Abstract
INTRODUCAO: Os marcadores sericos tem sido empregados na avaliacao da fibrose hepatica em pacientes portadores de hepatite cronica C (HCC). OBJETIVOS: Avaliar a capacidade do indice aspartato aminotransferase (AST)/alanina aminotransferase (ALT), dos niveis sericos de gama-glutamiltransferase (GGT), contagem de plaquetas, do indice AST/plaquetas (APRI) e do acido hialuronico (AH) em predizer a intensidade da fibrose hepatica na HCC e a variacao desses marcadores apos tratamento com interferon. PACIENTES E METODOS: Em 72 pacientes portadores de hepatite C determinamos no soro o indice AST/ALT, GGT, plaquetas, indice APRI (obtido pelo quociente AST/plaquetas) e o AH, que foram comparados ao estadiamento histologico, segundo os criterios de METAVIR. Receberam tratamento com interferon e ribavirina 65 pacientes. Os individuos que concluiram o tratamento (n = 33) realizaram nova dosagem dos marcadores sericos de fibrose para comparar com os niveis pre-tratamento. RESULTADOS: Observamos que a GGT, a contagem de plaquetas, o indice APRI e o AH se correlacionaram com estadio de doenca hepatica (p < 0,01), exceto o indice AST/ALT. A analise das areas sob as curvas ROC (AUC) evidenciaram que a melhor associacao com estadiamento hepatico foi para o indice APRI e a dosagem serica do AH: AUC (APRI) = 0,85 e AUC (AH) = 0,86. Na avaliacao pos-terapia com interferon, apenas a GGT e o indice APRI apresentaram reducao de seus niveis (p < 0,05). CONCLUSAO: O AH e o indice APRI apresentaram maior acuracia no estadiamento da fibrose, podendo ser aplicados como metodos diagnosticos alternativos na HCC.
Highlights
Serum markers have been used in the assessment of liver fibrosis in patients with chronic hepatitis C (CHC)
We evaluated the capacity of aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio, gama-glutamyltransferase (GGT) levels, platelet count, the AST to platelet ratio index (APRI) and serum hyaluronic acid (HA) to predict the intensity of hepatic fibrosis in patients with CHC and the variation of these markers after therapy with interferon
Patients and methods: In 72 patients with hepatitis C, AST/ALT ratio, GGT levels, platelet count, the APRI index and serum HA concentration were determined and compared to histological staging according to the scoring system of METAVIR
Summary
Serum markers have been used in the assessment of liver fibrosis in patients with chronic hepatitis C (CHC). Aims: We evaluated the capacity of aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio, gama-glutamyltransferase (GGT) levels, platelet count, the AST to platelet ratio index (APRI) and serum hyaluronic acid (HA) to predict the intensity of hepatic fibrosis in patients with CHC and the variation of these markers after therapy with interferon. Patients and methods: In 72 patients with hepatitis C, AST/ALT ratio, GGT levels, platelet count, the APRI index (calculated as the ratio of AST to platelets) and serum HA concentration were determined and compared to histological staging according to the scoring system of METAVIR. Results: GGT levels, platelet count, the APRI index and serum HA were correlated with the stage of hepatic fibrosis (p < 0.01), except AST/ALT ratio. 26, 4) Recentemente, o índice APRI (obtido pelo quociente AST/plaquetas) tem sido aplicado devido a sua elevada acurácia como preditor da fibrose hepática nos portadores de HCC(21). O objetivo deste estudo foi avaliar o valor preditivo desses marcadores séricos de fibrose hepática em portadores de HCC e sua variação pós-terapia antiviral
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