Tedavi Naif İnaktif Hepatit B Taşıyıcısı Olan Hastaların Fibrozis Durumlarının Non-İnvaziv Karaciğer Fibrozis Skorlama Sistemleri İle Değerlendirilmesi

Abstract

Hepatitis B (HBV) is a viral infectious disease that is likely to become chronic in the liver after acute infection and poses a major public health problem globally despite widespread vaccination efforts. One of the stages of chronic hepatitis B infection, which is divided into 5 stages according to the European Association for the Study of the Liver [EASL] 2017 classification, is phase 3, also called "inactive HBV carrier". In this stage, there is no indication for liver biopsy and antiviral treatment according to international guidelines. However, for reasons that are not yet fully understood, certain degrees of liver fibrosis may develop in this patient group. In this study, we investigated the presence or absence of liver fibrosis in patients at this stage by MR elastography (MRE) and MRI derived proton density fat fraction (MRI-PDFF) and tried to determine the accuracy of current noninvasive fibrosis scoring at this stage. Within the scope of the study, 79 patients diagnosed with "HBeAg-negative chronic HBV infection" (natural history phase 3, inactive carrier) according to EASL 2017 guidelines were retrospectively analyzed and demographic, anthropometric, radiologic and laboratory data of the patients were recorded. Patients with HBV-DNA levels permanently <2000 IU/ml were grouped as "true inactive stage" and those with at least two values between 2000-20000 IU/ml were grouped as "gray zone". Noninvasive liver fibrosis scores such as FIB-4, NFS, APRI, GUCI, HUI, BARD, FORNS, CDS, LOK index were calculated in these patient groups. The presence or absence of fibrosis was determined according to the kPA levels, which is the liver stiffness value in the previous MR elastography examinations of the patients. The liver steatosis ratios of all patients detected by MRI-PDFF were also recorded. In our study, liver stiffness in kPa by MRE measurement was <2.5 kPa (normal) in 55 patients (68%), between 2.5-3.0 kPa (increased liver stiffness) in 16 patients (20%), and between 3.0-3.5 kPa (stage 1-2 fibrosis) in 8 patients (9%). None of the patients showed signs of advanced fibrosis and cirrhosis. When the gray zone patient group was compared with true inactives (i.e. patients with HBV DNA measurements consistently <2000 IU/ml), 51 (72%) of the true inactives (n:70) had no evidence of fibrosis on MRI. Of the 9 patients in the gray zone, only 4 (44%) had no evidence of fibrosis on MRI (p:0.12). When the mean kPa values were examined, the mean stiffness value of the gray zone patient group was found to be significantly higher than true inactive patient group (p:0.007). Liver steatosis rates were evaluated by MRI-PDFF examination and were found to be between 5.75-15.5% in 15 patients (19%) and consistent with grade-1 steatosis. In 2 patients (2.5%), it was found to be between 15.5-21.34%, which corresponds to grade-2 steatosis. In 1 patient (1.2%), a result of >21.35% was obtained and was found to be compatible with stage-3 steatosis. It was observed that there was a significant correlation between BARD score, NFS, TyG index, HUI, S-index, platelet/monocyte ratio and liver stiffness value (kPA) measured on MRE (p = 0.01). In our study, the noninvasive fibrosis scoring tests (APRI, FIB-4, HUI, LOK, GUCI and others) within the scope of the study were found to be below expectations in detecting the absence of fibrosis and early stage fibrosis when the threshold values specified in the literature were used. Although previous studies have shown that these tests can be used successfully in the detection of advanced fibrosis and cirrhosis, our findings suggest that these tests are not appropriate for the detection of early stage fibrosis in follow-up of inactive hepatitis B. Our findings indicate that MR elastography measurements can distinguish between gray zone patients and true inactives, but the low number of gray zone patients in the study group makes it difficult to draw a definitive opinion. MRI-PDFF evaluation was also performed simultaneously in our patient group, and the findings showed that a significant number of our patients (77%) did not have liver steatosis.