Navegando por Palavras-chave "Transient Elastography"

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    Avaliação 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.
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    Transient 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.