RESUMO
INTRODUCTION AND OBJECTIVES: It has been proposed that non-invasive methods may replace liver biopsy for the diagnosis of tissue damage in patients with autoimmune liver disease (ALD). The aim of this study was to determine diagnostic performance and degree of concordance between the APRI index and liver biopsy for diagnosing cirrhosis in these patients. MATERIAL AND METHODS: In a cohort of patients with ALD, the value of the APRI index and liver biopsy results were determined according to the METAVIR score. The AUC and the degree of concordance between an APRI value >2 and a METAVIR score of F4 were evaluated as markers of liver cirrhosis, through a kappa statistic. RESULTS: In total, 70 patients (age 51 ± 13 years) were included. The most common autoimmune liver diseases were primary biliary cirrhosis (PBC) (40%), autoimmune hepatitis (AIH) (24.3%) and AIH-PBC overlap syndrome (32.9%). Cirrhosis was confirmed by biopsy in 16 patients (22.9%). 15 patients (21.4%) had an APRI index >2 (Cirrhosis) and only six met both criteria. The AUC of the APRI was 0.77 (95% CI 0.65-0.88). The degree of concordance between the tests was low for an APRI cut-off point >2 (kappa 0.213; 95% CI 0.094-0.332), as well as for cut-off points >1.5, >1 and >0.5 (kappa 0.213, 0.255, 0.257, respectively) CONCLUSION: Our results suggest that there is little concordance between APRI and liver biopsy for the diagnosis of cirrhosis in patients with ALD. It should therefore not be used as a single diagnostic method to determine cirrhosis.
Assuntos
Aspartato Aminotransferases/sangue , Doenças Autoimunes/patologia , Cirrose Hepática/sangue , Cirrose Hepática/patologia , Hepatopatias/sangue , Hepatopatias/imunologia , Hepatopatias/patologia , Fígado/patologia , Adulto , Biomarcadores/sangue , Biópsia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Estudos RetrospectivosRESUMO
Introducción: El espectro del compromiso hepático en la enfermedad celíaca es muy amplio e incluye hepatopatías virales y autoinmunes. Objetivo: Caracterizar el comportamiento de los marcadores serológicos de hepatopatías virales y autoinmunes en pacientes celíacos adultos atendidos en el Instituto de Gastroenterología. Materiales y Métodos: Se realizó un estudio observacional descriptivo transversal en el período comprendido entre marzo de 2016 y marzo 2017 en 43 pacientes adultos celíacos atendidos en el Instituto de Gastroenterología de La Habana. A todos, previo consentimiento informado se les realizaron estudios bioquímicos y serológicos para identificar infección por virus de hepatitis B, C y respuesta inmune humoral frente a autoanticuerpos hepáticos y sistémicos. Para el análisis estadístico se emplearon distribuciones de frecuencia y para la comparación entre los grupos se utilizó la probabilidad exacta de Fisher. Se consideró significativo una p < 0,05. Resultados: El 58,1 por ciento de los pacientes presentó hipofosfatasemia y 14 por ciento hipertransaminasemia, sin coincidencias entre los casos registrados. El 100 por ciento de los celíacos fue negativo para el virus de hepatitis C. La positividad de autoanticuerpos hepáticos se registró entre 2,3 por ciento y 14 por ciento de los pacientes evaluados. Existió asociación significativa entre hipertransaminasemia y la presencia de anticuerpos séricos contra la transglutaminasa tisular. Conclusiones: La expresión de marcadores de autoinmunidad hepática en los pacientes celíacos evaluados es frecuente, no así la presencia de marcadores de hepatopatías virales(AU)
Introduction: The spectrum of hepatic involvement in celiac disease is very broad and includes viral and autoimmune hepatopathies. Objective: To characterize the behavior of serologic markers of viral and autoimmune hepatopathies in adult celiac patients treated at the Institute of Gastroenterology. Materials and Methods: A cross-sectional observational study was conducted in 43 adult celiac patients treated at the Institute of Gastroenterology of Havana from March 2016 to March 2017. Prior informed consent, biochemical and serologic studies were carried out in all cases, in order to identify hepatitis B and C virus infections and humoral immune response to liver and systemic autoantibodies. Frequency distributions were used for statistical analysis, and Fisher's exact test was used for the comparison between groups. Results: 58.1 percent of the patients presented hypophosphatasemia and hypertransaminasemia in 14 percent, with no coincidence between the cases recorded. The 100 percent of the celiac patients were negative for hepatitis C virus. The positivity of liver autoantibodies was recorded between 2,3 percent and 14 percent of the patients evaluated. There was a significant association between hypertransaminasemia and the presence of serum antibodies against tissue transglutaminase. Conclusions: The expression markers of liver autoimmunity in celiac patients was frequent, but not the presence of markers of viral hepatopathy(AU)