Resumo

SEREJO, F. et al. Transitory hepatic elastography: A non invasive method to evaluate fibrosis in chronic HCV patients. J Port Gastrenterol. [online]. 2007, vol.14, n.1, pp.8-15. ISSN 0872-8178.

Liver biopsy is the current "gold standard" for evaluating liver fibrosis but it is an invasive procedure, unsuitable for monitoring disease progression. Aims: To evaluate the interest of hepatic elastography for assessment and monitoring of liver fibrosis in chronic HCV patients. Methods: 214 chronic hepatitis C patients, 134 male and 70 female, mean age 47.4 ± 11.6 years and 26 healthy individuals with normal liver function tests served as controls, were included in the study. Histological activity index (HAI) was graded according Knodell / Peter Scheuer: 154 patients F0/2; 50 patients F3/4. Liver stiffness was measured using Fibroscan® (Echosens, Paris, France). The median in 25 controls was 4.5 kPa (3.30 - 5.69) and was correlated with clinical and laboratorial data. Results: A significant correlation was found between liver stiffness and HAI (p< 0.003). Median liver stiffness was 12.55 kPa (9.10 - 16.24), and corresponded to the different stages: F0.1 - 4.92 kPa (4.21-6.17) vs F2.3.4 - 6.81 kPa (5.14- 15.95), P =0.006; F0.1.2 - 5.90 kPa (4.85 - 7.25) vs F3/F4 - 12.55 kPa (9.10-16.24), P =0.001. The median liver stiffness for detection of cirrhosis was 13.75 KPa (11.44-27.05), p=0.001. Optimal stiffness cut-off values for fibrosis stage assessment were determined by ROC curve analysis in 60 patients with concomitant liver biopsy specimens that contain more then 10 portal tracts. Optimized cut-off values: F≥ 2 - 5.43 (AUC- 0.79; Se- 0.78; sp- 0.67; PPV- 0.98; PNV-0.25); F≥3 - 8.18 (AUC- 0.96; se- 0.95; sp- 0.93; PPV- 0.87; PNV- 0.97); F4- 10.08 (AUC- 0.98; se- 0.93; sp- 0.93; PPV-0.82; PNV- 0.98). A significant correlation with liver stiffness was seen with age of the patient (p= 0.009) and serum iron levels (p =0.035) by multivariate analysis. Conclusions: These preliminary results suggest that Fibroscan® is able to differenciate between the different stages of fibrosis and correlates with other parameters of progressive liver fibrosis (age and iron). Being a non-invasive method, easy and quick to perform and providing reproducible results Fibroscan® may become a useful and reliable method for the follow-up of HCV patients.

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