Avaliação da Fibrose Hepática por Elastografia nos pacientes portadores de Esquistossomose Mansônica

• Autor(a) principal: Lima, Leila Maria Soares Tojal De Barros [UNIFESP]
• Data de Publicação: 2019
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=7748546; https://repositorio.unifesp.br/handle/11600/59111
• topic: Schistosomiasis; Schistosomiasis Mansoni; Elastography; Liver Fibrosis; Esquistossomose; Esquistossomose Mansoni; Elastografia; Fibrose Hepática

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.