Tranzijentna elastografija u neinvazivnoj proceni fibroze jetre kod pacijenata sa primarnom bilijarnom cirozom

  • Tamara Alempijevic 1. Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, Belgrade, Serbia 2. Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Ana Copertino 1. Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, Belgrade, Serbia 2. Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Ivan Boricic 1.Faculty of Medicine, University of Belgrade, Belgrade, Serbia 2.Institute for Pathology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Biljana Milicic Institute for Medical Informatics, University of Belgrade, Faculty of Dental Medicine, Belgrade, Serbia
  • Aleksandra Pavlovic-Markovic 1. Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, Belgrade, Serbia 2. Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Miodrag Krstic 1. Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, Belgrade, Serbia 2. Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Vera Matovic Emergency Center, Clinical Center of Serbia, Serbia
  • Dusan Dj Popovic 1. Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, Belgrade, Serbia 2. Faculty of Medicine, University of Belgrade, Belgrade, Serbia
DOI: https://doi.org/10.2298/10.2298/VSP160409337A

Sažetak


Uvod/Cilj: Prethodnih decenija su otkrivene neinvanzivne metode za procenu i praćenje fibroze jetre kod hroničnih bolesti jetre. Cilj ove studije je procena dijagnostičke preciznosti neinvanzivnih metoda za određivanje fibroze jetre (tranzijentna elastografija i biohemijski markeri), pri čemu je kao zlatni standard korišćena biopsija jetre a kod pacijenta sa primarnom bilijarnom cirozom.

Materijal i metode: U studiju je uključeno 140 pacijenata kod kojih su istog dana urađene biohemijske analize i biopsija jetre, a mesec dana kasnije je urađena tranzijentna elastografija. Za procenu fibroze jetre korišćen je METAVIR skor, a sve preparate biopsija je gledao jedan patolog. APRI skor-odnos aspartat aminotransferaze i trombocita, Forns indeks, odnos aminotransferaze i alanin transaminaze i tranzijentna elastografija su poređene sa stepenom fiboze jetre dobijene na osnovu biopsija jetre u cilju dobijanja najboljeg neinvanzivnog markera u proceni fibroze jetre.

Rezultati: Dokazana je statistička značajnost (p<0.05) za APRI skor, Forns indeks i tranzijentnu elastografiju za procenu stepena fibroze jetre. Tranzijentna elastografija je imala najbolji dijagnostički učinak u poređenju sa ostalim markerima koje smo istraživali. Optimalne granične vrednosti za prolaznu elastografiju su bile 4.25 i 5.9 kPa za dijagnozu fibroze jetre i razlikovanje slabe/umerene i uznapredovale fibroze. Površina ispod krive operativnih karakteristka (AUROC) za tranzitornu elastografiju je bila 0.963 i 0.865.

Zaključak: Na osnovu rezultata ove studije se došlo do zaključka da su APRI skor, Forns indeks, tranzijentna elastografija adekvatni dijagnostički markeri fibroze jetre kod pacijenata sa primarnom biijarnom cirozom, ali najsenzitivniji i najspecifičniji parametar je tranzijentna elastografija. Koristeći neinvanzivne parametre i metode u svakodnevnoj kliničkoj praksi se može smanjiti ali ne i potpuno izbaciti potreba za invanzivnim dijagnostičkim procedurama.

Ključne reči: transijentna elastografija, primarna bilijarna ciroza, biopsija jetre, fibroza jetre

Biografije autora

Tamara Alempijevic, 1. Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, Belgrade, Serbia 2. Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Ana Copertino, 1. Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, Belgrade, Serbia 2. Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Ivan Boricic, 1.Faculty of Medicine, University of Belgrade, Belgrade, Serbia 2.Institute for Pathology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Biljana Milicic, Institute for Medical Informatics, University of Belgrade, Faculty of Dental Medicine, Belgrade, Serbia
Aleksandra Pavlovic-Markovic, 1. Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, Belgrade, Serbia 2. Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Miodrag Krstic, 1. Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, Belgrade, Serbia 2. Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Vera Matovic, Emergency Center, Clinical Center of Serbia, Serbia
Dusan Dj Popovic, 1. Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, Belgrade, Serbia 2. Faculty of Medicine, University of Belgrade, Belgrade, Serbia

Reference

Lazaridis KN, Talwalkar JA. Clinical epidemiology of primary biliary cirrhosis: Incidence, prevalence, and impact of therapy. J Clin Gastroenterol 2007; 41(5): 494−500.

Kaplan MM, Gershwin ME. Primary biliary cirrhosis. N Engl J Med 2005; 353(12): 1261−73.

Seeff LB, Everson GT, Morgan TR, Curto TM, Lee WM, Ghany MG, et al. Complication rate of percutaneous liver biopsies among persons with advanced chronic liver disease in the HALT-C trial. Clin Gastroenterol Hepatol 2010; 8(10): 877−83.

Piccinino F, Sagnelli E, Pasquale G, Giusti G. Complications fol-lowing percutaneous liver biopsy. A multicentre retrospective study on 68,276 biopsies. J Hepatol 1986; 2(2): 165−73.

Bedossa P1, Dargère D, Paradis V. Sampling variability of liver fibrosis in chronic hepatitis C. Hepatology 2003; 38(6): 1449−57.

Gómez-Dominguez E, Mendoza J, García-Buey L, Trapero M, Gisbert JP, Jones EA, et al. Transient elastography to assess hepatic fibrosis in primary biliary cirrhosis. Aliment Pharmacol Ther 2008; 27(5): 441−7.

Floreani A, Cazzagon N, Martines N, Cavalletto L, Baldo V, Che-mello L. Performance and utility of transient elastography and noninvasive markers of liver fibrosis in primary biliary cirrho-sis. Dig Liver Dis 2011; 43(11): 887−92.

Corpechot C, Carrat F, Poujol-Robert A, Gaouar F, Wendum D, Chazouillères O, et al. Noninvasive elastography-based assess-ment of liver fibrosis progression and prognosis in primary bi-liary cirrhosis. Hepatology 2012; 56(1): 198−208.

Friedrich-Rust M, Müller C, Winckler A, Kriener S, Herrmann E, Holtmeier J, et al. Assessment of liver fibrosis and steatosis in PBC with FibroScan, MRI, MR-spectroscopy, and serum markers. J Clin Gastroenterol 2010; 44(1): 58−65.

Forns X, Ampurdanès S, Llovet JM, Aponte J, Quintó L, Martínez-Bauer E, et al. Identification of chronic hepatitis C patients without hepatic fibrosis by a simple predictive model. Hepa-tology 2002; 36(4 Pt 1): 986−92.

Alempijevic T, Krstic M, Jesic R, Jovanovic I, Sokic-Milutinovic A, Kovacevic N, et al. Biochemical markers for non-invasive assess-ment of disease stage in patients with primary biliary cirrhosis. World J Gastroenterol 2009; 15(5): 591−4.

Färkkilä M, Rautiainen H, Kärkkäinen P, Karvonen AL, Nurmi H, Niemelä O. Serological markers for monitoring disease progression in noncirrhotic primary biliary cirrhosis on ursodeoxycholic acid therapy. Liver Int 2008; 28(6): 787−97.

Obara N, Ueno Y, Fukushima K, Nakagome Y, Kakazu E, Kimura O, et al. Transient elastography for measurement of liver stiff-ness measurement can detect early significant hepatic fibrosis in Japanese patients with viral and nonviral liver diseases. J Gastroenterol 2008; 43(9): 720−8.

Ma JL, Wang R, Zhang FK, Jia JD, Ou XJ, Zhang T, et al. A noninvasive diagnostic model of liver fibrosis using serum markers in primary biliary cirrhosis. Zhonghua Nei Ke Za Zhi 2012; 51(8): 618−22. (Chinese)

Talwalkar JA, Kurtz DM, Schoenleber SJ, West CP, Montori VM. Ultrasound-based transient elastography for the detection of hepatic fibrosis: systematic review and meta-analysis. Clin Ga-stroenterol Hepatol 2007; 5(10): 1214−20.

Stebbing J, Farouk L, Panos G, Anderson M, Jiao LR, Mandalia S, et al. A meta-analysis of transient elastography for the detec-tion of hepatic fibrosis. J Clin Gastroenterol 2010; 44(3): 214−9.

Tsochatzis EA, Gurusamy KS, Ntaoula S, Cholongitas E, Davidson BR, Burroughs AK. Elastography for the diagnosis of severity of fibrosis in chronic liver disease: A meta analysis of diagnostic accuracy. J Hepatol 2011; 54(4): 650−9.

Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology 2003; 38(2): 518−26.

Objavljeno
2020/12/01
Broj časopisa
Vol. 75 Br. 4 (2018): Vojnosanitetski pregled
Rubrika
Originalni članak