Kronik Hepatit C Olgularında Doğrudan Etkili Antiviral Tedavi Öncesi ve Sonrası Non-invaziv Skorların Değerlendirilmesi

Yıl 2020, Cilt: 34 Sayı: 3, 86 - 90, 31.12.2020

Aziz Ahmad Hamidi , Cüneyt Kuru

https://doi.org/10.5222/ankem.2020.086

Öz

Doğrudan etkili antiviral (DEA) tedavi kullanan kronik hepatit C enfeksiyonu olan hastalarda kalıcı virolojik yanıt sağlanmaktadır. Ancak karaciğer fibrozu düzeyinde gerileme olup olmadığı bilinmemektedir. Non-invaziv serum skorları, tedavi öncesi karaciğer fibrozu düzeyini saptamada başarılıdır. Bu skorların tedavi sonrası kullanımı konusunda litetatürde yeterli çalışma bulunmamaktadır. Bu çalışma, non-invaziv skorları kullanarak tedavi sonrası inflamasyon ve fibroz düzeyindeki değişimi belirlemeyi amaçlamıştır.
Karabük Üniversitesi Eğitim ve Araştırma Hastanesi’ne, Ocak 2019 ile Ocak 2020 tarihleri arasında başvurup DEA tedavi kullanan erişkin hastalar çalışmaya alınmıştır. Olgularının klinik ve laboratuvar bulguları, hastane bilgi sisteminden geriye dönük olarak kaydedilmiştir. Tedavi öncesi ve sonrası (24. hafta) Fibrosis-4 (FIB-4), aspartat aminotransferaz (AST) - trombosit oranı indeksinin (APRI), γ glutamat peptidaz-trombosit oranı (GPR) ve AST/ALT oranı skorları hesaplanmıştır.
Yaş ortalaması 56,4 olan 42 hasta incelenmiştir. Bu hastaların % 52’si kadın idi. Tüm hastalarda kalıcı virolojik yanıt gelişmiştir. En sık (% 67) genotip 1b saptanmıştır. En çok kullanılan tedavi rejiminin (% 60) paritaprevir + ritonavir + ombitasvir + dasabuvir olduğu belirlenmiştir. Tedavi öncesine göre tedavi sonrası, ortalama AST değeri 24,69’dan 20,67’ye, ortalama ALT değeri 20,57’den 15,31’e ve APRI 0,33’den 0,29’a azalmıştır (sırasıyla p=0,01; p=0,03; p=0,01). İstatistiksel açıdan anlamlı olmasa da FIB-4 de tedavi sonrası düşük bulunmuştur.
Sonuç olarak, DEA tedavi kullanan kronik hepatit C olguların takibinde, non-invaziv serum biyobelirteç skorlarının kullanımı yararlı olabilir.

Anahtar Kelimeler

doğrudan etkili antiviral, genotip, kronik hepatit C, non-invaziv skorlar

Etik Beyan

29.05.2020 tarihli ve 2020/233 no’lu Karabük Üniversitesi, Girişimsel Olmayan Klinik Araştırmalar Etik kurulu onayı alınmıştır.

Evaluation of Non-invasive Scores Before and After Direct-acting Antiviral Treatment in Patients with Chronic Hepatitis C

Öz

The sustained virological response is achieved in patients with chronic hepatitis C infection using direct-acting antiviral (DAA) therapy. However, it is not known whether there is a decrease in liver fibrosis level. Non-invasive serum scores are successful in determining the level of liver fibrosis before treatment. There are no adequate studies in the literature about the use of these scores after treatment. This study aimed to determine the change in inflammation and fibrosis levels after treatment by using non-invasive scores. Adult patients who applied to the Karabuk University Training and Research Hospital between January 2019 and January 2020 and used DAA treatment were included in the study. Clinical and laboratory findings of the cases were recorded retrospectively from the hospital information system. Fibrosis-4 (FIB-4), aspartate aminotransferase (AST)-platelet ratio index (APRI), γ glutamate transpeptidase-platelet ratio (GPR) and AST / ALT ratio scores were calculated before and after (24th week) treatment. Forty-two patients with a mean age of 56.4 were evaluated. 52% of these patients were women. All patients developed a sustained virological response. Genotype 1b was the most common (67 %). The most commonly used treatment regimen (60 %) was paritaprevir + ritonavir + ombitasvir + dasabuvir. After treatment compared to pretreatment, mean AST value decreased from 24.69 to 20.67, mean ALT value decreased from 20.57 to 15.31 and APRI from 0.33 to 0.29 (p=0.01; p=0.03; p=0.01, respectively). Although not statistically significant, FIB-4 was low after treatment. In conclusion, the use of non-invasive serum biomarker scores may be useful in the follow-up of chronic hepatitis C cases using DAA treatment.

Anahtar Kelimeler

chronic hepatitis C, direct-acting antiviral, genotype, non-invasive scores

Etik Beyan

The approval of the NonInvasive Clinical Research Ethics Committee of Karabük University dated 29.05.2020 and numbered 2020/233 was obtained.

Kaynakça

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