Metin Dili: İngilizce DOI: 10.4274/iksstd.2021.82712 İndeks Tarihi: 07-02-2022

Differences of Accumulated Heavy Metal Levels in End-Stage Liver Disease, Wilson’s Disease, and Other Etiologies

Öz:

Objective: End-stage liver disease (ESLD) is a devastating condition, which leads to liver transplantation (LT). There are various proposed predisposing factors for ESLD. A significant proportion of ESLDs is of undetectable (cryptogenic) origin. Accumulation of heavy metals is a proposed but not thoroughly researched predisposing factor for ESLD. In this study, we measured the concentration of accumulated heavy metals in the explanted liver tissue of ESLD patients. Apart from various accompanying etiologies, such as rare hereditary diseases, infections, and tumors were also evaluated. Method: This prospective study aimed to evaluate the concentrations of heavy metals in the explanted liver of consecutive patients with ESLD and different etiologies who underwent elective and/or emergency LT. Bioaccumulation of nine heavy metals (Hg, As, Zn, Cr, Pb, Cu, Ni, Mg, and Fe) was evaluated by atomic absorption spectrophotometer in the explanted liver tissue of ESLD patients. Also, histopathologies of explanted livers and etiologies of patients were evaluated using data from histopathological techniques, medical records, or genetic counseling processes. Results: The male/female ratio was 33:15. The results of our study showed no statistical significance in terms of total heavy metal levels in the explanted livers (p > 0.05), including patients with cryptogenic etiology. However, four patients with Wilson’s disease had copper levels of 250 uq/g dried liver tissue. Histopathological examinations of explanted livers revealed that four (8%) patients had Wilson’s disease, one (2%) patient had tyrosinemia, 15 (31%) patients had unknown/undetectable (cryptogenic) etiology, 24 patients had viral infections (20 had hepatitis B virus infection, one had hepatitis C virus infection, three had multiple viral infections at once), one patient had a metastatic tumor, one patient had an unidentified autoimmune disease, and one patient had polycystic liver disease. Conclusion: Accumulated total heavy metal levels in explanted livers of ESLD patients do not appear to be a differential diagnosis tool, except the copper levels for Wilson’s disease. More research is needed to further elucidate the different roles of heavy metal concentrations in both normal and disease states of heavy metals in the liver.

Anahtar Kelime:

Karaciğerde Birikmiş Ağır Metal Düzeylerinin Kriptojenik Etiyoloji ile Wilson Hastalığı ve Diğer Etiyolojileri Açısından Farklılığı

Öz:

Amaç: Son evre karaciğer hastalığı (SEKH), karaciğer nakline (KN) yol açan yıkıcı bir klinik durumdur. SEKH’nin etiyolojisinde çeşitli hazırlayıcı faktörler mevcut olup hastaların önemli bir kısmında ise etiyoloji net olarak saptanamamaktadır (kriptojenik). Ağır metallerin karaciğerde birikmesi, SEKH’ye yol açan ancak kapsamlı bir şekilde araştırılmamış bir yatkınlık faktörüdür. Bu çalışmada; nadir görülen kalıtsal hastalıklar, enfeksiyonlar, tümörler ve kriptojenik gibi eşlik eden çeşitli etiyolojiler nedeniyle gelişen SEKH olgularının karaciğer dokusunda biriken ağır metal konsantrasyonları değerlendirildi. Yöntem: Bu prospektif çalışmada, elektif ve/veya acil KN uygulanan farklı etiyolojilere sahip SEKH mevcut olan hastaların rezeke edilmiş karaciğerindeki ağır metal konsantrasyonları değerlendirilmektedir. Dokuz adet ağır metalin (Hg, As, Zn, Cr, Pb, Cu, Ni, Mg, Fe) birikim değerleri atomik absorpsiyon spektrofotometresi ile değerlendirildi. Rezeke edilen karaciğerlerin histopatolojileri ve etiyolojileri, tıbbi kayıtlar ve/veya genetik danışma süreçlerinden elde edilen veriler kullanılarak değerlendirildi. Bulgular: Erkek/kadın oranı 33/15 idi. Çalışmamızın sonuçları değerlendirildiğinde; kriptojenik etiyolojisi olan hastalar da dahil olmak üzere rezeke edilen karaciğerlerdeki toplam ağır metal seviyeleri açısından istatistiksel anlamlılık görülmedi (p > 0,05). Bununla birlikte, Wilson hastalığı olan dört hastanın kurutulmuş karaciğer dokusunda bakır seviyeleri 250 uq/g üstündeydi. Rezeke karaciğerlerin histopatolojik incelemelerinde; dört hastada (%8) Wilson hastalığı, bir hastada tirozinemi (%2), on beş hastada kriptojenik etiyolojiye (%31), yirmidört hastada viral enfeksiyon (20’sinde hepatit B virüs enfeksiyonu, birinde hepatit C virüsü enfeksiyonu, 3’ünde aynı anda birden fazla viral enfeksiyon), 1’inde metastatik tümör, birinde tanımlanamayan otoimmün hastalık ve bir hastada ise polikistik karaciğer hastalığı vardı. Sonuç: SEKH olgularının karaciğerlerinde biriken toplam ağır metal seviyeleri, Wilson hastalığı için bakır seviyeleri dışında ayırıcı bir tanı aracı olarak görünmemektedir. Karaciğerdeki ağır metallerin hem standart hem de hastalık durumlarında ağır metal konsantrasyonlarının farklı rollerini açıklığa kavuşturmak için daha fazla deneysel araştırmaya ihtiyaç vardır.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

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APA	hatipoglu s, Dirican A, Ates M, CEVIK M, yumrutaş ö, IŞIK A, Yilmaz S (2021). Differences of Accumulated Heavy Metal Levels in End-Stage Liver Disease, Wilson’s Disease, and Other Etiologies. , 184 - 193. 10.4274/iksstd.2021.82712
Chicago	hatipoglu sinan,Dirican Abuzer,Ates Mustafa,CEVIK MUHAMMER OZGUR,yumrutaş önder,IŞIK Ali,Yilmaz Sezai Differences of Accumulated Heavy Metal Levels in End-Stage Liver Disease, Wilson’s Disease, and Other Etiologies. (2021): 184 - 193. 10.4274/iksstd.2021.82712
MLA	hatipoglu sinan,Dirican Abuzer,Ates Mustafa,CEVIK MUHAMMER OZGUR,yumrutaş önder,IŞIK Ali,Yilmaz Sezai Differences of Accumulated Heavy Metal Levels in End-Stage Liver Disease, Wilson’s Disease, and Other Etiologies. , 2021, ss.184 - 193. 10.4274/iksstd.2021.82712
AMA	hatipoglu s,Dirican A,Ates M,CEVIK M,yumrutaş ö,IŞIK A,Yilmaz S Differences of Accumulated Heavy Metal Levels in End-Stage Liver Disease, Wilson’s Disease, and Other Etiologies. . 2021; 184 - 193. 10.4274/iksstd.2021.82712
Vancouver	hatipoglu s,Dirican A,Ates M,CEVIK M,yumrutaş ö,IŞIK A,Yilmaz S Differences of Accumulated Heavy Metal Levels in End-Stage Liver Disease, Wilson’s Disease, and Other Etiologies. . 2021; 184 - 193. 10.4274/iksstd.2021.82712
IEEE	hatipoglu s,Dirican A,Ates M,CEVIK M,yumrutaş ö,IŞIK A,Yilmaz S "Differences of Accumulated Heavy Metal Levels in End-Stage Liver Disease, Wilson’s Disease, and Other Etiologies." , ss.184 - 193, 2021. 10.4274/iksstd.2021.82712
ISNAD	hatipoglu, sinan vd. "Differences of Accumulated Heavy Metal Levels in End-Stage Liver Disease, Wilson’s Disease, and Other Etiologies". (2021), 184-193. https://doi.org/10.4274/iksstd.2021.82712

APA	hatipoglu s, Dirican A, Ates M, CEVIK M, yumrutaş ö, IŞIK A, Yilmaz S (2021). Differences of Accumulated Heavy Metal Levels in End-Stage Liver Disease, Wilson’s Disease, and Other Etiologies. İstanbul Kanuni Sultan Süleyman Tıp Dergisi, 13(3), 184 - 193. 10.4274/iksstd.2021.82712
Chicago	hatipoglu sinan,Dirican Abuzer,Ates Mustafa,CEVIK MUHAMMER OZGUR,yumrutaş önder,IŞIK Ali,Yilmaz Sezai Differences of Accumulated Heavy Metal Levels in End-Stage Liver Disease, Wilson’s Disease, and Other Etiologies. İstanbul Kanuni Sultan Süleyman Tıp Dergisi 13, no.3 (2021): 184 - 193. 10.4274/iksstd.2021.82712
MLA	hatipoglu sinan,Dirican Abuzer,Ates Mustafa,CEVIK MUHAMMER OZGUR,yumrutaş önder,IŞIK Ali,Yilmaz Sezai Differences of Accumulated Heavy Metal Levels in End-Stage Liver Disease, Wilson’s Disease, and Other Etiologies. İstanbul Kanuni Sultan Süleyman Tıp Dergisi, vol.13, no.3, 2021, ss.184 - 193. 10.4274/iksstd.2021.82712
AMA	hatipoglu s,Dirican A,Ates M,CEVIK M,yumrutaş ö,IŞIK A,Yilmaz S Differences of Accumulated Heavy Metal Levels in End-Stage Liver Disease, Wilson’s Disease, and Other Etiologies. İstanbul Kanuni Sultan Süleyman Tıp Dergisi. 2021; 13(3): 184 - 193. 10.4274/iksstd.2021.82712
Vancouver	hatipoglu s,Dirican A,Ates M,CEVIK M,yumrutaş ö,IŞIK A,Yilmaz S Differences of Accumulated Heavy Metal Levels in End-Stage Liver Disease, Wilson’s Disease, and Other Etiologies. İstanbul Kanuni Sultan Süleyman Tıp Dergisi. 2021; 13(3): 184 - 193. 10.4274/iksstd.2021.82712
IEEE	hatipoglu s,Dirican A,Ates M,CEVIK M,yumrutaş ö,IŞIK A,Yilmaz S "Differences of Accumulated Heavy Metal Levels in End-Stage Liver Disease, Wilson’s Disease, and Other Etiologies." İstanbul Kanuni Sultan Süleyman Tıp Dergisi, 13, ss.184 - 193, 2021. 10.4274/iksstd.2021.82712
ISNAD	hatipoglu, sinan vd. "Differences of Accumulated Heavy Metal Levels in End-Stage Liver Disease, Wilson’s Disease, and Other Etiologies". İstanbul Kanuni Sultan Süleyman Tıp Dergisi 13/3 (2021), 184-193. https://doi.org/10.4274/iksstd.2021.82712