ŞUA SÜMER, NAZLIM AKTUĞ DEMİR, Servet KÖLGELİER, LÜTFİ SALTUK DEMİR, ONUR URAL

Kronik hepatit B'de fibrotest ve actitest karaciğer biyopsisine alternatif olabilir mi?

Amaç: Bu çalışmada kronik hepatit B (KHB)'de karaciğer biyopsisinde saptanan fibrozis ve inflamasyon derecesi referans alınarak fibrotestin (FT) fibrozisi ve actitestin (AT) nekroinflamatuar aktiviteyi belirlemedeki duyarlılığının araştırılması amaçlandı.Gereç ve Yöntem: Bu prospektif çalışmaya 2013 yılı içerisinde takip edilen 53 KHB hastası dahil edildi. Biyopsiler modifiye Knodell skorlama sistemine gore değerlendirildi. Karaciğer biyopsisi yapıldığı gün hastalardan FT ve AT için kan örneği alındı.Bulgular: Çalışmaya alınan hastaların 22'si kadın, 31'i erkekti. KHB hastalarında karaciğer biyopsisi ve FT karşılaştırılmasında ciddi fibrozisi tespit etmek için FT'nin duyarlılığı %93.5, seçiciliği ise %54.5 olarak tespit edildi. FT'nin pozitif prediktif değeri (PPD) %74.3, negatif prediktif değeri (NPD) ise %85.7 olarak hesaplandı. FT için ROC analizi sonucu eğri altında kalan alan %75.1'ti (p=0.003). KHB hastalarında karaciğer biyopsisi ve AT karşılaştırılmasında ise ciddi nekroinflamasyonun tespiti için AT'nin duyarlılığı %89.2, seçiciliği %64'tü. PPD %73.5 ve NPD ise %84.2 olarak hesaplandı. AT için ROC analizi sonucu eğri altında kalan alan % 65'ti (p=0.001). Sonuç: KHB'de FT ve AT'nin ciddi fibrozis ve nekroinflamasyonu göstermedeki duyarlılıkları yüksekti. Bununla birlikte FT ve AT biyopsi yapılmaksızın tek başına kullanılabilecek bir belirteç olarak görülmemektedir.

Objectives: In this study, we aimed at investigating the accuracy of fibrotest (FT) in measuring fibrosis and actitest (AT) in measuring necroinflammatory activity by taking the fibrosis and inflammation level found in liver biopsy as reference in chronic hepatitis B (CHB).Material and Methods: This prospective study included 53 CHB patients who were being monitored in 2013. The biopsies were assessed in line with the modified Knodell scoring system Blood samples were drawn from the patients for FT and AT on the day when their liver biopsies were performed.Results: Twenty two of the patients included in the study were female and 31 male. FT sensitivity of 93.5% and selectivity of 54.5% was detected to identify severe fibrosis in CHB patients as a result of comparison of liver biopsy with FT. Positive predictive value (PPV) of FT was calculated as 74.3% and negative predictive value (NPV) as 85.7%. ROC curves analysis showed an AUC value of 75.1% for FT (p=0.003). In comparison of the liver biopsy with AT, on the other hand, an AT sensitivity of 89.2% and selectivity of 64% was detected to identify severe necroinflammation in CHB patients. PPV was calculated as 73.5% and NPV as 84.2%. ROC curves analysis showed an AUC value of 65% for AT (p=0.001).Conclusion: The accuracy of FT and AT in showing fibrosis and necroinflammation in CHB was quite high. However FT and AT does not seem to be a marker to be used alone without performing a liver biopsy.

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