Navegando por Palavras-chave "Hepatic fibrosis"

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    Association between age at diagnosis and degree of liver injury in hepatitis C
    (Brazilian Society of Infectious Diseases, 2014-09-01) Oliveira, Ana Claudia de [UNIFESP]; Bortotti, Ana Clara; Nunes, Nathália Neves; Bacha, Ibrahin Ahmad Hussein El [UNIFESP]; Parise, Edison Roberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal de São Carlos (UFSCar) Department of Medicine
    Introduction: A population-based survey conducted in Brazilian capital cities found that only 16% of the population had ever been tested for hepatitis C. These data suggest that much of the Brazilian population with HCV infection remains undiagnosed. The distribution of age ranges at diagnosis and its association with the degree of hepatitis C are still unknown in Brazilian patients. Material and methods: Patients with HCV infection, diagnosed by HCV RNA (Amplicor-HCV, Roche), were included in the study. Patients with HBV or HIV coinfection, autoimmune diseases, or alcohol intake > 20 g/day were excluded. HCV genotyping was performed by sequence analysis, and viral load by quantitative RT-PCR (Amplicor, Roche). The METAVIR classification was used to assess structural liver injury. The Chi-square (χ2) test and student's t-test were used for between-group comparisons. Spearman's rank correlation coefficient were used for analysing the correlation between parameters. Results: A total of 525 charts were reviewed. Of the patients included, 49.5% were male, only 10% of the patients were aged less than 30 years; peak prevalence of HCV infection occurred in the 51-to-60 years age range. Genotype 1 accounted for 65.4% of the cases. Information on HCV subtype was obtained in 227 patients; 105 had subtype 1a and 122 had 1b. According to the degree of structural liver injury, 8.3% had F0, 23.4% F1, 19.8% F2, 11.9% F3, and 36.5% F4. Age at diagnosis of hepatitis correlated significantly with fibrosis (rs = 0.307, p < 0.001). The degree of fibrosis increased with advancing age. Only age at diagnosis and fasting blood glucose were independently associated with disease stage. Those patients with subtype 1a had higher prevalence of F2–F4 than those with subtype 1b. Conclusion: In Brazil, diagnosis of hepatitis C is more commonly established in older patients (age 45–60 years) with more advanced disease. Reassessment of strategies for hepatitis C diagnosis in the country is required.
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    Os níveis séricos de calicreína plasmática e catepsina B estão associados com à fibrose hepática em pacientes com hepatite c crônica
    (Universidade Federal de São Paulo (UNIFESP), 2018-06-28) Zanelatto, Alexia de Cassia Oliveira [UNIFESP]; Tersariol, Ivarne Luis dos Santos [UNIFESP]; http://lattes.cnpq.br/4859954582615304; http://lattes.cnpq.br/6267588099859327; Universidade Federal de São Paulo (UNIFESP)
    Introduction. Hepatitis C Virus (Hcv) Is One Of The Leading Causes Of Chronic Liver Disease Worldwide, Where 85% Of Those Infected Have Some Degree Of Liver Fibrosis. Transforming Growth Factor-Beta 1 (Tgf-"1) Plays An Important Role In The Proliferation And Activation Of Hepatic Stellate Cells (Hsc) In The Process Of Inducing Liver Fibrosis. Cathepsin B (Cat B) And Plasma Kallikrein (Plk) Are Enzymes That Can Proteolytically Activate The Latent Form Of Tgf-"1 During Hepatic Fibrosis Induced By Hcv Infection. The Severity Of Hepatic Fibrosis Determines The Prognosis And Treatment Of Patients With Chronic Hepatitis C (Hcc). Objectives. Verify Whether Serum Levels Of Cat B And Plk Correlated With The Severity Of Hepatic Inflammation And Fibrosis In Patients With Chc Before And After Treatment With Interferon " With Ribavirin, And Could Serve Introduction. Hepatitis C virus (HCV) is one of the leading causes of chronic liver disease worldwide, where 85% of those infected have some degree of liver fibrosis. Transforming growth factorbeta 1 (TGFβ1) plays an important role in the proliferation and activation of hepatic stellate cells (HSC) in the process of inducing liver fibrosis. Cathepsin B (Cat B) and plasma kallikrein (PLK) are enzymes that can proteolytically activate the latent form of TGFβ1 during hepatic fibrosis induced by HCV infection. The severity of hepatic fibrosis determines the prognosis and treatment of patients with chronic hepatitis C (HCC). Objectives. Verify whether serum levels of Cat B and PLK correlated with the severity of hepatic inflammation and fibrosis in patients with CHC before and after treatment with interferon α with ribavirin, and could serve as new noninvasive biomarkers for the diagnosis of hepatic fibrosis. Methodology. Serum levels of Cat B and PKL were classified in patients with CHC, according to the METAVIR (N = 53) table, as well as in blood donors without HCV (N = 70). The different laboratory data were correlated with each other and with Cat B and PKL measures, using Pearson's coefficient to evaluate parametric data and Spearman's coefficient for nonparametric data. The sensitivity, specificity and diagnostic accuracy of Cat B and PKL were evaluated by the ROC curve, these results were compared with the performance of noninvasive biomarkers APRI and FIB4. Also, Cat B and PKL values were correlated with sustained virological response (SVR) in patients receiving interferonα + ribavirin, all with histological assessment of hepatic fibrosis prior to treatment (METAVIR). Results. Serum levels of Cat B (3.61 ± 0.26 U/ml) and PKL (3.77 ± 0.24 U/ml) were significantly higher (P <0.0001) in subjects with hepatic fibrosis ≥ F2 when compared to healthy subjects without hepatic fibrosis (1.61 ± 0.06 U/ml). In addition, we found that levels of Cat B and PLK were gradually elevated according to the severity of the liver fibrosis score. Cat B levels correlated strongly with serum PLK levels in CHC patients (r = 0.953, CI95% = 0,916 0,974, P <0.0001). According to the area under the ROC curve, levels of Cat B (AUROC = 0.99 ± 0.01) and PKL (AUROC = 0.99 ± 0.01) were significantly higher than APRI (AUROC = 0, 71 ± 0.05) and FIB4 (AUROC = 0.67 ± 0.06) to predict initial hepatic fibrosis (≥ F2) in patients with HCC. The cutoff value established for serum levels of Cat B ≥ 2.61 U / mL identifies with high precision the presence of inflammation and hepatic fibrosis in the ≥ A1F2 score in patients with HCV, as well as serum levels of Cat B < 2.61 U/ml identified the absence of hepatic lesion in the population (Sensitivity = 96%, Specificity = 95%). The cutoff value for serum PKL ≥ 2.9 U/ml accurately identifies the presence of inflammation and hepatic fibrosis in the ≥ A1F2 score in patients with HCV, such as serum PKL <2.9 U/ml identified absence of hepatic fibrosis in the population (Sensitivity = 96%, Specificity = 98%). Furthermore, the high concentration of Cat B (> 3.3 U/ml) in the serum of patients with HCV is able to predict the failure of treatment with interferon α associated with ribavirin. Conclusion. Serum levels of Cat B and PKL can be used as reliable biomarkers for the prediction of initial inflammation and hepatic fibrosis (≥ A1F2) in patients with HCV, as well as being reliable for excluding the diagnosis of liver fibrosis in the population. Serum cathepsin B levels may aid in the prediction of successful treatment of patients with interferon α + ribavirin.
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    Serum laminin, type IV collagen and hyaluronan as fibrosis markers in non-alcoholic fatty liver disease
    (Associação Brasileira de Divulgação Científica, 2005-05-01) Santos, V.n. dos [UNIFESP]; Leite-Mór, Marilisa Moraes Barros [UNIFESP]; Kondo, Mario [UNIFESP]; Martins, J.r. [UNIFESP]; Nader, Helena Bonciani [UNIFESP]; Lanzoni, Valeria Pereira [UNIFESP]; Parise, Edison Roberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Hepatic fibrosis in patients with non-alcoholic fatty liver disease is associated with progression of the disease. In the present study, we analyzed the discriminative ability of serum laminin, type IV collagen and hyaluronan levels to predict the presence of fibrosis in these patients. In this preliminary report, we studied 30 overweight patients divided into two groups according to the absence (group I, N = 19) or presence (group II, N = 11) of fibrosis in a liver biopsy. Triglycerides, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyltranspeptidade, hyaluronan (noncompetitive fluoroassay), type IV collagen, and laminin (ELISA) were determined. Group II presented significantly higher mean laminin, hyaluronan, type IV collagen, and aspartate aminotransferase values, which were due to the correlation between these parameters and the stage of fibrosis in the biopsy (Spearman's correlation coefficient, rS = 0.65, 0.62, 0.53, and 0.49, respectively). Analysis of the ROC curve showed that laminin values >282 ng/ml were those with the best diagnostic performance, with 87% accuracy. Association of laminin with type IV collagen showed improvement in the positive predictive value (100%), but with reduction in diagnostic sensitivity (64%). When compared with the criteria of Ratziu et al. [Gastroenterology (2000) 118: 1117-1123] for the diagnosis of septal fibrosis, laminin values presented a better diagnostic accuracy (83 vs 70%). Determination of extracellular matrix components in serum, especially of laminin, may identify patients with non-alcoholic fatty liver disease and fibrosis and these components may be used as indicators for liver biopsy in these patients.
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    Valor preditivo de marcadores séricos de fibrose hepática em pacientes portadores de hepatite crônica viral C
    (Sociedade Brasileira de Patologia ClínicaSociedade Brasileira de PatologiaSociedade Brasileira de Citopatologia, 2008-06-01) Lima, Leila Maria Soares Tojal de Barros [UNIFESP]; Martins, João Roberto Maciel [UNIFESP]; Nader, Helena Bonciani [UNIFESP]; Lacet, Celina Maria Costa; Balwani, Maria Do Carmo Lins Vasconcelos; Pinhal, Maria Aparecida da Silva [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal de Alagoas Hospital Universitário; Fundação Universitária de Ciências da Saúde de Alagoas Governador Lamenha Filho; UFAL HU
    INTRODUCTION: Serum markers have been used in the assessment of liver fibrosis in patients with chronic hepatitis C (CHC). AIMS: We evaluated the capacity of aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio, gama-glutamyltransferase (GGT) levels, platelet count, the AST to platelet ratio index (APRI) and serum hyaluronic acid (HA) to predict the intensity of hepatic fibrosis in patients with CHC and the variation of these markers after therapy with interferon. PATIENTS AND METHODS: In 72 patients with hepatitis C, AST/ALT ratio, GGT levels, platelet count, the APRI index (calculated as the ratio of AST to platelets) and serum HA concentration were determined and compared to histological staging according to the scoring system of METAVIR. Sixty-five patients received interferon and ribavirin therapy. The individuals that completed the treatment (n = 33) underwent a new test for serum marker of fibrosis in order to compare it with pre-treatment levels. RESULTS: GGT levels, platelet count, the APRI index and serum HA were correlated with the stage of hepatic fibrosis (p < 0.01), except AST/ALT ratio. The analysis of the areas under the ROC curve (AUC) evidenced that APRI and HA levels were the markers with the best association with hepatic staging: AUC (APRI) = 0.85 and AUC (HA) = 0.86. After therapy with interferon, only GGT and the APRI showed reduction of their levels (p < 0.05). CONCLUSION: HA and the APRI index were the most accurate approaches to liver fibrosis staging and they may be used as alternative diagnostic methods in patients with CHC.