Kronik Hepatit B Hastalarında Karaciğer Fibrozisinin On Adet Noninvaziv Metod ile Değerlendirilmesi: Karşılaştırmalı Çalışma

Öz

Amaç: Çalışma kronik hepatit B hastalarında hepatik fi brozisin değerlendirilmesi ve tahmininde noninvaziv metodların değerlendirilmesini amaçlamaktadır. Gereç ve Yöntemler: Çalışmaya, Akdeniz Üniversitesi Tıp Fakültesi Gastroenteroloji Bölümüne 2009-2014 yılları arasında başvuran, invaziv karaciğer biyopsisi yapılmış, 158 KHB’ li hasta dahil edildi. Çalışmamızda, non-invaziv hepatik fi brozis belirteçlerinden literatüre geçmiş Lok indeks, King’ s skoru, CDS Bonacini skoru , Fibro-Q indeks, FİB-4 indeks, HUI modeli, APRI, AAR, Forn’s ve PAPAS indeksleri kullanılmış, çalışmaya alınan hastaların verileri retrospektif olarak taranarak, bu veriler ışığında hastaların invaziv biyopsi skorları ile 10 farklı non-invaziv yöntem karşılaştırılmıştır. Bulgular: Çalışmaya dahil edilen invaziv karaciğer biyopsisi yapılmış158 hastada ortalama yaş 49,39±13,04 saptandı. Hastaların 100'ü erkek %63,3 , 58’ise kadındı %36,7 . 139 %88 hasta HBe Ag negatif, 19 hasta %12 HBe Ag pozitif idi. Çalışmada kullanılan 10 adet noninvaziv metodun her biri için ROC eğrileri oluşturulup İshak fi brozis skorları ile karşılaştırmalı cutt-off değerleri metodlara göre şu şekilde saptandı; AAR = 0,562, Forns indeks = 0,604, FIB-4 indeks = 0,608, PAPAS skoru = 0,565, AP indeks= 0,625, Fibro-Q indeks = 0,589, Kings skoru = 0,590, CDS = 0,598, RPR = 0,614 ve Lok indeks = 0,631.Sonuç: İnceleme sonucunda KHB hasta grubumuzda Lok indeks fi brozis tesbitinde en etkin noninvaziv yöntem olarak saptandı. Lok indeksi etkinlik açısından sırasıyla AP indeks, RPR, FİB-4 ve Forns indeksin izlediği saptandı. HBV DNA düzeyi ile HAİ ve anlamlı fi brozis arasında pozitif korelasyon saptanırken, anlamlı fi brozis ile cinsiyet, HBe Ag ve Hbe Ab arasında istatistiksel olarak korelasyon saptanmadı

Anahtar Kelimeler

• Kronik hepatit B, Fibrozis, Lok indeks

Evaluation of Liver Fibrosis by Ten Noninvasive Methods in Evaluation of Liver Fibrosis by Ten Noninvasive Methods in Patients with Chronic Hepatitis B: A Comparative Study Patients with Chronic Hepatitis B: A Comparative Study

Abstract

Objective: This study aims to evaluate the predictive value of noninvasive serum markers of hepatic fi brosis in patients with chronic hepatitis B.Material and Methods: This study involved 158 patients with chronic hepatitis B. Noninvasive markers used were as follows; aspartate transaminase AST to alanine transaminase ALT ratio AAR , fi brosis-4 FIB-4 index, age-platelet index AP , Forns index, cirrhosis discriminant score CDS , Kings score, Fibro-Q index, PAPAS score, Lok index and red cell distribution width to platelet ratio RPR . Concurrent liver biopsy specimens were evaluated with the Ishak scoring system. Patients were divided into two groups, those with signifi cant fi brosis Ishak fi brosis score F ≥ 3 and those without Ishak fi brosis score F ≤ 2 . Receiver operating characteristic ROC curve analyses were carried out to compare the results of the noninvasive markers in the two groups.Results: Of the 158 patients evaluated mean age 49.39 ± 13.04, 100 males [63.3%], 58 females [36,7%] , 139 88% were HBe Ag negative and HBe Ab positive and 19 %12 were HBe Ag positive and HBe Ab negative.ROC curve analyses with the Ishak fi brosis score had cutoff values as follows: AAR = 0.562, Forns index = 0.604, FIB-4 index = 0.608, PAPAS score = 0.565, AP index = 0.625, Fibro-Q index = 0.589, Kings score = 0.590, CDS = 0.598, RPR = 0.614 and Lok index = 0.631. Conclusion: The Lok index was found to be the most effective noninvasive method for estimating hepatic fi brosis. The AP index, RPR, Forns index and FIB-4 index were also effective models in our study

Keywords

• Chronic hepatitis B, Fibrosis, Lok index

Kaynakça

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