Kronik hepatit C'li hastalarda karaciğer fibrozisini göstermede kullanılan biyokimyasal belirteçler ile karaciğer biyopsisinin tanısal değerliliklerinin karşılaştırılması
Özet
The aim of this study was to investigate three noninvasivetests for assessing liver fibrosis in treatment-naïve chronic hepatitisC and to compare results with those of liver biopsy. A total of 90 individualswith chronic hepatitis C were enrolled. APRI (AST-to-platelet ratio index),FibroTest (Biopredictive SAS, Paris, France), and FIB-4 calculation wereperformed on the same day as the liver biopsy. APRI was calculated as AST/ upper normal X 100 / platelets. FibroTest was calculated by using ?-glutamyltransferase, haptoglobin, ?2-macroglobulin, bilirubin, andapolipoprotein A1. FIB-4 calculated from the formula: age X AST / (plateletsX ALT1/2). All liver biopsies were analyzed by the same pathologist, andfibrosis was assessed using the METAVIR index. No/moderate fibrosis wasdefined METAVIR score 0-1-2 and severe fibrosis was defined as METAVIRscore of 3-4. Receiver operating characteristic (ROC) curves was used todescribe and compare the performance of diagnostics value of 3 methods.According to the METAVIR score, 64.4% of samples showed no/moderatefibrosis and the remaining 35.6% of samples showed severe fibrosis. APRIscores ranged from 0.1 to 4.0, FibroTest score ranged from 0.05 to 0.95, andFIB-4 values ranged from 0.19 to 13.5. Cut-off value to enable the correctidentification of samples with severe fibrosis was 0.97 with 56% sensitivityand 87% specificity for APRI, 0.44 with 90% sensitivity and 50% specificityfor FibroTest, and 1.9 with 84% sensitivity and 79% specificity for FIB-4.There were no significant difference between areas under the ROC curve forFibroTest and for APRI (p>0.05), for FIB-4 and for APRI (p>0.05), forFibrotest and for FIB-4 (p>0.05). The positive predictive value for extendedfibrosis for APRI was 72.0%, for FibroTest 50.0% and for FIB-4 69.2%. Thenegative predictive value for no fibrosis and/or moderate fibrosis was 78.4%for APRI, 90.6% for FibroTest, and 90.2% for FIB-4. Based on the results ofthis study, the three non-invasive tests (FibroTest, APRI and FIB4) aresimple, accurate and reasonable methods for assessing the liver fibrosis inindividuals with chronic hepatitis C.