Kronik Hepatit B Hastalarında Karaciğer Fibrozisi ve Steatohepatit Gelişiminde Gamma Glutamil Transferaz Trombosit Oranının Öngörü Değeri

Öz

Amaç: Kronik hepatit B (KHB), dünya çapında karaciğer fibrozisinin ve sirozun önemli bir nedenidir. Bu çalışmada, gama-glutamil transferaz (GGT)/trombosit oranının (GPR) karaciğer fibrozisi ve steatohepatit ile ilişkisini ve öngörü değerini araştırmayı amaçladık. Materyal ve Metot: Bu retrospektif kohort çalışmaya 100 KHB'li hasta ve 100 sağlıklı kontrol dahil edildi. Fibrozis indeksleri hesaplandı ve karaciğer biyopsisinde tespit edilen fibrozis durumu ve steatohepatit için ultrason sonuçlarıyla karşılaştırıldı. Bu parametrelerin tanısal performansı, alıcı işletim karakteristiği (ROC) eğrisi analizi kullanılarak değerlendirildi. Bulgular: Kronik hepatit B hastalarında vücut kitle indeksi, karaciğer enzim düzeyleri ve fibroz indeksleri sağlıklı bireylere kıyasla daha yüksekti; trombosit sayıları ise bu hastalarda daha düşüktü (tümü p<0,05). ROC analizi, GPR'nin CHB hastalarını sağlıklı kontrollerden ayırt etmede en yüksek ayırt edici performansa sahip olduğunu, AUC değerinin 0.96, duyarlılığının %96 ve özgüllüğünün %80 olduğunu ve hem APRI hem de FIB-4'ten daha iyi performans gösterdiğini ortaya koymuştur. GGT ve FIB-4 en güçlü ayırt edici performansı sergiledi. GPR, APRI ve FIB-4 ile güçlü bir korelasyon göstermesine rağmen, yalnızca FIB-4, Ishak fibroz evreleriyle bağımsız olarak ilişkiliydi (OR≈1,8, p=0,037). Endekslerin hiçbiri hepatik steatozun şiddetini anlamlı şekilde tahmin etmedi. Sonuç: GPR, KHB hastalarını sağlıklı bireylerden ayırmada yüksek doğruluk göstermektedir. FIB-4'ün fibrozis ilerlemesinin evrelendirilmesinde GPR'den daha değerli olduğu bulunmuştur; bu da GPR'nin öncelikle bir fibrozis evreleme aracı olarak değil, bir hastalık ayırt etme indeksi olarak yorumlanması gerektiğini göstermektedir. Bu indekslerin birlikte kullanımı, KHB'li hastaların tanı ve takibi için uygun maliyetli ve invaziv olmayan bir tanı aracı sağlayabilir ve klinisyenler için faydalı bir biyobelirteç görevi görebilir.

Anahtar Kelimeler

• Kronik hepatit B
• FIB-4 indeksi
• gama-glutamil transferaz/trombosit oranı
• karaciğer fibrozu
• Steatohepatit

Predictive Value of Gamma Glutamyl Transferase Platelet Ratio in The Development of Liver Fibrosis and Steatohepatitis in Chronic Hepatitis B Patients

Öz

Objective: Chronic hepatitis B (CHB) represents a major contributor to fibrosis and cirrhosis worldwide. In this study, we aimed to investigate the relationship and predictive value of the gamma-glutamyl transferase (GGT)-to-platelet ratio (GPR) with liver fibrosis and steatohepatitis. Materials and Methods: This retrospective cohort study included 100 patients with CHB and 100 healthy controls. Fibrosis indices were calculated and compared with ultrasound results for fibrosis status and steatohepatitis identified on liver biopsy. The diagnostic performance of these parameters was assessed using receiver operating characteristic (ROC) curve analysis. Results: The body mass index, liver enzyme levels, and fibrosis indices were higher in patients with chronic hepatitis B than in healthy individuals, while platelet counts were lower in these patients (all p<0.05). ROC analysis showed that GPR had the highest discriminative performance in distinguishing CHB patients from healthy controls, with an AUC of 0.960, sensitivity of 96%, and specificity of 80%, and it outperformed both APRI and FIB-4. GGT and FIB-4 exhibited the strongest discriminatory performance. Although GPR showed a strong correlation with APRI and FIB-4, only FIB-4 was independently associated with Ishak fibrosis stages (OR≈1.8, p=0.037). None of the indices significantly predicted hepatic steatosis severity. Conclusion: GPR demonstrates high accuracy in distinguishing CHB patients from healthy individuals. FIB-4 was found to be more valuable than GPR for staging fibrosis progression, indicating that GPR should be interpreted primarily as a disease discrimination index, rather than as a fibrosis staging tool. The combined use of these indices could provide a cost-effective, noninvasive diagnostic tool for the diagnosis and follow-up of patients with CHB and serve as a useful biomarker for clinicians.

Anahtar Kelimeler

• Chronic Hepatitis B
• FIB-4 index
• gamma-glutamyl transferase to platelet ratio
• liver fibrosis
• steatohepatitis

Kaynakça

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