Murat AFYON, Cumhur ARTUK, Ercan YENİLMEZ, Berksan ŞİMŞEK, Ayper KAYA

Tedavi görmemiş sirozu olmayan hepatit B virüs enfeksiyonu olan erkek hastalarda fibrozis şiddetini öngörmede laboratuar indekslerinin değerlendirilmesi

Amaç: Bu çalışmada fibrozis ciddiyetini öngörmede, serum aspartat aminotransferaz (AST) ve alanin aminotransferaz (ALT) seviyeleri, platelet sayısı, INR değeri veya serum Hepatit B virüs (HBV) deoksiribonükleik asit (DNA) seviyelerinin, özellikle AST-platelet oranı (APRI), FIB-4 indeks ve King’s skoru gibi skorlama sistemleri içinde değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Yüzelli karaciğer iğne biyopsisi olan tedavi naif erkek HBV hastaları geriye dönük olarak değerlendirildi. Değişkenler arasında farkı değerlendirmek amacıyla, hastalar minimal fibrozisi olanlar (fibrozis skoru<2) ve anlamlı fibrozisi olanlar (fibrozis skoru≥2) olmak üzere iki gruba ayrıldı. Bulgular: Minimal fibrozisi olan 79 hasta (52.7%) ve anlamlı fibrozisi olan 71 hasta (42.3%) vardı. Anlamlı fibrozisi tanımlayan optimal değeri, HBV DNA seviyesi için 4.5 log10 IU/ml (duyarlılık:71.8%, özgüllük:70.9%), APRI için 0.45 (duyarlılık:63.4%, özgüllük:63.3%), FIB-4 indeks için 0.45 (duyarlılık:64.8%, özgüllük:64.3%) ve son olarak King’s skor için 4.00 (duyarlılık: 67.6%, özgüllük:60.8%) olarak belirledik.Sonuç: Tedavi görmemiş sirozu olmayan HBV enfeksiyonu olan erkek hastalarda fibrozis ciddiyetini öngörmede APRI, FIB-4 index ve King’s skorun birbirlerine üstünlüğünün olmadığını, ancak serum HBV DNA seviyelerinin bu skorlara kıyasla biraz daha iyi olduğunu değerlendirmekteyiz.

Anahtar Kelimeler:

Hepatitis B virus, fibrosis, HBV DNA

Assessment of laboratory indices for predicting severity of fibrosis in treatment naive young male patients with non-cirrhotic hepatitis B virus infection

Purpose: We aimed to assess serum levels of AST and ALT, platelet counts, INR or serum HBV DNA levels, especially in score systems such as APRI (AST/platelet ratio), FIB-4 index and King’s score, for predicting severity of fibrosis.Material and Methods: One hundred fifty treatment naive male HBV patients underwent percutaneous liver biopsy were evaluated retrospectively. For evaluating the difference in variables and scores, patients were divided into 2 groups such as no or minimal fibrosis group (fibrosis score<2) and significiant fibrosis group (fibrosis score≥2). Results: There were 79 patients (52.7%) with minimal fibrosis and 71 patients (42.3%) with significiant fibrosis. We considered that optimal cut-off values defining significant fibrosis for serum HBV DNA level was 4.5 log10 IU/ml (sensivity:71.8%, specificity:70.9%), for APRI was 0.45 (sensivity:63.4%, specificity: 63.3%), for FIB-4 index was 0.45 (sensivity:64.8%, specificity:64.3%) and lastly for King’s score was 4.00 (sensivity:67.6%, specificity:60.8%).Conclusion: We identified that the scoring systems such as APRI, FIB-4 index and ing’s score are not superior to each other, but serum HBV DNA level is a little better compared with those to predict significiant fibrosis in treatment naive young male patients with non-cirrhotic HBV infection.

Keywords:

Hepatit B virüsü, fibrozis, HBV DNA,

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1. World Health Organization. Guidelines for the Prevention, Care and Treatment of Persons With Chronic Hepatitis B Infection. Geneva, World Health Organization, 2015.
2. Afyon M. Letter: nucleos(t)ide analogues are good, but not sufficient for hepatitis B virus clearance. Aliment Pharmacol Ther. 2016;43:654-5.
3. Yenilmez E, Afyon M, Ulcay A, Ulus S, Kaya A, Erdem H. Evaluation of 135 liver biopsy results between 2011 and 2014, according to hepatitis B virus DNA and liver transaminase levels in naive young patients with HBeAg positive and negative chronic hepatitis B infection. J Clin Virol. 2015;69:235.
4. Kose S, Ersan G, Tatar B, Adar P, Sengel BE. Evaluation of percutaneous liver biopsy complications in patients with chronic viral hepatitis. Eurasian J Med. 2015;47:161-4.
5. Afyon M, Artuk C. Noninvasive indirect serum markers of liver fibrosis in patients with chronic viral hepatitis. Turk J Gastroenterol. 2016;27:397-8.
6. Stasi C, Milani S. Non-invasive assessment of liver fibrosis: Between prediction/prevention of outcomes and cost-effectiveness. World J Gastroenterol. 2016;22:1711-20.
7. Abdollahi M, Pouri A, Ghojazadeh M, Estakhri R, Somi M. Non-invasive serum fibrosis markers: A study in chronic hepatitis. Bioimpacts. 2015;5:17-23.
8. Schmid P, Bregenzer A, Huber M, Rauch A, Jochum W, Müllhaupt B et al. Progression of liver fibrosis in HIV/HCV co-infection: a comparison between non-invasive assessment methods and liver biopsy. PLoS One. 2015;10:e0138838
9. Kim WR, Berg T, Asselah T, Flisiak R, Fung S, Gordon SC et al. Evaluation of APRI and FIB-4 scoring systems for non-invasive assessment of hepatic fibrosis in chronic hepatitis B patients. J Hepatol. 2016;64:773-80.
10. Vergara M, Bejarano G, Dalmau B, Gil M, Miquel M, Sanchez-Delgado J et al. Usefulness of indirect noninvasive methods in predicting progression to cirrhosis in chronic hepatitis C. Eur J Gastroenterol Hepatol. 2015;27:826-33.
11. Tachi Y, Hirai T, Toyoda H, Tada T, Hayashi K, Honda T et al. Predictive ability of laboratory indices for liver fibrosis in patients with chronic hepatitis c after the eradication of hepatitis c virus. PLoS One. 2015;10:e0133515.
12. Li SM, Li GX, Fu DM, Wang Y, Dang LQ. Liver fibrosis evaluation by ARFI and APRI in chronic hepatitis C. World J Gastroenterol. 2014;20:9528-33.
13. Kliemann DA, Wolff FH, Tovo CV, Alencastro PR, Ikeda ML, Brandão AB et al. Biochemical non-invasive assessment of liver fibrosis cannot replace biopsy in HIV-HCV coinfected patients. Ann Hepatol. 2016;15:27-32.
14. Kandemir O, Polat G, Saracoglu G, Tasdelen B. The predictive role of AST level, protrombin time, and platelet count in the detection of liver fibrosis in patients with chronic hepatitis C. Turk J Med Sci. 2009;39:857-62.
15. Praneenararat S, Chamroonkul N, Sripongpun P, Kanngurn S, Jarumanokul R, Piratvisuth T. HBV DNA level could predict significant liver fibrosis in HBeAg negative chronic hepatitis B patients with biopsy indication. BMC Gastroenterol. 2014;14:218.
16. Gao Y, Zou G, Ye J, Pan G, Rao J, Li F et al. Relationship between hepatitis B surface antigen, HBV DNA quantity and liver fibrosis severity Zhonghua Gan Zang Bing Za Zhi. 2015;23:254-7.
17. Mohamadnejad M, Montazeri G, Fazlollahi A, Zamani F, Nasiri J, Nobakht H et al. Noninvasive markers of liver fibrosis and inflammation in chronic hepatitis B-virus related liver disease. Am J Gastroenterol. 2006;101:2537-45.
18. Lapalus M, Laouenan C, Cardoso AC, Estrabaud E, Carvalho-Filho RJ, Zhang Q et al. Precore/core promoter variants to predict significant fibrosis in both HBeAg positive and negative chronic hepatitis B. Liver Int. 2015;35:2082-9.
19. Koziel MR, Thio CL. Hepatitis B virus and Hepatitis D virus. In Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 7th ed (Eds GL Mandell, JE Bennett, R Dolin):2059-87. Philadelphia, PA, USA, Churchill-Livingstone, 2010.
20. Pondé RA. Atypical serological profiles in hepatitis B virus infection. Eur J Clin Microbiol Infect Dis. 2013;32:461-6.
21. Harkisoen S, Arends JE, van den Hoek JA, Whelan J, van Erpecum KJ, Boland GJ et al. Historic and current hepatitis B viral DNA and quantitative HBsAg level are not associated with cirrhosis in non-Asian women with chronic hepatitis B. Int J Infect Dis. 2014;29:133-8.
22. Gökcan H, Kuzu UB, Öztaş E, Saygılı F, Öztuna D, Suna N et al. The predictive value of noninvasive serum markers of liver fibrosis in patients with chronic hepatitis C. Turk J Gastroenterol. 2016;27:156-64.
23. D'Souza RS, Neves Souza L, Isted A, Fitzpatrick E, Vimalesvaran S, Cotoi C et al. AST-to-platelet ratio index in non-invasive assessment of long-term graft fibrosis following pediatric liver transplantation. Pediatr Transplant. 2016;20:222-6.
24. Orasan OH, Iancu M, Sava M, Saplontai-Pop A, Cozma A, Sarlea ST et al. Non-invasive assessment of liver fibrosis in chronic viral hepatitis. Eur J Clin Invest. 2015;45:1243-51.
25. Derbala M, Elbadri ME, Amer AM, AlKaabi S, Sultan KH, Kamel YM et al. Aspartate transaminase to platelet ratio index in hepatitis C virus and Schistosomiasis coinfection. World J Gastroenterol. 2015;21:13132-9.
26. Degos F, Perez P, Roche B, Mahmoudi A, Asselineau J, Voitot H et al. Diagnostic accuracy of FibroScan and comparison to liver fibrosis biomarkers in chronic viral hepatitis: a multicenter prospective study (the FIBROSTIC study). J Hepatol. 2010;53:1013-21.
27. Yilmaz Y, Yonal O, Kurt R, Bayrak M, Aktas B, Ozdogan O. Noninvasive assessment of liver fibrosis with the aspartate transaminase to platelet ratio index (APRI): Usefulness in patients with chronic liver disease: APRI in chronic liver disease. Hepat Mon. 2011;11:103-6.
28. Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS, Lok AS. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology. 2003;38:518-26.
29. Vallet-Pichard A, Mallet V, Nalpas B, Verkarre V, Nalpas A, Dhalluin-Venier V et al. FIB-4: an inexpensive and accurate marker of fibrosis in HCV infection. comparison with liver biopsy and fibrotest. Hepatology. 2007;46:32-6.
30. Cross TJ, Rizzi P, Berry PA, Bruce M, Portmann B, Harrison PM. King's Score: an accurate marker of cirrhosis in chronic hepatitis C. Eur J Gastroenterol Hepatol. 2009;21:730-8.