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

Resumo

A biopsia hepática é o melhor método para avaliar a fibrose, mas é invasivo e não isento de complicações. Objectivos: Verificar o interesse da elastografia hepática transitória na monitorização da gravidade histológica em doentes com hepatite C crónica. Métodos: Foram estudados 214 doentes com hepatite C crónica, 134 homens e 70 mulheres, idade média 47,4 ± 11,6 anos e 26 indivíduos considerados saudáveis, com provas hepáticas normais, serviram de controlos. Nas biopsias hepáticas foi utilizado o Índice de Actividade Histológico (IAH) de Knodell / Peter Scheuer: 154 com estádio F0/F2; 50 com F3/F4. O valor normal da elastografia hepática transitória (Fibroscan®, Echosens, Paris, França) foi de 4,5 kPa (3,30 - 5,69). Resultados: A elastografia hepática diferenciou os diversos estádios de fibrose: 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; na cirrose hepática (F4) - 13.75 kPa (11,44-27,05), p =0,001.Utilizando as curvas de ROC foram optimizados os pontos de corte para diferenciar os estádios de fibrose em 60 doentes com biopsia hepática concomitante e com mais de 10 espaços porta estudados: F≥2 - 5,43 (AUC- 0,79; Se- 0,78; esp- 0,67; VPP- 0,98; VPN- 0,25); F≥3 - 8,18 (AUC- 0,96; se- 0,95; esp- 0,93; VPP- 0,87; VPN- 0,97); F4- 10,08 (AUC- 0,98; se- 0,93; esp- 0,93; VPP- 0,82; VPN- 0,98). Verificou-se uma correlação significativa entre a elastografia hepática e o IAH (P <0,003), assim como com a fibrose (p <0,0005), mas não com a actividade inflamatória (p =0,28). Por análise multivariada confirmou-se uma relação entre a elastografia hepática e a idade do doente (p =0,009) e o valor do ferro sérico (p =0,035). Conclusões: A elastografia hepática revelou-se eficaz na detecção de fibrose hepática significativa e para o diagnóstico de cirrose. Verificou-se uma relação entre este meio de diagnóstico a idade do doente e o ferro sérico, parâmetros associados à progressão da doença. Como método não invasivo fácil de executar, rápido e reprodutível é útil para o seguimento dos doentes com hepatite C crónica com o objectivo de avaliar a gravidade da fibrose hepática.

Transitory hepatic elastography. A non invasive method to evaluate fibrosis in chronic HCV patients

Summary

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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Correspondência:

Fátima Serejo

Rua Henrique António da Mota, 27 - 3º Dto.

2775-700 Carcavelos

Tel.: 214570665

Fax: 214570665

e-mail: fátima_serejo@netcabo.pt

Recebido para publicação: 12/01/2007

Aceite para publicação: 22/01/2007