Otoimmün Hepatitli Hastalarda Hepatik Fibrozis Düzeyinin Değerlendirilmesinde Elf Testi ile Karaciğer Biyopsisinin Tanısal Değerlerinin Karşılaştırılması

Abstract

Autoimmune hepatitis is a chronic inlammatory disease characterized by hepatomegaly, presence of autoantibodies and polyclonal hypergammaglobulinemia. As a chronic liver disease, fibrosis is one of the complications of autoimmune hepatitis. Hepatic fibrosis is a pathological condition defined as excess accumulation of extracellular matrix (ECM) components causing hepatic dysfunction in long term. Liver biopsy has been recommended as gold standard method in the evaluation of hepatic fibrosis. However, its unconvenience for frequent use and complications have lead researchers to the development of noninvasive methods for the evaluation and staging of hepatic fibrosis. ELF test is a biochemical test panel made up of serum markers reflecting ECM metabolism. ELF test panel consists of three parameters: Hyaluronic acid (HA), procollagen III N-terminal propeptide (PIIINP) and tissue inhibitor of matrix metalloprotease-1 (TIMP-1). Serum levels of these parameters are used to calculate statistically developed ELF score. The aim of this study is to compare diagnostic values of ELF test and liver biopsy in evaluation of hepatic fibrosis in patients with autoimmune hepatitis. 46 patients were included in the study group. Blood samples for ELF test were drawn from patients with liver biopsy results within the last one year. Patient samples were analyzed with SIEMENS ADVIA Centaur XP immunoanalyzer and ELF scores were calculated. Patients were divided into two groups according to METAVIR staging system as F0-1 Group 1 (no-mild fibrosis) and F2-3-4 Group 2 (moderate-severe fibrosis). 19.6 % of patients were in Group 1 and 80.4 % of patients were in Group 2. The means of ELF scores were 8.62±1.05 for Group 1 and 10.60±1.39 for Group 2 and the difference between the groups were statistically significant (p<0,001). To compare the diagnostic values of two methods, ROC curve was plotted. Area under ROC curve (AUROC) was calculated as 0.88. The cut-off value to discriminate no-mild fibrosis from moderate-severe fibrosis group, sensitivitiy, specificity, positive predictive value, negative predictive value, likelihood ratios were calculated as 8.84, 91.89 %, 77.78 %, 94.4 %, 70 %, 4.14 (LR+) and 10 (LR-), respectively. In conclusion, ELF test can be used for screening and follow-up of hepatic fibrosis İn patients with autoimmune hepatitis.