Avaliação da ultrassonografia hepática com dopplerfluxometria em pacientes portadores de hepatite C crônica
Autor(a) principal: | |
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Data de Publicação: | 2011 |
Tipo de documento: | Dissertação |
Idioma: | por |
Título da fonte: | Repositório Institucional da UFU |
Texto Completo: | https://repositorio.ufu.br/handle/123456789/12704 |
Resumo: | INTRODUCTION: Hepatitis C is an important cause of chronic liver disease worldwide. The grading of hepatic fibrosis in chronic hepatitis C (CHC) is important for better clinical management. However, until now, liver biopsy is the only test accepted for this purpose, despite their contraindications and complications. New methods for noninvasive assessment of hepatic fibrosis are under investigation. One proposal is the Doppler ultrasound, as a noninvasive, widely available and inexpensive. OBJECTIVES: To compare laboratory parameters and liver Doppler ultrasound of patients with CHC with a healthy control group and to correlate the portal vein index (PVI), splenic index, liver histogram and hepatorenal ratio (HRR) with degrees of hepatic fibrosis. MATERIAL AND METHODS: 50 patients with CHC with liver biopsy and 44 healthy controls underwent laboratory tests and Doppler ultrasound. We evaluated several ultrasound parameters, especially maximum and minimum speed of the portal vein, PVI, pulsatility index and resistance of the hepatic artery, splenic index, liver histogram, HRR and patterns of flow velocity of the hepatic vein. Compared the means between groups and were correlated with the degree of fibrosis with sonographic parameters. We used SPSS 17 for statistical analysis. RESULTS: The groups were matched for sex and age. Of the patients who underwent biopsy, 5 (10%) had F0 fibrosis, 12 (24%) F1 fibrosis, 22 (44%) F2 fibrosis, 9 (18%) F3 fibrosis and 2 (4%) F4 fibrosis. All patients had some degree of inflammation on biopsy and only four patients had moderate or severe steatosis. There was significant difference between groups when comparing the liver enzymes AST, ALT and GGT (p<0.001), and platelets (p=0.001). There was significant difference in sonographic parameters of PVI (p<0.001), splenic index (p=0.003), liver histogram (p<0.001) and HRR (p<0.001). The triphasic pattern of supra-hepatic vein was predominant in both groups. The ultrasonographic parameters were correlated with the degree of fibrosis and plotted the ROC curve. The PVI revealed an inverse correlation of r=-0.448 (p<0.001), AUROC of 78.4% (95% CI: 68.8 to 88%) and cutoff of 0.28 (Sensibility=73.5% and Specificity=71.1%), spleen index showed a correlation of r=0.354 (p=0.001). The correlation of liver histogram was r=0.416 (p<0.001), AUROC 74.4% (95% CI: 58.5 to 90.3%), a cutoff of 77.5 (Sensibility=60% and Specificity=74.4%); The HRR was correlated with fibrosis with r=0.509 (p<0.001), AUROC of 62.4% (95% CI: 46.4 to 78.5%) and a cutoff of 1.22 (Sensibility=60% and Specificity=65.9%). None of the parameters was significant for differentiating the degree of hepatic fibrosis. CONCLUSIONS: The platelet count and liver enzymes AST, ALT and GGT were significantly different between groups of patients with CHC and control, as well as the sonographic parameters PVI, splenic index, liver histogram and HRR. There were significant and moderate correlation between fibrosis and ultrasonographic data presented previously. However these parameters were not significant in differentiating the degree of fibrosis in the group of patients with CHC. |
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2016-06-22T18:33:03Z2011-06-102016-06-22T18:33:03Z2011-03-29ROCHA, Haroldo Luís Oliva Gomes. Avaliação da ultrassonografia hepática com dopplerfluxometria em pacientes portadores de hepatite C crônica. 2011. 67 f. Dissertação (Mestrado em Ciências da Saúde) - Universidade Federal de Uberlândia, Uberlândia, 2011.https://repositorio.ufu.br/handle/123456789/12704INTRODUCTION: Hepatitis C is an important cause of chronic liver disease worldwide. The grading of hepatic fibrosis in chronic hepatitis C (CHC) is important for better clinical management. However, until now, liver biopsy is the only test accepted for this purpose, despite their contraindications and complications. New methods for noninvasive assessment of hepatic fibrosis are under investigation. One proposal is the Doppler ultrasound, as a noninvasive, widely available and inexpensive. OBJECTIVES: To compare laboratory parameters and liver Doppler ultrasound of patients with CHC with a healthy control group and to correlate the portal vein index (PVI), splenic index, liver histogram and hepatorenal ratio (HRR) with degrees of hepatic fibrosis. MATERIAL AND METHODS: 50 patients with CHC with liver biopsy and 44 healthy controls underwent laboratory tests and Doppler ultrasound. We evaluated several ultrasound parameters, especially maximum and minimum speed of the portal vein, PVI, pulsatility index and resistance of the hepatic artery, splenic index, liver histogram, HRR and patterns of flow velocity of the hepatic vein. Compared the means between groups and were correlated with the degree of fibrosis with sonographic parameters. We used SPSS 17 for statistical analysis. RESULTS: The groups were matched for sex and age. Of the patients who underwent biopsy, 5 (10%) had F0 fibrosis, 12 (24%) F1 fibrosis, 22 (44%) F2 fibrosis, 9 (18%) F3 fibrosis and 2 (4%) F4 fibrosis. All patients had some degree of inflammation on biopsy and only four patients had moderate or severe steatosis. There was significant difference between groups when comparing the liver enzymes AST, ALT and GGT (p<0.001), and platelets (p=0.001). There was significant difference in sonographic parameters of PVI (p<0.001), splenic index (p=0.003), liver histogram (p<0.001) and HRR (p<0.001). The triphasic pattern of supra-hepatic vein was predominant in both groups. The ultrasonographic parameters were correlated with the degree of fibrosis and plotted the ROC curve. The PVI revealed an inverse correlation of r=-0.448 (p<0.001), AUROC of 78.4% (95% CI: 68.8 to 88%) and cutoff of 0.28 (Sensibility=73.5% and Specificity=71.1%), spleen index showed a correlation of r=0.354 (p=0.001). The correlation of liver histogram was r=0.416 (p<0.001), AUROC 74.4% (95% CI: 58.5 to 90.3%), a cutoff of 77.5 (Sensibility=60% and Specificity=74.4%); The HRR was correlated with fibrosis with r=0.509 (p<0.001), AUROC of 62.4% (95% CI: 46.4 to 78.5%) and a cutoff of 1.22 (Sensibility=60% and Specificity=65.9%). None of the parameters was significant for differentiating the degree of hepatic fibrosis. CONCLUSIONS: The platelet count and liver enzymes AST, ALT and GGT were significantly different between groups of patients with CHC and control, as well as the sonographic parameters PVI, splenic index, liver histogram and HRR. There were significant and moderate correlation between fibrosis and ultrasonographic data presented previously. However these parameters were not significant in differentiating the degree of fibrosis in the group of patients with CHC.INTRODUÇÃO: A hepatite C é uma importante causa de hepatopatia crônica no mundo. A avaliação do grau de fibrose hepática na hepatite C crônica (HCC) é importante para o melhor manejo clínico. Entretanto, até o momento, a biópsia hepática é o único teste aceito para esta finalidade, apesar de suas contraindicações e complicações. Novos métodos para avaliação não invasiva de fibrose hepática estão sendo pesquisados. Uma proposta é o ultrassom com Doppler, por ser um método não invasivo, amplamente disponível e de baixo custo. OBJETIVOS: Comparar parâmetros laboratoriais e ultrassonográficos com Doppler hepático entre pacientes portadores de HCC com um grupo controle sadio e correlacionar o índice venoso portal (IVP), índice esplênico, histograma hepático e razão hepatorrenal (RHR) com graus de fibrose hepática. MATERIAL E MÉTODOS: 50 pacientes portadores de HCC com biópsia hepática e 44 controles sadios foram submetidos a exames laboratoriais e ultrassonográfico com Doppler. Foram avaliados vários parâmetros ultrassonográficos, com destaque para velocidade máxima e mínima da veia porta, IVP, índices de pulsatilidade e resistividade da artéria hepática, índice esplênico, histograma hepático, RHR e padrões de velocidade de fluxo da veia hepática. Compararam-se as médias entre os grupos, bem como foram correlacionados os graus de fibrose com os parâmetros ultrassonográficos. Utilizou-se o programa SPSS 17 para a análise estatística. RESULTADOS: os grupos foram pareados quanto ao sexo e idade. No grupo de pacientes biopsiados, 5 (10%) apresentaram grau de fibrose F0, 12 (24%) fibrose F1, 22(44%) fibrose F2, 9 (18%) fibrose F3 e 2 (4%) fibrose F4. Todos os pacientes apresentavam algum grau de inflamação à biópsia e apenas 4 pacientes apresentaram esteatose moderada ou acentuada. Houve diferença significante entre os grupos quando se comparou as enzimas hepáticas AST, ALT e GGT (p<0,001), assim como as plaquetas (p=0,001). Encontrou-se diferença significante também nos parâmetros ultrassonográficos IVP (p<0,001), índice esplênico (p=0,003), histograma hepático (p<0,001) e RHR (p<0,001). O padrão trifásico da veia suprahepática predominou em ambos os grupos. Os parâmetros ultrassonográficos foram correlacionados com os graus de fibrose e plotados na curva ROC. O IVP apresentou correlação inversa de r=-0,448 (p<0,001), AUROC de 78,4% (IC 95%: 68,8-88%) e ponto de corte em 0,28 (S=73,5% e E=71,1%); o índice esplênico demonstrou correlação de r=0,354 (p=0,001). A correlação do histograma hepático foi de r=0,416 (p<0,001), AUROC 74,4% (IC 95%: 58,5-90,3%), ponto de corte de 77,5 (S=60% e E=74,4%); a RHR correlacionou-se com a fibrose com r=0,509 (p<0,001), AUROC de 62,4% (IC 95%: 46,4-78,5%) e ponto de corte de 1,22 (S=60% e E=65,9%). Nenhum dos parâmetros foi significante para diferenciação dos graus de fibrose hepática. CONCLUSÕES: O número de plaquetas e as enzimas hepáticas AST, ALT e GGT diferiram significativamente entre os grupos de pacientes com HCC e controle, assim como os parâmetros ultrassonográficos IVP, índice esplênico, histograma hepático e RHR. Houve correlação moderada e significante entre a fibrose e os dados ultrassonográficos apresentados anteriormente. Porém estes parâmetros não foram significantes em diferenciar os graus de fibrose no grupo de pacientes portadores de HCC.Mestre em Ciências da Saúdeapplication/pdfporUniversidade Federal de UberlândiaPrograma de Pós-graduação em Ciências da SaúdeUFUBRCiências da SaúdeVeia portaUltrassonografiaDopplerHepatite CFibroseFígadoHepatite C - Diagnóstico por imagemDoppler, Ul-trassonografiaPortal veinUltrasonographyDopplerHepatitis CFibrosisLiverCNPQ::CIENCIAS DA SAUDEAvaliação da ultrassonografia hepática com dopplerfluxometria em pacientes portadores de hepatite C crônicainfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisDiniz, Angélica Lemos Debshttp://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4776008J6http://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4428432U1Rocha, Haroldo Luís Oliva Gomesinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFUinstname:Universidade Federal de Uberlândia (UFU)instacron:UFUTHUMBNAILd.pdf.jpgd.pdf.jpgGenerated Thumbnailimage/jpeg1291https://repositorio.ufu.br/bitstream/123456789/12704/3/d.pdf.jpgd7894e5898a4f7ee32ff8092c5da95acMD53ORIGINALd.pdfapplication/pdf1825293https://repositorio.ufu.br/bitstream/123456789/12704/1/d.pdf6ef2dfacee10a78c2d97fd1d7fa4588eMD51TEXTd.pdf.txtd.pdf.txtExtracted texttext/plain106810https://repositorio.ufu.br/bitstream/123456789/12704/2/d.pdf.txtdd0640629cadedf3ef09e723e82e4a31MD52123456789/127042016-06-23 03:10:24.653oai:repositorio.ufu.br:123456789/12704Repositório InstitucionalONGhttp://repositorio.ufu.br/oai/requestdiinf@dirbi.ufu.bropendoar:2016-06-23T06:10:24Repositório Institucional da UFU - Universidade Federal de Uberlândia (UFU)false |
dc.title.por.fl_str_mv |
Avaliação da ultrassonografia hepática com dopplerfluxometria em pacientes portadores de hepatite C crônica |
title |
Avaliação da ultrassonografia hepática com dopplerfluxometria em pacientes portadores de hepatite C crônica |
spellingShingle |
Avaliação da ultrassonografia hepática com dopplerfluxometria em pacientes portadores de hepatite C crônica Rocha, Haroldo Luís Oliva Gomes Veia porta Ultrassonografia Doppler Hepatite C Fibrose Fígado Hepatite C - Diagnóstico por imagem Doppler, Ul-trassonografia Portal vein Ultrasonography Doppler Hepatitis C Fibrosis Liver CNPQ::CIENCIAS DA SAUDE |
title_short |
Avaliação da ultrassonografia hepática com dopplerfluxometria em pacientes portadores de hepatite C crônica |
title_full |
Avaliação da ultrassonografia hepática com dopplerfluxometria em pacientes portadores de hepatite C crônica |
title_fullStr |
Avaliação da ultrassonografia hepática com dopplerfluxometria em pacientes portadores de hepatite C crônica |
title_full_unstemmed |
Avaliação da ultrassonografia hepática com dopplerfluxometria em pacientes portadores de hepatite C crônica |
title_sort |
Avaliação da ultrassonografia hepática com dopplerfluxometria em pacientes portadores de hepatite C crônica |
author |
Rocha, Haroldo Luís Oliva Gomes |
author_facet |
Rocha, Haroldo Luís Oliva Gomes |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
Diniz, Angélica Lemos Debs |
dc.contributor.advisor1Lattes.fl_str_mv |
http://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4776008J6 |
dc.contributor.authorLattes.fl_str_mv |
http://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4428432U1 |
dc.contributor.author.fl_str_mv |
Rocha, Haroldo Luís Oliva Gomes |
contributor_str_mv |
Diniz, Angélica Lemos Debs |
dc.subject.por.fl_str_mv |
Veia porta Ultrassonografia Doppler Hepatite C Fibrose Fígado Hepatite C - Diagnóstico por imagem Doppler, Ul-trassonografia |
topic |
Veia porta Ultrassonografia Doppler Hepatite C Fibrose Fígado Hepatite C - Diagnóstico por imagem Doppler, Ul-trassonografia Portal vein Ultrasonography Doppler Hepatitis C Fibrosis Liver CNPQ::CIENCIAS DA SAUDE |
dc.subject.eng.fl_str_mv |
Portal vein Ultrasonography Doppler Hepatitis C Fibrosis Liver |
dc.subject.cnpq.fl_str_mv |
CNPQ::CIENCIAS DA SAUDE |
description |
INTRODUCTION: Hepatitis C is an important cause of chronic liver disease worldwide. The grading of hepatic fibrosis in chronic hepatitis C (CHC) is important for better clinical management. However, until now, liver biopsy is the only test accepted for this purpose, despite their contraindications and complications. New methods for noninvasive assessment of hepatic fibrosis are under investigation. One proposal is the Doppler ultrasound, as a noninvasive, widely available and inexpensive. OBJECTIVES: To compare laboratory parameters and liver Doppler ultrasound of patients with CHC with a healthy control group and to correlate the portal vein index (PVI), splenic index, liver histogram and hepatorenal ratio (HRR) with degrees of hepatic fibrosis. MATERIAL AND METHODS: 50 patients with CHC with liver biopsy and 44 healthy controls underwent laboratory tests and Doppler ultrasound. We evaluated several ultrasound parameters, especially maximum and minimum speed of the portal vein, PVI, pulsatility index and resistance of the hepatic artery, splenic index, liver histogram, HRR and patterns of flow velocity of the hepatic vein. Compared the means between groups and were correlated with the degree of fibrosis with sonographic parameters. We used SPSS 17 for statistical analysis. RESULTS: The groups were matched for sex and age. Of the patients who underwent biopsy, 5 (10%) had F0 fibrosis, 12 (24%) F1 fibrosis, 22 (44%) F2 fibrosis, 9 (18%) F3 fibrosis and 2 (4%) F4 fibrosis. All patients had some degree of inflammation on biopsy and only four patients had moderate or severe steatosis. There was significant difference between groups when comparing the liver enzymes AST, ALT and GGT (p<0.001), and platelets (p=0.001). There was significant difference in sonographic parameters of PVI (p<0.001), splenic index (p=0.003), liver histogram (p<0.001) and HRR (p<0.001). The triphasic pattern of supra-hepatic vein was predominant in both groups. The ultrasonographic parameters were correlated with the degree of fibrosis and plotted the ROC curve. The PVI revealed an inverse correlation of r=-0.448 (p<0.001), AUROC of 78.4% (95% CI: 68.8 to 88%) and cutoff of 0.28 (Sensibility=73.5% and Specificity=71.1%), spleen index showed a correlation of r=0.354 (p=0.001). The correlation of liver histogram was r=0.416 (p<0.001), AUROC 74.4% (95% CI: 58.5 to 90.3%), a cutoff of 77.5 (Sensibility=60% and Specificity=74.4%); The HRR was correlated with fibrosis with r=0.509 (p<0.001), AUROC of 62.4% (95% CI: 46.4 to 78.5%) and a cutoff of 1.22 (Sensibility=60% and Specificity=65.9%). None of the parameters was significant for differentiating the degree of hepatic fibrosis. CONCLUSIONS: The platelet count and liver enzymes AST, ALT and GGT were significantly different between groups of patients with CHC and control, as well as the sonographic parameters PVI, splenic index, liver histogram and HRR. There were significant and moderate correlation between fibrosis and ultrasonographic data presented previously. However these parameters were not significant in differentiating the degree of fibrosis in the group of patients with CHC. |
publishDate |
2011 |
dc.date.available.fl_str_mv |
2011-06-10 2016-06-22T18:33:03Z |
dc.date.issued.fl_str_mv |
2011-03-29 |
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2016-06-22T18:33:03Z |
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info:eu-repo/semantics/publishedVersion |
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masterThesis |
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dc.identifier.citation.fl_str_mv |
ROCHA, Haroldo Luís Oliva Gomes. Avaliação da ultrassonografia hepática com dopplerfluxometria em pacientes portadores de hepatite C crônica. 2011. 67 f. Dissertação (Mestrado em Ciências da Saúde) - Universidade Federal de Uberlândia, Uberlândia, 2011. |
dc.identifier.uri.fl_str_mv |
https://repositorio.ufu.br/handle/123456789/12704 |
identifier_str_mv |
ROCHA, Haroldo Luís Oliva Gomes. Avaliação da ultrassonografia hepática com dopplerfluxometria em pacientes portadores de hepatite C crônica. 2011. 67 f. Dissertação (Mestrado em Ciências da Saúde) - Universidade Federal de Uberlândia, Uberlândia, 2011. |
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Universidade Federal de Uberlândia |
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UFU |
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Ciências da Saúde |
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Universidade Federal de Uberlândia |
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