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Paula Teixeira Vieira Vidigalhttp://lattes.cnpq.br/8537115801581858http://lattes.cnpq.br/9668190105665448Túlio de Paula Vasconcelos2023-10-26T16:55:56Z2023-10-26T16:55:56Z2023-07-28http://hdl.handle.net/1843/60090A doença hepática gordurosa não alcoólica (DHGNA) é a hepatopatia crônica mais comum no mundo embora o conhecimento acerca da sua fisiopatologia permaneça insuficiente. De forma semelhante, não são reconhecidos bons marcadores de gravidade e evolução da doença, sendo o grau de fibrose hepática o único fator prognóstico validado. Para se avaliar o grau de fibrose do fígado pode-se utilizar de um método invasivo, no caso a biópsia e que é considerada o padrão-ouro; e métodos não invasivos como os escores clínicos e os métodos de avaliação da rigidez hepática com o uso de ultrassom ou ressonância magnética. Portanto, o presente projeto teve como objetivo avaliar o grau da fibrose hepática por métodos semiquantitativos (escores histológicos), quantitativo (morfometria) em biópsias hepáticas de pacientes com diagnóstico de esteatohepatite não-alcoólica (EHNA) e comparar com os valores elastográficos de rigidez hepática e escores clínicos preditores de fibrose (FIB-4, APRI score e razão AST/ALT) dos mesmos pacientes. Foram selecionados 451 pacientes em acompanhamento clínico no ambulatório de Doença Hepática Gordurosa Não Alcoólica do HC/UFMG. Preencheram os critérios de inclusão no estudo 21 pacientes, sendo 20 mulheres e um homem. Além destes, foram incluídos mais três pacientes do HPMMG, em rotina de consultório de gastroenterologia, com duas mulheres e um homem, todos obedecendo os mesmos critérios de inclusão. A média de idade foi de aproximadamente 60 anos e a mediana do tempo de intervalo entre a biópsia e a elastografia foi de 8,5 meses. Segundo o escore de Laennec 15 pacientes eram cirróticos (cinco em cada grau) e nove não cirróticos. Foram observadas diferenças significativas entre os grupos com e sem cirrose quanto aos escores FIB-4, APRI e morfometria, porém não encontradas em relação à elastografia transitória e razão AST/ALT. O escore histológico de Laennec mostrou correlação direta com a elastografia transitória, escore clínico de FIB-4 e morfometria. No entanto, quando separados por graus (4A, 4B e 4C) os pacientes cirróticos, segundo Laennec, apresentou correlação somente com a morfometria. Foi realizada uma análise de Curva ROC com o objetivo de avaliar a sensibilidade e a especificidade do ponto de corte que melhor discrimina um paciente com cirrose baseando-se no escore de Laennec para as variáveis FIB- 4 (1,070), APRI (0,450) e morfometria (13,2550). Para a elastografia transitória e Razão AST/ALT as áreas sob as curvas (AUROC) encontradas não foram estatisticamente significativas. Os escores clínicos de FIB-4, APRI e a morfometria se mostraram bons preditores do grau de fibrose hepática. Houve correlação entre o escore de Laennec com ET, FIB-4 e morfometria. O tamanho amostral prejudicou a avaliação estatística.Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the world, although knowledge about its pathophysiology remains insufficient. Similarly, good markers of disease severity and evolution are not recognized, with the degree of liver fibrosis being the only validated prognostic factor. In order to assess the degree of liver fibrosis, an invasive method can be used, in this case biopsy, which is considered the gold standard; and non-invasive methods such as clinical scores and liver stiffness assessment methods using ultrasound or magnetic resonance imaging. Therefore, the present project aimed to evaluate the degree of hepatic fibrosis by means of semi-quantitative (histological scores) and quantitative (morphometry) methods in liver biopsies of patients diagnosed with non- alcoholic steatohepatitis (NASH) and to compare with the elastographic values of hepatic stiffness and clinical scores predictors of fibrosis (FIB-4, APRI score and AST/ALT ratio) of the same patients. A total of 451 patients undergoing clinical follow-up at the Non-Alcoholic Fatty Liver Disease Outpatient Clinic at HC/UFMG were selected. Twenty-one patients met the inclusion criteria in the study, 20 women and one man. In addition to these, three more HPMMG patients were included, in the routine of a gastroenterology office, with two women and one man, all meeting the same inclusion criteria. The mean age was approximately 60 years and the median interval between biopsy and elastography was 8.5 months. According to the Laennec score, 15 patients were cirrhotic (five in each degree) and nine were non- cirrhotic. Significant differences were observed between the groups with and without cirrhosis regarding FIB-4 scores, APRI and morphometry, but not found regarding transient elastography and AST/ALT ratio. Laennec's histological score showed a direct correlation with transient elastography, clinical FIB-4 score and morphometry. However, when separated by grades (4A, 4B and 4C), cirrhotic patients, according to Laennec, presented a correlation only with morphometry. A ROC curve analysis was performed in order to assess the sensitivity and specificity of the cutoff point that best discriminates a patient with cirrhosis based on the Laennec score for the variables FIB-4 (1.070), APRI (0.450) and morphometry (13.2550). For transient elastography and AST/ALT ratio, the areas under the curves (AUROC) found were not statistically significant. Clinical FIB- 4, APRI scores and morphometry were good predictors of the degree of liver fibrosis. There was a correlation between the Laennec score and ET, FIB-4 and morphometry. The sample size impaired the statistical evaluation.porUniversidade Federal de Minas GeraisPrograma de Pós-Graduação em PatologiaUFMGBrasilICB - DEPARTAMENTO DE PATOLOGIAhttp://creativecommons.org/licenses/by-nc-nd/3.0/pt/info:eu-repo/semantics/openAccessPatologiaHepatopatia Gordurosa não AlcoólicaCirrose HepáticaEsteatohepatiteEsteatohepatite não-alcoólicaEsteatoseFibroseElastografiaMorfometriaAvaliação dos diferentes graus de fibrose na esteatohepatite não- alcoólica por métodos semiquantitativos, quantitativo, elastográfico e escores preditores de fibrose não invasivosinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisreponame:Repositório Institucional da UFMGinstname:Universidade Federal de Minas Gerais (UFMG)instacron:UFMGORIGINALDissertação Tulio Vasconcelos.pdfDissertação Tulio Vasconcelos.pdfDissertacao de metrado de Tulio Vasconcelosapplication/pdf2263440https://repositorio.ufmg.br/bitstream/1843/60090/1/Dissertac%cc%a7a%cc%83o%20Tulio%20Vasconcelos.pdf37cfc299d3cbc8cac0f9f385710664d1MD51CC-LICENSElicense_rdflicense_rdfapplication/rdf+xml; charset=utf-8811https://repositorio.ufmg.br/bitstream/1843/60090/2/license_rdfcfd6801dba008cb6adbd9838b81582abMD52LICENSElicense.txtlicense.txttext/plain; charset=utf-82118https://repositorio.ufmg.br/bitstream/1843/60090/3/license.txtcda590c95a0b51b4d15f60c9642ca272MD531843/600902023-10-26 13:55:57.337oai:repositorio.ufmg.br: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ório InstitucionalPUBhttps://repositorio.ufmg.br/oaiopendoar:2023-10-26T16:55:57Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)false
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