The evalution of correlations between the incidence of gallstones in patients with cirrhosis and findings of hypersplenism with the splenic ultrasound elastography findings

In liver cirrhosis the incidence of gallstones is more than normal population and the most valuable examination is the ultrasound. With elastography developed in recent years; liver, gallbladder, spleen pathologies have been diagnosed easier and non-invasively. This study is carried out for the patients who diagnosed with liver cirrhosis and for the examination of the relationship between gallstones presence and hypersplenism, and to identify levels of myeloperoxidase (MPO) that plays a significant role in immune system and also for calculatıon of insulin resistance in these patients. In the study patients diagnosed with liver cirrhosis; were divided into two subgroups as patients with liver cirrhosis and hypersplenism findings (KC-S+H) and patients who have liver cirrhosis but don't have hypersplenism findings (KC-S-H). In the KC-S+H group thirty seven, in KC-S-H group twenty three, totally sixty patients with KC-S and twenty eight healthy controls included in the study. Insulin resistance values and MPO levels were measured for total patient group and subgroups from venous blood. Ultrasonography was performed for each group; gallstones and spleen stiffness is determined by measuring strain values on semiquantitative elastography. Significant differences were found between groups in terms of MPO activity among the individuals with liver cirrhosis and control group. MPO activity was lower in patients with KC-S. Between these two groups no statistically significant difference were found in terms of insulin resistance. The incidence of gallstones in KC-S group were found significantly higher than control group. Between individuals with liver cirrhosis and hypersplenism and KC-S-H groups no significant difference were found in terms of MPO activity and insulin resistance. Incidence of gallstones in KC-S+H group were found to be significantly higher than KC-S-H group. In the total group of patients with liver cirrhosis, while positive correlation was detected between maximum and minimum spleen strain and insulin resistance values, but no significant correlation were found between MPO activity and incidence of gallstones. In the control group, no correlation were detected between spleen strain values and MPO activity but between HOMA values negative correlation was determined. In the patients with liver cirrhosis and hypersplenism while positive correlation was detected between the incidence of gallstones with maximum, minimum and average spleen strain values but there was no correlation between MPO activity. As a result, in the group with hypersplenism a significant positive correlation was found between maximum, minimum and average values of spleen strain sonoelastography and incidence of gallstones. In patients with liver cirrhosis, increased spleen stiffness which may be measured with sonoelastography can be considered as a risk factor in terms of gallstones in future. Keywords: Liver cirrhosis, gallstones, myeloperoxidase, hypersplenism, elastography