Araştırma Makalesi
Yıl 2025,
Cilt: 64 Sayı: 2, 274 - 282, 10.06.2025
Öz
Amaç: Karaciğer biyopsisi, siroz tanısında altın standart yöntem olmasına rağmen invazif olması, nadir ancak yaşamı tehdit edici komplikasyonlara neden olması gibi bazı sınırlılıkları bulunmaktadır. Karaciğer biyopsisinin bu sınırlılıkları siroz tanısında kullanılabilecek invazif olmayan yöntemlerin geliştirilmesini gerektirmektedir. Bu invazif olmayan yöntemler arasında aspartat transaminazın platelete oranı (APRI) ve dört faktörü temel alan fibrozis indeksi (FIB-4) kronik hepatit B (HBV) ve C (HCV) hastalarında fibrozis ve sirozun tanımlanmasında sık tercih edilmektedir.
Gereç ve Yöntem: Bu çalışmanın amacı çeşitli etiyolojilerdeki kronik karaciğer hastalarında APRI ve FIB-4’ün sirozun tahmin edilmesindeki performansını değerlendirmektir. Çalışmamızda klinik pratikte kullanım için yüksek sensitivite ve spesifitede yeni eşik değerler oluşturmak için kronik karaciğer hastalarında APRI ve FIB-4’ün yeni eşik değerleri analiz ettik.
Bulgular: Çalışmamızda ROC analizlerinde, siroz tanısı için optimal eşik değerin APRI için 1,32, FIB-4 için 4,24 olduğu görüldü.
Sonuç: Bu invazif olmayan yöntemlerin daha sık kullanımı sirozun erken tanınmasını ve önemli komplikasyonları olan gereksiz biyopsilerin önlenmesini sağlayacaktır.
Anahtar Kelimeler
Kaynakça
- Forestier, J.B, Dumortier, J., Guillaud, O., Ecochard, M., Roman, S., Boillot, O., ve ark. Noninvasive diagnosis and prognosis of liver cirrhosis: a comparison of biological scores, elastometry, and metabolic liver function tests. Eur J Gastroenterol Hepatol. 2010;22(5):532-40.
- Arena U, Vizzutti F, Abraldes JG, Corti G, Stasi C, Moscarella S, ve ark. Reliability of transient elastography for the diagnosis of advanced fibrosis in chronic hepatitis C. Gut. 2008;57(9):1288-93.
- Kim WR, Berg T, Asselah T, Flisiak R, Fung S, Gordon SC, ve ark. Evaluation of APRI and FIB-4 scoring systems for non-invasive assessment of hepatic fibrosis in chronic hepatitis B patients. J Hepatol. 2016;64(4):773-80.
- Girleanu I, Trifan A, Singeap AM, Stoica OC, Cojocariu C, Stanciu C. Platelet Indices and Liver Fibrosis Evaluation in Chronic Hepatitis C. Rev Med Chir Soc Med Nat Iasi. 2016;120(1):55-61.
- Bruyn G, Graviss EA. A systematic review of the diagnostic accuracy of physical examination for the detection of cirrhosis. BMC Med Inform Decis Mak. 2001;1:6.
- Vallet-Pichard A, Mallet V, Nalpas B, Verkarre V, Nalpas A, Dhalluin-Venier V, ve ark. FIB-4: an inexpensive and accurate marker of fibrosis in HCV infection. comparison with liver biopsy and fibrotest. Hepatology. 2007;46(1):32-6.
- Li Y, Chen Y, Zhao Y. The Diagnostic Value of the FIB-4 Index for Staging Hepatitis B-Related Fibrosis: A Meta-Analysis. PLoS ONE. 2014;9(8):e105728.
- Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology. 2003;38(2):518-26.
- Wong S, Huynh D, Zhang F, Nguyen NQ. Use of aspartate aminotransferase to platelet ratio to reduce the need for FibroScan in the evaluation of liver fibrosis. World journal of hepatology. 2017;9(17):791-6.
- Li Q, Lu C, Li W, Huang Y, Chen L. Impact of age on the diagnostic performances and cut-offs of APRI and FIB-4 for significant fibrosis and cirrhosis in chronic hepatitis B. Oncotarget. 2017;8(28):45768-76.
- Lurie Y, Webb M, Cytter-Kuint R, Shteingart S, Lederkremer GZ. Non-invasive diagnosis of liver fibrosis and cirrhosis. World journal of gastroenterology. 2015;21(41):11567-83.
- Hui AY, Chan HL, Wong VW, Liew CT, Chim AM, Chan FK, ve ark. Identification of chronic hepatitis B patients without significant liver fibrosis by a simple noninvasive predictive model. The American journal of gastroenterology. 2005;100(3):616-23.
- Castera L, Negre I, Samii K, Buffet C. Pain experienced during percutaneous liver biopsy. Hepatology. 1999;30(6):1529-30.
- Lin CL, Liu CH, Wang CC, Liang CC, Su TH, Liu CJ, ve ark. Serum Biomarkers Predictive of Significant Fibrosis and Cirrhosis in Chronic Hepatitis B. Journal of clinical gastroenterology. 2015;49(8):705-13.
- Lin ZH, Xin YN, Dong QJ, Wang Q, Jiang XJ, Zhan SH, ve ark. Performance of the aspartate aminotransferase-to-platelet ratio index for the staging of hepatitis C-related fibrosis: an updated meta-analysis. Hepatology. 2011;53(3):726-36.
- Zhu X, Wang LC, Chen EQ, Chen XB, Chen LY, Liu L, ve ark. Prospective evaluation of FibroScan for the diagnosis of hepatic fibrosis compared with liver biopsy/AST platelet ratio index and FIB-4 in patients with chronic HBV infection. Digestive diseases and sciences. 2011;56(9):2742-9.
- Usluer G, Erben N, Aykin N, Dagli O, Aydogdu O, Barut S, et al. Comparison of non-invasive fibrosis markers and classical liver biopsy in chronic hepatitis C. European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology. 2012;31(8):1873-8.
- Zhang YF, Shi H, Chen LB, Xu QH. [Value of FIB-4 for the diagnosis of liver fibrosis in chronic hepatitis B]. Zhonghua shi yan he lin chuang bing du xue za zhi = Zhonghua shiyan he linchuang bingduxue zazhi = Chinese journal of experimental and clinical virology. 2010;24(3):215-7.
- Cheng J, Hou J, Ding H, Chen G, Xie Q, Wang Y, ve ark. Validation of Ten Noninvasive Diagnostic Models for Prediction of Liver Fibrosis in Patients with Chronic Hepatitis B. PLoS One. 2015;10(12):e0144425.
- Xiao G, Zhu F, Wang M, Zhang H, Ye D, Yang J, ve ark. Diagnostic accuracy of APRI and FIB-4 for predicting hepatitis B virus-related liver fibrosis accompanied with hepatocellular carcinoma. Digestive and Liver Disease. 2016;48(10):1220-6.
- Perazzo H, Pais R, Munteanu M, Ngo Y, Monneret D, Imbert-Bismut F, ve ark. Variability in definitions of transaminase upper limit of the normal impacts the APRI performance as a biomarker of fibrosis in patients with chronic hepatitis C: "APRI c'est fini ?". Clinics and research in hepatology and gastroenterology. 2014;38(4):432-9.
- Festi D, Schiumerini R, Marzi L, Di Biase AR, Mandolesi D, Montrone L, ve ark. Review article: the diagnosis of non-alcoholic fatty liver disease -- availability and accuracy of non-invasive methods. Alimentary pharmacology & therapeutics. 2013;37(4):392-400.
- Naveau S, Gaude G, Asnacios A, Agostini H, Abella A, Barri-Ova N, ve ark. Diagnostic and prognostic values of noninvasive biomarkers of fibrosis in patients with alcoholic liver disease. Hepatology. 2009;49(1):97-105.
- Chou R, Wasson N. Blood tests to diagnose fibrosis or cirrhosis in patients with chronic hepatitis C virus infection. Annals of internal medicine. 2013;159(5):372.
- Shah AG, Lydecker A, Murray K, Tetri BN, Contos MJ, Sanyal AJ. Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2009;7(10):1104-12.
- Younossi Z. M. Non-alcoholic fatty liver disease – A global public health perspective. J. Hepatol. 2019, 70, 531–544.
- Maurice J.; Manousou P. Non-alcoholic fatty liver disease. Clin. Med. 2018, 18, 245–250. 10.7861/clinmedicine.18-3-245.
- Winarto J., Song D.G., Pan C.H. The Role of Fucoxanthin in Non-Alcoholic Fatty Liver Disease. Int. J. Mol. Sci. 2023;24:8203.
- Schelbert S., Schindeldecker M., Drebber U., Witzel H.R., Weinmann A., Dries V., Schirmacher P., Roth W., Straub B.K. Lipid Droplet-Associated Proteins Perilipin 1 and 2: Molecular Markers of Steatosis and Microvesicular Steatotic Foci in Chronic Hepatitis C. Int. J. Mol. Sci. 2022;23:15456
- Kartasheva-Ebertz D., Gaston J., Lair-Mehiri L., Mottez E., Buivan T.-P., Massault P.-P., Scatton O., Gaujoux S., Vaillant J.-C., Pol S., et al. IL-17A in Human Liver: Significant Source of Inflammation and Trigger of Liver Fibrosis Initiation. Int. J. Mol. Sci. 2022;23:9773.
- Jastrzębska J., Daniel W.A. Cocaine-Induced Time-Dependent Alterations in Cytochrome P450 and Liver Function. Int. J. Mol. Sci. 2023;24:1632
Yıl 2025,
Cilt: 64 Sayı: 2, 274 - 282, 10.06.2025
Öz
AİM: Liver biopsy is the gold standard for the diagnosis of cirrhosis, but has limitations such as invasive procedure, high cost, risk of rare but potentially life-threatening complications. These limitations of liver biopsy promote the development of noninvasive methods for assessments of cirrhosis. Among this models, aspartate transaminase-to-platelet ratio index (APRI) and fibrosis index based on four factors (FIB-4) are commonly used for identifying liver fibrosis and cirrhosis in patients with chronic hepatitis B (HBV) and C virus (HCV) infection. The aim of this study was to evaluate the performance of APRI and FIB-4 to predict cirrhosis in chronic liver diseases of various etiologies.
MATERIAL AND METHOD: To propose a new set of cut-offs with high specificity and sensitivity for use in clinical practice, we evaluated new cut-offs of APRI and FIB-4 patients with chronic liver diseases.
FINDINGS: Based on ROC analysis, the optimal cut-offs were 1.32 for APRI, and 4.24 for FIB-4, for diagnosing cirrhosis in this study.
CONCLUSİON:The more frequent use of these non-invasive methods in clinical practice will lead to the early identification of cirrhosis, and prevent unnecessary biopsy with significant complications.
Anahtar Kelimeler
Kaynakça
- Forestier, J.B, Dumortier, J., Guillaud, O., Ecochard, M., Roman, S., Boillot, O., ve ark. Noninvasive diagnosis and prognosis of liver cirrhosis: a comparison of biological scores, elastometry, and metabolic liver function tests. Eur J Gastroenterol Hepatol. 2010;22(5):532-40.
- Arena U, Vizzutti F, Abraldes JG, Corti G, Stasi C, Moscarella S, ve ark. Reliability of transient elastography for the diagnosis of advanced fibrosis in chronic hepatitis C. Gut. 2008;57(9):1288-93.
- Kim WR, Berg T, Asselah T, Flisiak R, Fung S, Gordon SC, ve ark. Evaluation of APRI and FIB-4 scoring systems for non-invasive assessment of hepatic fibrosis in chronic hepatitis B patients. J Hepatol. 2016;64(4):773-80.
- Girleanu I, Trifan A, Singeap AM, Stoica OC, Cojocariu C, Stanciu C. Platelet Indices and Liver Fibrosis Evaluation in Chronic Hepatitis C. Rev Med Chir Soc Med Nat Iasi. 2016;120(1):55-61.
- Bruyn G, Graviss EA. A systematic review of the diagnostic accuracy of physical examination for the detection of cirrhosis. BMC Med Inform Decis Mak. 2001;1:6.
- Vallet-Pichard A, Mallet V, Nalpas B, Verkarre V, Nalpas A, Dhalluin-Venier V, ve ark. FIB-4: an inexpensive and accurate marker of fibrosis in HCV infection. comparison with liver biopsy and fibrotest. Hepatology. 2007;46(1):32-6.
- Li Y, Chen Y, Zhao Y. The Diagnostic Value of the FIB-4 Index for Staging Hepatitis B-Related Fibrosis: A Meta-Analysis. PLoS ONE. 2014;9(8):e105728.
- Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology. 2003;38(2):518-26.
- Wong S, Huynh D, Zhang F, Nguyen NQ. Use of aspartate aminotransferase to platelet ratio to reduce the need for FibroScan in the evaluation of liver fibrosis. World journal of hepatology. 2017;9(17):791-6.
- Li Q, Lu C, Li W, Huang Y, Chen L. Impact of age on the diagnostic performances and cut-offs of APRI and FIB-4 for significant fibrosis and cirrhosis in chronic hepatitis B. Oncotarget. 2017;8(28):45768-76.
- Lurie Y, Webb M, Cytter-Kuint R, Shteingart S, Lederkremer GZ. Non-invasive diagnosis of liver fibrosis and cirrhosis. World journal of gastroenterology. 2015;21(41):11567-83.
- Hui AY, Chan HL, Wong VW, Liew CT, Chim AM, Chan FK, ve ark. Identification of chronic hepatitis B patients without significant liver fibrosis by a simple noninvasive predictive model. The American journal of gastroenterology. 2005;100(3):616-23.
- Castera L, Negre I, Samii K, Buffet C. Pain experienced during percutaneous liver biopsy. Hepatology. 1999;30(6):1529-30.
- Lin CL, Liu CH, Wang CC, Liang CC, Su TH, Liu CJ, ve ark. Serum Biomarkers Predictive of Significant Fibrosis and Cirrhosis in Chronic Hepatitis B. Journal of clinical gastroenterology. 2015;49(8):705-13.
- Lin ZH, Xin YN, Dong QJ, Wang Q, Jiang XJ, Zhan SH, ve ark. Performance of the aspartate aminotransferase-to-platelet ratio index for the staging of hepatitis C-related fibrosis: an updated meta-analysis. Hepatology. 2011;53(3):726-36.
- Zhu X, Wang LC, Chen EQ, Chen XB, Chen LY, Liu L, ve ark. Prospective evaluation of FibroScan for the diagnosis of hepatic fibrosis compared with liver biopsy/AST platelet ratio index and FIB-4 in patients with chronic HBV infection. Digestive diseases and sciences. 2011;56(9):2742-9.
- Usluer G, Erben N, Aykin N, Dagli O, Aydogdu O, Barut S, et al. Comparison of non-invasive fibrosis markers and classical liver biopsy in chronic hepatitis C. European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology. 2012;31(8):1873-8.
- Zhang YF, Shi H, Chen LB, Xu QH. [Value of FIB-4 for the diagnosis of liver fibrosis in chronic hepatitis B]. Zhonghua shi yan he lin chuang bing du xue za zhi = Zhonghua shiyan he linchuang bingduxue zazhi = Chinese journal of experimental and clinical virology. 2010;24(3):215-7.
- Cheng J, Hou J, Ding H, Chen G, Xie Q, Wang Y, ve ark. Validation of Ten Noninvasive Diagnostic Models for Prediction of Liver Fibrosis in Patients with Chronic Hepatitis B. PLoS One. 2015;10(12):e0144425.
- Xiao G, Zhu F, Wang M, Zhang H, Ye D, Yang J, ve ark. Diagnostic accuracy of APRI and FIB-4 for predicting hepatitis B virus-related liver fibrosis accompanied with hepatocellular carcinoma. Digestive and Liver Disease. 2016;48(10):1220-6.
- Perazzo H, Pais R, Munteanu M, Ngo Y, Monneret D, Imbert-Bismut F, ve ark. Variability in definitions of transaminase upper limit of the normal impacts the APRI performance as a biomarker of fibrosis in patients with chronic hepatitis C: "APRI c'est fini ?". Clinics and research in hepatology and gastroenterology. 2014;38(4):432-9.
- Festi D, Schiumerini R, Marzi L, Di Biase AR, Mandolesi D, Montrone L, ve ark. Review article: the diagnosis of non-alcoholic fatty liver disease -- availability and accuracy of non-invasive methods. Alimentary pharmacology & therapeutics. 2013;37(4):392-400.
- Naveau S, Gaude G, Asnacios A, Agostini H, Abella A, Barri-Ova N, ve ark. Diagnostic and prognostic values of noninvasive biomarkers of fibrosis in patients with alcoholic liver disease. Hepatology. 2009;49(1):97-105.
- Chou R, Wasson N. Blood tests to diagnose fibrosis or cirrhosis in patients with chronic hepatitis C virus infection. Annals of internal medicine. 2013;159(5):372.
- Shah AG, Lydecker A, Murray K, Tetri BN, Contos MJ, Sanyal AJ. Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2009;7(10):1104-12.
- Younossi Z. M. Non-alcoholic fatty liver disease – A global public health perspective. J. Hepatol. 2019, 70, 531–544.
- Maurice J.; Manousou P. Non-alcoholic fatty liver disease. Clin. Med. 2018, 18, 245–250. 10.7861/clinmedicine.18-3-245.
- Winarto J., Song D.G., Pan C.H. The Role of Fucoxanthin in Non-Alcoholic Fatty Liver Disease. Int. J. Mol. Sci. 2023;24:8203.
- Schelbert S., Schindeldecker M., Drebber U., Witzel H.R., Weinmann A., Dries V., Schirmacher P., Roth W., Straub B.K. Lipid Droplet-Associated Proteins Perilipin 1 and 2: Molecular Markers of Steatosis and Microvesicular Steatotic Foci in Chronic Hepatitis C. Int. J. Mol. Sci. 2022;23:15456
- Kartasheva-Ebertz D., Gaston J., Lair-Mehiri L., Mottez E., Buivan T.-P., Massault P.-P., Scatton O., Gaujoux S., Vaillant J.-C., Pol S., et al. IL-17A in Human Liver: Significant Source of Inflammation and Trigger of Liver Fibrosis Initiation. Int. J. Mol. Sci. 2022;23:9773.
- Jastrzębska J., Daniel W.A. Cocaine-Induced Time-Dependent Alterations in Cytochrome P450 and Liver Function. Int. J. Mol. Sci. 2023;24:1632
Toplam 31 adet kaynakça vardır.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Gastroenteroloji ve Hepatoloji |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 10 Haziran 2025 |
| Gönderilme Tarihi | 23 Eylül 2024 |
| Kabul Tarihi | 17 Şubat 2025 |
| Yayımlandığı Sayı | Yıl 2025Cilt: 64 Sayı: 2 |
