Utilidade da elastografia hepática transitória (FibroScan®) na cirrose hepática

R. Marinho*, F. Serejo*, J. Velosa*, M. Carneiro de Moura*

 

Resumo

Introdução: A elastografia hepática transitória (Fibro-Scan®), é um sistema de ultrasons não invasivo que avalia a fibrose hepática. Objectivo: Avaliar a utilidade do FibroScan® no diagnóstico de cirrose. Métodos: A elastografia (Kilopascals, kPa) realizou-se em 120 doentes: 61 com cirrose de diversas etiologias (31 com cirrose VHC) e 59 sem cirrose (55 com hepatite C crónica) e em 25 controlos. Resultados: A mediana na cirrose foi 16,9 kPa (4,5 - 70,5), naqueles sem cirrose 5,8 kPa (3,8 - 19,6), p < 0,05. Os valores mais altos foram encontrados naqueles com mais de um factor etiológico (VHB, VHC, etanol, VIH), 57 kPa (7,7 - 75) comparativamente com aqueles com apenas um factor, 14 kPa (4,5 - 46,4), p < 0,001. A mediana na cirrose VHC foi 17,1 kPa (6,0 - 40,3), na VHB 13,1 kPa (7,4 - 19,8) e na alcoólica 13,4 kPa (6,8 - 35,8), P = NS. Para um cut-off de 12 kPa a sensibilidade foi 64%, especificidade 98%, o valor predizente positivo 98% (VPP) e o valor predizente negativo 73%, AUROC 0,93. Conclusões: O FibroScan® é um exame não invasivo com utilidade diagnóstica na cirrose. Para valores superiores a 12 kPa o FibroScan® tem um VPP e uma especificidade muito elevados.

 

Clinical usefulness of transitory hepatic elastography (FibroScan®) in the diagnosis of cirrhosis

Summary

Introduction: FibroScan®, is a non-invasive ultrasound device used to quantify liver fibrosis. Aims:Assess clinical usefulness of the FibroScan® in the diagnosis of cirrhosis. Methods: The FibroScan® was performed (kilopascals, kPa) on 120 patients, all with a liver biopsy: 61 with liver cirrhosis of diverse etiologies (31 hepatitis C) and 59 without cirrhosis (55 with chronic hepatitis C). Results: The median in cirrhosis was 16.9 kPa (4.5 - 70.5), and in those without cirrhosis 5.8 kPa (3.8 - 19.6), p < 0,05. The highest values in patients with cirrhosis were found in those with combined causes for liver disease such as hepatitis B, hepatitis C, alcohol, HIV: 57 kPa (7.7 - 75) compared to those with one only factor, 14 kPa (4.5 - 46.4), p <0.001. The median was not different between the different causes of liver cirrhosis. For a cut-off level of 12 kPa and considering all causes of cirrhosis, the sensitivity was 64%, specificity 98%, positive predictive value (PPV) 98% and negative predictive value (NPV) 73%, AUROC 0.93. Conclusions: FibroScan® is a clinically useful non-invasive tool in the assessment of liver cirrhosis. For a cut-off level of 12 kPa the PPV and the specificity were very high.

 

 

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Correspondência:

Rui Tato Marinho

Av. Prof. Egas Moniz

1600 Lisboa, Portugal

Tel.: 916984040

E-mail: rui.marinho@mail.telepac.pt

 

* Serviço de Gastrenterologia e Hepatologia, Hospital Santa Maria de Lisboa, Faculdade de Medicina de Lisboa, Instituto de Medicina Molecular, Lisboa, Portugal.

 

Recebido para publicação: 12/01/2007

Aceite para publicação: 22/01/2007