Kronik hepatit B'de hemogram ve biyokimyasal parametrelerin modifiye histolojik aktivite indeksi ve hepatik fibrozis ile ilişkisi

Year 2021, Volume: 46 Issue: 3, 1237 - 1244, 30.09.2021

Selma Erdoğan Düzcü , Şeyma Öztürk

Abstract

Amaç: Kronik hepatit B sirozun ve hepatosellüler karsinomun önemli nedenlerinden biri olup karaciğer biopsisi fibrozis tanısında altın standart yöntemdir. Karaciğer biopsilerinin histolojik değerlendirilmesinde noninvaziv prediktif faktörlere ihtiyaç vardır. Bu çalışmada kronik hepatit B vakalarında modifiye histolojik aktivite indeksi ve fibrozis için hemogram ve biyokimyasal markerların diagnostic value araştırılması amaçlanmıştır.
Gereç ve Yöntem: Bu çalışmada kronik hepatit B tanılı 248 hastaya ait karaciğer trucut biopsileri retrospektif olarak değerlendirilmiştir. Modifiye histolojik aktivite ve fibrozis skoru Ishak sınıflaması dikkate alınarak yapılmış olup hemogram ve biyokimyasal markerlarla karşılaştırılmıştır.
Bulgular: Fibrozis < 3 ve ≥3 gruplarını en iyi ayırt eden biyobelirteç %70.3 ayırt etme performansı ile aspartat aminotransferaz (AST) değeriydi. Histolojik aktivite indeksinde <6 ve ≥6 gruplarını en iyi ayırt eden biyobelirteçler, %75.5 ayırt etme performansı ile AST ve %73.7 ile alanine aminotransferaz (ALT) ve %73.4 ile gama-glutamil-transferaz değerleriydi.
Sonuç: Çalışmamızda kronik hepatit B vakalarında klinik pratikte kullanılan girişimsel olmayan markerların fibrozis ve nekroinflamatuar aktivitesini tahminde tanısal değere sahip olduğu gösterilmiştir.

Keywords

Kronik B hepatiti, histolojik aktivite indeksi, karaciğer fibrozisi, tam kan sayımı, biyokimya

Relationship of hemogram and biochemical parameters with modified histologic activity index and hepatic fibrosis in chronic hepatitis B

Abstract

Purpose: Chronic hepatitis B is still one of the leading causes of cirrhosis and hepatocellular carcinoma worldwide, and the liver biopsy the gold standard method to assess the severity of liver fibrosis. Noninvasive predictive factors are needed for histological evaluation of liver biopsies. In this study, it was aimed to investigate the diagnostic value of hemogram and biochemical parameters for modified histological activity index and fibrosis in patients with chronic hepatitis B.
Materials and Methods: In this study, liver tru-cut biopsies of 248 patients diagnosed with chronic hepatitis B, were evaluated retrospectively. Modified histological activity index and fibrosis were scored in accordance with the Ishak staging system and compared with hemogram and biochemical parameters.
Results: In the fibrosis groups, the aspartate aminotransferase (AST) value was the best marker to discriminate < 3 ve ≥3 groups, with 70,3% discrimination performance. In the histological activity index groups, AST, alanine aminotransferase (ALT), and gamma-glutamyl transferase (GGT) was the best parameters to discriminate <6 ve ≥6 groups with 75,5%, 73,7%, and 73,4% discrimination performances, respectively.
Conclusion: In our study, we showed that noninvasive parameters used in clinical practice in patients with chronic hepatitis B have diagnostic value in predicting fibrosis and necroinflammatory activity.

Keywords

Chronic hepatitis B, histological activity index, liver fibrosis, complete blood count, biochemistry

References

• 1. Ekiz F, Yüksel O, Koçak E, et al. Mean platelet volume as a fibrosis marker in patients with chronic hepatitis B. J Clin Lab Anal. 2011;25(3):162-165. doi:10.1002/jcla.20450
• 2. Peng J, Cai S, Yu T, Chen Y, Zhu Y, Sun J. Aspartate aminotransferase to platelet ratio index - A reliable predictor of therapeutic efficacy and improvement of Ishak score in chronic hepatitis B patients treated with nucleoside analogues. Scand J Clin Lab Invest. 2016;76(2):133-142. doi:10.3109/00365513.2015.1125013
• 3. Gümüsay Ö, Özenirler S, Atak A, et al. Diagnostic potential of serum direct markers and non-invasive fibrosis models in patients with chronic hepatitis B. Hepatol Res. 2013;43(3):228-237. doi:10.1111/j.1872-034X.2012.01057.x
• 4. Ray Kim W, Berg T, Asselah T, 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(4):773-780. doi:10.1016/j.jhep.2015.11.012
• 5. Sahin T, Suleymanlar I. Evaluation of Liver Fibrosis by Ten Noninvasive Methods in Patients with Chronic Hepatitis B: A Comparative Study. Akdeniz Med J. 2018;4(1):18-24. doi:10.17954/amj.2018.111
• 6. Sebastiani G, Vario A, Guido M, Alberti A. Sequential algorithms combining non-invasive markers and biopsy for the assessment of liver fibrosis in chronic hepatitis B. World J Gastroenterol. 2007;13(4):525-531. doi:10.3748/wjg.v13.i4.525
• 7. Wai CT, Cheng CL, Wee A, et al. Non-invasive models for predicting histology in patients with chronic hepatitis B. Liver Int. 2006;26(6):666-672. doi:10.1111/j.1478-3231.2006.01287.x 8. Hakyemez IN, Bolukcu S, Durdu B, Aslan T. Red Cell Volume Distribution Width to Platelet Ratio is an Important Predictor of Liver Fibrosis and Cirrhosis in Chronic Hepatitis B. Viral Hepatit Derg. 2016;22(2):52-57. doi:10.4274/vhd.94914
• 9. Mao WL, Wu JP. Haematologic indices in hepatitis B virus-related liver disease. Clin Chim Acta. 2020;500(August 2019):135-142. doi:10.1016/j.cca.2019.10.007
• 10. Eminler AT, Irak K, Ayyildiz T, et al. The relation between liver histopathology and GGT levels in viral hepatitis: More important in hepatitis B. Turkish J Gastroenterol. 2014;25(4):411-415. doi:10.5152/tjg.2014.3693
• 11. Güzelbulut F, Sezikli M, Akkan-Çetinkaya Z, Yaşar B, Özkara S, Kurdaş-Övünç AO. AST-platelet ratio index in the prediction of significant fibrosis and cirrhosis in patients with chronic hepatitis B. Turkish J Gastroenterol. 2012;23(4):353-358. doi:10.4318/tjg.2012.0348
• 12. Ishak K, Baptista A, Bianchi L, et al. Histological grading and staging of chronic hepatitis. J Hepatol. 1995;22(6):696-699. doi:10.1016/0168-8278(95)80226-6
• 13. Karagoz E, Ulcay A, Tanoglu A, et al. Clinical usefulness of mean platelet volume and red blood cell distribution width to platelet ratio for predicting the severity of hepatic fibrosis in chronic hepatitis B virus patients. Eur J Gastroenterol Hepatol. 2014;26(12):1320-1324. doi:10.1097/MEG.0000000000000203
• 14. Kim BK, Kim SA, Park YN, et al. Noninvasive models to predict liver cirrhosis in patients with chronic hepatitis B. Liver Int. 2007;27(7):969-976. doi:10.1111/j.1478-3231.2007.01519.x
• 15. Seto WK, Lee CF, Lai CL, et al. A new model using routinely available clinical parameters to predict significant liver fibrosis in chronic hepatitis B. PLoS One. 2011;6(8):2-8. doi:10.1371/journal.pone.0023077
• 16. Ceylan B, Mete B, Fincanci M, et al. A new model using platelet indices to predict liver fibrosis in patients with chronic hepatitis B infection. Wien Klin Wochenschr. 2013;125(15-16):453-460. doi:10.1007/s00508-013-0394-3
• 17. Özkara S, Tosun I, Sari B, et al. The correlation of serum transaminase values with fibrosis staging and necroinflammatory activity scores in chronic hepatitis. Turkiye Klin J Med Sci. 2011;31(1):68-74. doi:10.5336/medsci.2009-16514
• 18. Güçlü E, Öğütlü A, Kösem M, Erkorkmaz Ü, Karabay O. Relationship Between Basic Laboratory Results and Fibrosis in Chronic Hepatitis B Patients. Viral Hepat J. 2019;25(2):45-49. doi:10.4274/vhd.galenos.2019.2019.0010
• 19. Ormeci A, Aydın Y, Sumnu A, et al. Predictors of treatment requirement in HBeAg-negative chronic hepatitis B patients with persistently normal alanine aminotransferase and high serum HBV DNA levels. Int J Infect Dis. 2016;52:68-73. doi:10.1016/j.ijid.2016.09.007
• 20. Celikbilek M, Dogan S, Gursoy S, et al. Noninvasive assessment of liver damage in chronic hepatitis B. World J Hepatol. 2013;5(8):439-444. doi:10.4254/wjh.v5.i8.439
• 21. Jin W, Lin Z, Xin Y, Jiang X, Dong Q, Xuan S. Diagnostic accuracy of the aspartate aminotransferase-to-platelet ratio index for the prediction of hepatitis B-related fibrosis: A leading meta-analysis. BMC Gastroenterol. 2012;12(1):1-8. doi:10.1186/1471-230X-12-14