Schiavon Leonardo L, Carvalho-Filho Roberto J, Narciso-Schiavon Janaína L, Medina-Pestana José O, Lanzoni Valéria P, Ferraz Maria Lucia G, Silva Antonio Eduardo B
Division of Gastroenterology, Federal University of Sao Paulo, Sao Paulo, Brazil.
Scand J Gastroenterol. 2010 May;45(5):615-22. doi: 10.3109/00365521003637203.
Hepatitis C is highly prevalent among kidney transplant (KT) recipients. In this population, the natural history of hepatitis C virus (HCV) infection and its proper management remains controversial. The invasiveness of the procedure and the interpretation variability of liver biopsy limit its use in these patients. We sought to evaluate the performance of YKL-40 and HA as markers of liver fibrosis in KT patients with HCV infection.
This cross-sectional study included HCV infected KT individuals. Univariate analysis was used to identify variables associated with significant fibrosis (METAVIR >or= F2). The diagnostic values of the YKL-40 and HA were compared using receiver operating characteristic (ROC) curves.
Eighty-five patients were included (60% males, mean age 44.9 +/- 9.4 years). Significant fibrosis was observed in 14 patients (17%). When compared to F0/F1 individuals, patients with significant fibrosis were older, showed a higher time since transplantation, and higher prevalence of diabetes. No difference was observed in YKL-40 levels between the groups. Significantly higher levels of HA were noted in METAVIR >or= F2 subjects (108 vs. 37 ng/ml, p = 0.002). The AUROCs of YKL-40 and HA for predicting significant fibrosis were 0.615 and 0.765, respectively (p = 0.144). Levels of YKL-40 <or= 105 ng/ml and of HA <or= 27 ng/ml showed a NPV of 36% and 96%, respectively. YKL-40 >or= 418 ng/ml and HA >or= 120 ng/ml exhibited a PPV of 31% and 39%, respectively.
Increased serum levels of HA but not of YKL-40 were associated with more advanced stages of liver fibrosis in KT HCV-infected patients.
丙型肝炎在肾移植（KT）受者中高度流行。在这一人群中，丙型肝炎病毒（HCV）感染的自然史及其恰当管理仍存在争议。该检查的侵入性以及肝活检结果解读的变异性限制了其在这些患者中的应用。我们试图评估YKL-40和透明质酸（HA）作为HCV感染的KT患者肝纤维化标志物的性能。
这项横断面研究纳入了HCV感染的KT个体。采用单因素分析来确定与显著纤维化（METAVIR≥F2）相关的变量。使用受试者工作特征（ROC）曲线比较YKL-40和HA的诊断价值。
纳入85例患者（60%为男性，平均年龄44.9±9.4岁）。14例患者（17%）观察到显著纤维化。与F0/F1个体相比，有显著纤维化的患者年龄更大，移植后时间更长，糖尿病患病率更高。两组间YKL-40水平无差异。METAVIR≥F2的受试者中HA水平显著更高（108 vs. 37 ng/ml，p = 0.002）。YKL-40和HA预测显著纤维化的曲线下面积（AUROC）分别为0.6
