Navegando por Palavras-chave "Liver Fibrosis"
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- ItemSomente MetadadadosAspectos evolutivos de pacientes hemofílicos infectados pelo vírus da hepatite C(Universidade Federal de São Paulo (UNIFESP), 2020-12-10) Bastos, Dauana Arruda De Oliveira [UNIFESP]; Ferraz, Maria Lucia Cardoso Gomes [UNIFESP]; Universidade Federal de São PauloIntroduction: The improvement in the treatment of hemophilia from the 90's, as well as the advent of interferon-free therapy against the hepatitis C virus (HCV) for infected patients, enabled a better evolution of these special group of patients. However, the impact of hemophilia on the progression of liver fibrosis is still not completely understood. Objectives: To evaluate the progression of liver fibrosis in hemophiliac patients with HCV using non-invasive methods, in viremic (HCV-RNA positive) and non-viremic (HCV-RNA negative) patients, after ten years of follow-up. Casuistic and Method: Retrospective cohort study of hemophiliac patients with HCV followed since 2007 in a single tertiary Hematology center and reassessed 10 years later (2017/2018), in relation to biochemical tests, hepatic fibrosis (APRI, FIB-4 and transient hepatic elastography by Fibroscan ® - EHT), performance and response to antiviral therapy and outcome. The comparative statistical analysis was performed using the Wilcoxon test and the global survival curve was constructed using the Kaplan-Meier method. Results: The group of 66 patients evaluated in 2007 were men, with a median age of 31.5 years and 58 patients (87.9%) with hemophilia A. In the year 2017/2018, 42 (63.7%) patients were on medical follow-up and composed the revaluation sample. Antiviral therapy was performed in 33/42 patients and 30 (90.9%) reached SVR; thus, 30 and 12 patients (3 without SVR and 9 untreated) were non-viremic and viremic in the reassessment, respectively. There was a significant reduction in aminotransferases among the 30 non-viremic patients: AST (median 0.71 and 0.50, p <0.001), ALT (median 0.63 and 0.53, p = 0.026) and GGT (median 0.82 and 0.60, p = 0.004), between 2007 and 2017/2018, respectively. Also the APRI values showed a significant reduction (median of 0.36 and 0.20 in the two periods, p <0.001) only in the group without viremia. In relation to FIB-4, the values remained stable among patients with HCVRNA negative, and there was progression only among those with HCVRNA positive. Regarding the analysis of fibrosis by EHT, 8/33 treated patients (7 with SVR) performed it in the pre and post-treatment periods. There was a significant reduction in liver stiffness values in the post-treatment period (median from 7.9 kPa to 3.2 kPa, p = 0.018) among non-viremic patients. For the remaining 25/33 patients, the analysis of fibrosis by EHT was performed on a single occasion, and when done before treatment or in untreated patients, it showed few patients with advanced degrees of fibrosis. Regarding the outcome, the average cumulative overall survival of the 66 patients in the study, since the diagnosis of HCV infection, was 23.02 years (95% CI 24.49; 27.53). Conclusions: The results suggest a slower progression and a more benign evolution of hepatic fibrosis among hemophilics, with a different prognosis in relation to non-hemophiliac patients.Antiviral therapy against HCV showed an elevated response rate, similar to the general population.
- ItemSomente MetadadadosAvaliação da evolução da Fibrose Hepática em pacientes cirróticos com resposta virológica sustentada após tratamento de Hepatite C crônica(Universidade Federal de São Paulo (UNIFESP), 2019-09-11) Campos, Antonio Guelfer Saraiva [UNIFESP]; Ferraz, Maria Lucia Cardoso Gomes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background The advent of chronic hepatitis C therapy with direct acting antiviral agents (DAAs) without interferon made possible a cure rate in more than 90% of the infected patients and allowed the evaluation, through noninvasive measures, of changes in the stage disease and the development or resolution of hepatic complications. The objective of this study was to evaluate the evolution of hepatic fibrosis in cirrhotic patients with sustained virological response (SVR) after treatment of chronic hepatitis C with DAAs and to correlate the evolution pattern of hepatic fibrosis with clinical, laboratory and histological variables. Casuistic and Method: A total of 113 cirrhotic patients from the Hepatitis Division of the Federal University of Sao Paulo, treated between January 2016 and December 2017, were included. Non-invasive methods, APRI, FIB-4 and hepatic stiffness were measured using transient elastography (TE) before and after treatment. Results: The APRI and FIB-4 values showed a significant decrease in the comparison before and after treatment. APRI ranged from 2.52 (0.52 - 20.7) to 0.74 (0.24 - 3.82) post-treatment, (P <0.001). Likewise, FIB-4 showed improvement in the indexes, with FIB-4 from 5.71 (1.17 - 23.36) to 3.94 (0.83 - 16.46) post-treatment (P <0.001). In 52 /113 patients, TE was performed before and after treatment. The results showed a median pre-treatment of 21.65 kPa (8.3-48.8) with a significant reduction to 17.6 (5.3-88.0) after SVR (P<0.001). The laboratory parameters ALT, AST albumin and platelets also significatively improved after SVR. The stage of fibrosis assessed by hepatic elastography after a mean period of 14.6 ± 4.4 months, was maintained in 33/52 (63.5%) patients and there was improvement of the stage in 19/52 (36.5%). The absence of improvement in the stage of fibrosis was associated with the presence of portal hypertension (esophageal varices, splenomegaly and platelet count).Conclusions: In patients with hepatic cirrhosis due to hepatitis C, non-invasive fibrosis scores, APRI, FIB-4 and transient elastography obtained significant improvement after sustained virological response with direct-acting antiviral therapy. Improvement of these scores is probably a combination of resolution of hepatic inflammation as well as regression of liver fibrosis. In the presence of portal hypertension, the improvement in the stage of fibrosis in improbable.
- ItemAcesso aberto (Open Access)Avaliação da Fibrose Hepática por Elastografia nos pacientes portadores de Esquistossomose Mansônica(Universidade Federal de São Paulo (UNIFESP), 2019-06-11) Lima, Leila Maria Soares Tojal De Barros [UNIFESP]; Parise, Edison Roberto [UNIFESP]; Lacet, Celina Maria Costa [UNIFESP]; http://lattes.cnpq.br/2511547113985954; http://lattes.cnpq.br/8624120197731317; Universidade Federal de São Paulo (UNIFESP)Introduction: Schistosomiasis persists as an important public health problem. Its main pathogenic event is hepatic fibrosis, associated with disease progression and its prognosis. The applicability of hepatic elastography in the evaluation of schistosomal fibrosis remains undefined. Objectives: To correlate the degree of fibrosis obtained by transient liver elastography (TE) with sonographic graduation and clinical forms of patients with schistosomiasis mansoni (SM). Methods: A cross sectional study with prospective inclusion of patients with SM, in all its forms, coming from the hepatology outpatient clinic of the University Hospital of the Federal University of Alagoas and from active search in Alagoas municipalities with high endemicity. Clinical and laboratory characteristics (clinical form, AST dosage, ALT, gammaGT, alkaline phosphatase and platelet count) were evaluated. The patients were classified according to the degree of hepatic fibrosis of the Niamey sonographic protocol, adopted by the World Health Organization, gold standard in this study. The TE, performed with FIBROSCAN ECHOSENS 502 device, was correlated with sonographic findings and its performance was calculated as area under the ROC curve (AUC). Results: A total of 117 patients with schistosomiasis mansoni, 55.6% female and 44.4% male, with mean age of 47 + 15 years were studied, 37 patients with intestinal forms, 12 with hepatointestinal form and 68 with compensated hepatosplenic form. Applying the Niamey sonographic protocol, the patients were regrouped for a better statistical analysis in absent fibrosis (A) 34.2%, mild to moderate fibrosis (MM) 27.4% and intense fibrosis (I) 38.5% of the sample. The median value of TE in the entire study population was 8.0 kPa; in the hepatointestinal form 4.4 kPa, in the hepatointestinal form 5.8 kPa and in the hepatosplenic form 10.6 kPa, with statistical differentiation between the clinical forms (p<0.01). In the correlation between TE and ultrasonography (US), patients in group A presented a median of 4.7 kPa; group MM 9.3 kPa and group I 10.3 kPa. There was a significant difference in TE values between groups A and MM and between groups A and I (p <0.05). TE was not able to differentiate patients from the MM and I groups. In the bivariate analysis between the markers of fibrosis and the clinical and laboratory characteristics, the TE and the sonographic classification of Niamey showed a strong and direct correlation with the clinical form (r>=0.77) and moderate and direct with the levels of AST and GGT (0.45<=r<=0.56). The cut-off point of TE to define the presence of fibrosis according to the sonographic classification that presented the best sensitivity and specificity ratio was 6.1 kPa (AUC 0.92) and for advanced fibrosis 8.9 kPa (AUC 0.791). Conclusions: The TE had a direct correlation with the sonographic classification of Niamey and was able to differentiate the clinical forms of SM. Based on the AUC value, TE has proven to be effective in detecting the presence of schistosomiasis fibrosis and may assist in the identification of advanced forms of liver disease caused by Schistosoma mansoni.
- ItemSomente MetadadadosFibrose hepática e comprometimento neurológico em pacientes com Ataxia-telangiectasia: relação com resistência à insulina e inflamação(Universidade Federal de São Paulo (UNIFESP), 2021) Barreto, Talita Lemos Neves [UNIFESP]; Sarni, Roseli Oselka Saccardo [UNIFESP]; Universidade Federal de São PauloBackground: Ataxia-telangiectasia (A-T) is a DNA repair disorder characterized by alterations in several organs and systems. Advances in clinical protocols have resulted in increased survival of A-T patients, however disease progression is evident, mainly through metabolic and liver changes. Objective: Identify the frequency of significant liver fibrosis in A-T patients and verify the association with metabolic alterations and degree of ataxia. To assess the correlation between neurological features, nutritional status, and metabolic changes in A-T patients. Methods: Cross-sectional study that included 25 A-T patients aged between 5 and 31 years. Anthropometric data, liver, inflammatory, lipid metabolism and glucose biomarkers (oral glucose tolerance test with insulin curve - OGTT) were collected. The Cooperative Ataxia Rating Scale (ICARS) and Assessment and Rating of Ataxia (SARA) were applied to assess the degree of ataxia. The following were calculated: Homeostasis Model Assessment - Insulin Resistance (HOMA-IR), Homeostasis Model Assessment - Adiponectin (HOMA-AD), Matsuda index, aspartate aminotransferase (AST): platelet ratio index (APRI), nonalcoholic fatty liver disease fibrosis score (NFS) and BARD score. Liver ultrasonography and transient liver elastography (EHT) by FibroScan® were performed. Patients who presented values ≥7 kPa or changes in the APRI index and one of the scores (NFS or BARD) simultaneously were considered as suggestive of significant liver fibrosis. Results: The following were observed: dyslipidemia in 16/25 (64%), diabetes in 4/22 (18%), insulin resistance in 5/17 (29%), liver steatosis in 13/20 (65%) and suggestive of significant liver fibrosis in 5/25 (20%). Patients in the group with suggestive of significant liver fibrosis were older (p<0.001), they were lower values of platelet (p=0.027), albumin (p=0.019), HDL-c (p=0.013), and Matsuda index (p=0.044); and high values of LDL-c (p=0.049), AST (p=0.001), alanine aminotransferase (p=0.002), gamma glutamyl transferase (p=0.001), ferritin (p=0.001), blood glucose in 120 minutes in the OGTT (p=0.049), HOMA-AD (p=0.016), and degree of ataxia (p=0.009). Significant correlations were found between the scores on the ICARS scale and age (rho = 0.748; p <0.001), GGT (rho = 0.743; p <0.001), insulin levels (rho = 0.520; p = 0.016) and the Homeostasis Model Assessment for Insulin Resistance index (HOMA-IR) (rho = 0.585; p = 0.005) as well as the scores on the SARA scale and age (rho = 0.704; p <0.001), GGT (rho = 0.701; p <0.001), insulin levels (rho = 0.706; p <0.001) and HOMA-IR index (rho = 0.764; p <0.001). Conclusion: It was found suggestive of significant liver fibrosis in 20% of A-T patients, which was associated with the degree of ataxia and higher values of liver biomarkers, LDL-c, ferritin, HOMA-AD compared to A-T patients without liver fibrosis. The relevant correlation between severity of ataxia and disease progression with metabolic changes such as liver function impairment and insulin resistance reinforce the importance to monitoring metabolic changes and evaluate nutritional status in these patients.
- ItemSomente MetadadadosTransient elastography and apri score: looking at false positives and false negatives. Diagnostic performance and association to fibrosis staging in chronic hepatitis c(Hindawi Ltd, 2016) Mendes, L. C.; Ferreira, P. A. [UNIFESP]; Miotto, N.; Zanaga, L.; Goncales, E.; Lazarini, M. S.; Goncales Junior, F. L.; Stucchi, R. S. B.; Vigani, A. G.Although long regarded as the gold standard for liver fibrosis staging in chronic hepatitis C (CHC), liver biopsy (LB) implies both the risk of an invasive procedure and significant variability. The aim of this study was to evaluate the diagnostic performance for transient elastography (TE) and aspartate aminotransferase to platelet index (APRI) used alone and in combination compared to liver biopsy and to analyze false positive/negative results. Patients with CHC, and no previous clinical diagnosis of cirrhosis were enrolled to undergo liver biopsy, TE and APRI. A total of 182 adult patients with a median age of 55 years and median body mass index of 26.71 kg/m(2) were analyzed. On LB, 56% of patients had significant levels of fibrosis (METAVIR F >= 2) and 28% had advanced fibrosis (F3/F4). The strongest performance for both tests was observed for exclusion of advanced fibrosis with good negative predictive values (89 and 86%, respectively). Low necroinflammatory activity on LB was associated with false negative TE. False positives were associated with NASH and smaller LB fragments. Correlation between APRI and Fibroscan for F >= 2 was 100% and 84% for F >= 3 and remained high in both false negative and false positive instances, correctly identifying F < 2 in 71% of cases and F < 3 in 78% (and potentially foregoing up to 84% of LB). We concluded that low individual performance indicators could be attributable to limitations of LB. Poorer differentiation of lower levels of fibrosis is a known issue for LB and remains so for noninvasive tests. Good predictability is possible, however, for advanced fibrosis.
- ItemSomente MetadadadosValor da elastografia hepática transitória isoladamente ou em associação a biomarcadores no estadiamento da doença hepática gordurosa não alcoólica(Universidade Federal de São Paulo (UNIFESP), 2019-09-26) Sammarco, Glauco Najas [UNIFESP]; Parise, Edison Roberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: The prevalence of non-alcoholic fatty liver disease (NAFLD) has significantly increased in the world, affecting up to 30% of the Western population. It is associated with hepatic and systemic complications, determining worse prognosis and higher mortality. Many non-invasive models for evaluation of hepatic fibrosis have been studied, with particular role in screening patients at risk for more advanced disease and unfavorable outcome. Objectives: To evaluate the diagnostic accuracy of transient elastography (TE), singly and in association with other non-invasive tests obtained through routine laboratory tests, in predicting liver fibrosis, having as standard reference the histological staging. Methods: An accuracy study was performed with patients with a histological diagnosis of NAFLD. The areas under receiver operating characteristics curves (AUROC) of Fibrosis-4 index (FIB-4), NAFLD fibrosis score (NFS) e TE (by FibroScan®) were compared for significant (≥ F2) and advanced (F3-F4) fibrosis, singly and serial combined each other. Results: The prevalence of significant and advanced fibrosis was 33,6% and 18,7%, respectively. The AUROC for significant fibrosis for TE, FIB-4 and NFS was 0,853, 0,729 e 0,639, respectively. For advanced fibrosis, the AUROC for TE, FIB-4 and NFS was 0,893, 0,810 e 0,746, respectively. The TE presented negative predictive value (NPV) of 84%, positive predictive value (PPV) of 90,6% for significant fibrosis diagnosis. For advanced fibrosis diagnosis, the TE showed NPV of 96%, PPV of 65,6% and high identification rate of sick individuals (84%). The serial combination generated accuracy ranging from 82,8% to 88% and identification rate of sick individuals ranging from 57% to 80%. Conclusions: The TE presented the better performance for advanced and significant fibrosis diagnostic in NAFLD than the other studied models. The methods association, in this study, did not increased diagnostic performance regarding the singly TE to significant or advanced fibrosis detection in NAFLD patients.