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

Yıl 2016, Cilt: 26 Sayı: 3, 74 - 79, 01.09.2016

Şua Sümer Nazlım Aktuğ Demir Servet Kölgelier Lütfi Saltuk Demir Onur Ural

Öz

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

Anahtar Kelimeler

Kronik hepatit B karaciğer biyopsisi fibrotest actitest

Kaynakça

  • Perz JF, Armstrong GL, Farrington LA, Hutin YJ, Bell BP. The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide. J Hepatol 2006;45:529-38.
  • Uyar C, Akcam FZ, Ciris M, Kaya O, Kockar C, Isler M. Comparison of FibroTest-ActiTest with histopathology in demonstrating fibrosis and necroinflammatory activity in chronic hepatitis B and C. Indian J Pathol Microbiol 2010;53:470-5.
  • Myers RP, Tainturier MH, Ratziu V, et al. Prediction of liver histological lesions with biochemical markers in patients with chronic hepatitis B. J Hepatol 2003;39:222-30.
  • Anastasiou J, Alisa A, Virtue S, Portmann B, Murray-Lyon I, Williams R. Noninvasive markers of fibrosis and inflam- mation in clinical practice: prospective comparison with liver biopsy. Eur J Gastroenterol Hepatol 2010;22:474-80.
  • Smith JO, Sterling RK. Systematic review: non-invasive methods of fibrosis analysis in chronic hepatitis C. Aliment Pharmacol Ther 2009;30:557-76.
  • Poynard T, Ratziu V, Bedossa P. Appropriateness of liver bi- opsy. Can J Gastroenterol 2000;14:543-8.
  • Afdhal NH. Biopsy or biomarkers: is there a gold standard for diagnosis of liver fibrosis?. Clin Chem 2004;50:1299- 300.
  • Halfon P, Munteanu M, Poynard T. FibroTest-ActiTest as a non-invasive marker of liver fibrosis. Gastroenterol Clin Biol 2008;32:22-39.
  • Imbert-Bismut F, Ratziu V, Pieroni L, et al. Biochemical markers of liver fibrosis in patients with hepatitis C virus infection: a prospective study. Lancet 2001;357:1069-75.
  • Rossi E, Adams L, Prins A, et al. Validation of the FibroTest biochemical markers score in assessing liver fibrosis in he- patitis C patients. Clin Chem 2003;49:450-4.
  • Gressner OA, Beer N, Jodlowski A, Gressner AM. Impact of quality control accepted inter-laboratory variations on calculated Fibrotest/Actitest scores for the non-invasive biochemical assessment of liver fibrosis. Clin Chim Acta 2009;409:90-5.
  • Poynard T, Munteanu M, Ngo Y, et al. ActiTest accuracy for the assessment of histological activity grades in patients with chronic hepatitis C, an overview using Obuchowski measure. Gastroenterol Clin Biol 2010;34:388-96.
  • Poynard T, Ngo Y, Munteanu M, et al. Noninvasive Markers of Hepatic Fibrosis in Chronic Hepatitis B. Curr Hepat Rep 2011;10:87-97.
  • Keeffe EB, Dieterich DT, Han SH, et al. A treatment algo- rithm for the management of chronic hepatitis B virus infe- ction in the United States: 2008 update. Clin Gastroenterol Hepatol 2008;6:1315-41.
  • European Association For The Study of The Liver. EASL cli- nical practice guidelines: Management of chronic hepatitis B virus infection. J Hepatol 2012;57:167-85.
  • Poynard T, Imbert-Bismut F, Munteanu M, et al. Overview of the diagnostic value of biochemical markers of liver fibrosis (FibroTest, HCV FibroSure) and necrosis (Acti- Test) in patients with chronic hepatitis C. Comp Hepatol 2004;3:8.
  • Ishak K, Baptista A, Bianchi L, et al. Histological grading and staging of chronic hepatitis. J Hepatol 1995;22:696–9.
  • Wai CT, Greenson JK, Fontana RJ, et al. A simple nonin- vasive index can predict both significant fibrosis and cir- rhosis in patients with chronic hepatitis C. Hepatology 2003;38:518-26.
  • 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 lea- ding meta-analysis. Gastroenterol 2012;12:14.
  • Lin ZH, Xin YN, Dong QJ, et al. Performance of the As- partate Aminotransferase-to- Platelet Ratio Index for the Staging of Hepatitis C-Related Fibrosis: An Updated Me- ta-Analysis. Hepatology 2011;53:726-36.
  • Hui AY, Chan HL, Wong VW, et al. Identification of chro- nic hepatitis B patients without significant liver fibrosis by asimple noninvasive predictive model. Am J Gastroenterol 2005;100:616-23.
  • Halfon P, Bourliere M, Deydier R, et al. Independent pros- pective multicenter validation of biochemical markers (Fibrotest–Actitest) for theprediction of liver fibrosis and activity in patients with chronic hepatitis C: The Fibropaca Study. Am J Gastroenterol 2006;101:547–55.
  • Halfon P, Bourlière M, Pénaranda G, Deydier R, Renou C, Fridlund DB. Accuracy of hyaluronic acid level for predic- ting liver fibrosis stages in patients with hepatitis C virus. Comp Hepatol 2005;4:1-12.
  • Poynard T, Morra R, Halfon P, et al. Meta-analyses of Fibro- Test diagnostic value in chronic liver disease. BMC Gastro- enterol 2007;7:40.
  • Castera L. Non-invasive assessment of liver fibrosis in chro- nic hepatitis C. Hepatol Int 2011;5:625-34.
  • Usluer G, Erben N, Aykin N, et al. Comparison of non-in- vasive fibrosis markers and classical liver biopsy in chronic hepatitis C. Eur J Clin Microbiol Infect Dis 2012;31:1873-8.
  • Sökücü S, Gökçe S, Güllüoğlu M, Aydoğan A, Celtik C, Durmaz O. The role of the non-invasive serum marker FibroTest-ActiTest in the prediction of histological stage of fibrosis and activity in children with naïve chronic hepatitis B infection. Scand J Infect Dis 2010;42:699-703.
  • Gui HL, Xie Q, Wang H. FibroTest-ActiTest for predicting liver fibrosis and inflammatory activity in Chinese patients with chronic hepatitis B. Zhonghua Gan Zang Bing Za Zhi 2008;16:897-901.
  • Férard G, Piton A, Messous D, et al. Intermethod calibra- tion of alanine aminotransferase (ALT) and gamma-glu- tamyltransferase (GGT) results: application to Fibrotest and Actitest scores. Clin Chem Lab Med 2006;44:400-6.

Yıl 2016, Cilt: 26 Sayı: 3, 74 - 79, 01.09.2016

Şua Sümer Nazlım Aktuğ Demir Servet Kölgelier Lütfi Saltuk Demir Onur Ural

Öz

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

Anahtar Kelimeler

Chronic hepatitis B liver biopsy fibrotest actitest

Kaynakça

  • Perz JF, Armstrong GL, Farrington LA, Hutin YJ, Bell BP. The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide. J Hepatol 2006;45:529-38.
  • Uyar C, Akcam FZ, Ciris M, Kaya O, Kockar C, Isler M. Comparison of FibroTest-ActiTest with histopathology in demonstrating fibrosis and necroinflammatory activity in chronic hepatitis B and C. Indian J Pathol Microbiol 2010;53:470-5.
  • Myers RP, Tainturier MH, Ratziu V, et al. Prediction of liver histological lesions with biochemical markers in patients with chronic hepatitis B. J Hepatol 2003;39:222-30.
  • Anastasiou J, Alisa A, Virtue S, Portmann B, Murray-Lyon I, Williams R. Noninvasive markers of fibrosis and inflam- mation in clinical practice: prospective comparison with liver biopsy. Eur J Gastroenterol Hepatol 2010;22:474-80.
  • Smith JO, Sterling RK. Systematic review: non-invasive methods of fibrosis analysis in chronic hepatitis C. Aliment Pharmacol Ther 2009;30:557-76.
  • Poynard T, Ratziu V, Bedossa P. Appropriateness of liver bi- opsy. Can J Gastroenterol 2000;14:543-8.
  • Afdhal NH. Biopsy or biomarkers: is there a gold standard for diagnosis of liver fibrosis?. Clin Chem 2004;50:1299- 300.
  • Halfon P, Munteanu M, Poynard T. FibroTest-ActiTest as a non-invasive marker of liver fibrosis. Gastroenterol Clin Biol 2008;32:22-39.
  • Imbert-Bismut F, Ratziu V, Pieroni L, et al. Biochemical markers of liver fibrosis in patients with hepatitis C virus infection: a prospective study. Lancet 2001;357:1069-75.
  • Rossi E, Adams L, Prins A, et al. Validation of the FibroTest biochemical markers score in assessing liver fibrosis in he- patitis C patients. Clin Chem 2003;49:450-4.
  • Gressner OA, Beer N, Jodlowski A, Gressner AM. Impact of quality control accepted inter-laboratory variations on calculated Fibrotest/Actitest scores for the non-invasive biochemical assessment of liver fibrosis. Clin Chim Acta 2009;409:90-5.
  • Poynard T, Munteanu M, Ngo Y, et al. ActiTest accuracy for the assessment of histological activity grades in patients with chronic hepatitis C, an overview using Obuchowski measure. Gastroenterol Clin Biol 2010;34:388-96.
  • Poynard T, Ngo Y, Munteanu M, et al. Noninvasive Markers of Hepatic Fibrosis in Chronic Hepatitis B. Curr Hepat Rep 2011;10:87-97.
  • Keeffe EB, Dieterich DT, Han SH, et al. A treatment algo- rithm for the management of chronic hepatitis B virus infe- ction in the United States: 2008 update. Clin Gastroenterol Hepatol 2008;6:1315-41.
  • European Association For The Study of The Liver. EASL cli- nical practice guidelines: Management of chronic hepatitis B virus infection. J Hepatol 2012;57:167-85.
  • Poynard T, Imbert-Bismut F, Munteanu M, et al. Overview of the diagnostic value of biochemical markers of liver fibrosis (FibroTest, HCV FibroSure) and necrosis (Acti- Test) in patients with chronic hepatitis C. Comp Hepatol 2004;3:8.
  • Ishak K, Baptista A, Bianchi L, et al. Histological grading and staging of chronic hepatitis. J Hepatol 1995;22:696–9.
  • Wai CT, Greenson JK, Fontana RJ, et al. A simple nonin- vasive index can predict both significant fibrosis and cir- rhosis in patients with chronic hepatitis C. Hepatology 2003;38:518-26.
  • 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 lea- ding meta-analysis. Gastroenterol 2012;12:14.
  • Lin ZH, Xin YN, Dong QJ, et al. Performance of the As- partate Aminotransferase-to- Platelet Ratio Index for the Staging of Hepatitis C-Related Fibrosis: An Updated Me- ta-Analysis. Hepatology 2011;53:726-36.
  • Hui AY, Chan HL, Wong VW, et al. Identification of chro- nic hepatitis B patients without significant liver fibrosis by asimple noninvasive predictive model. Am J Gastroenterol 2005;100:616-23.
  • Halfon P, Bourliere M, Deydier R, et al. Independent pros- pective multicenter validation of biochemical markers (Fibrotest–Actitest) for theprediction of liver fibrosis and activity in patients with chronic hepatitis C: The Fibropaca Study. Am J Gastroenterol 2006;101:547–55.
  • Halfon P, Bourlière M, Pénaranda G, Deydier R, Renou C, Fridlund DB. Accuracy of hyaluronic acid level for predic- ting liver fibrosis stages in patients with hepatitis C virus. Comp Hepatol 2005;4:1-12.
  • Poynard T, Morra R, Halfon P, et al. Meta-analyses of Fibro- Test diagnostic value in chronic liver disease. BMC Gastro- enterol 2007;7:40.
  • Castera L. Non-invasive assessment of liver fibrosis in chro- nic hepatitis C. Hepatol Int 2011;5:625-34.
  • Usluer G, Erben N, Aykin N, et al. Comparison of non-in- vasive fibrosis markers and classical liver biopsy in chronic hepatitis C. Eur J Clin Microbiol Infect Dis 2012;31:1873-8.
  • Sökücü S, Gökçe S, Güllüoğlu M, Aydoğan A, Celtik C, Durmaz O. The role of the non-invasive serum marker FibroTest-ActiTest in the prediction of histological stage of fibrosis and activity in children with naïve chronic hepatitis B infection. Scand J Infect Dis 2010;42:699-703.
  • Gui HL, Xie Q, Wang H. FibroTest-ActiTest for predicting liver fibrosis and inflammatory activity in Chinese patients with chronic hepatitis B. Zhonghua Gan Zang Bing Za Zhi 2008;16:897-901.
  • Férard G, Piton A, Messous D, et al. Intermethod calibra- tion of alanine aminotransferase (ALT) and gamma-glu- tamyltransferase (GGT) results: application to Fibrotest and Actitest scores. Clin Chem Lab Med 2006;44:400-6.
Toplam 29 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Original Article
Yazarlar

Şua Sümer Bu kişi benim

Nazlım Aktuğ Demir Bu kişi benim

Servet Kölgelier Bu kişi benim

Lütfi Saltuk Demir Bu kişi benim

Onur Ural Bu kişi benim

Yayımlanma Tarihi 1 Eylül 2016
Yayımlandığı Sayı Yıl 2016 Cilt: 26 Sayı: 3

Kaynak Göster

Vancouver Sümer Ş, Demir NA, Kölgelier S, Demir LS, Ural O. Kronik hepatit B’de fibrotest ve actitest karaciğer biyopsisine alternatif olabilir mi?. Genel Tıp Derg. 2016;26(3):74-9.

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