Tatar Bengu, Kose Sukran, Pala Emel, Tatar Erhan
University of Health Science, Izmir Tepecik Education and Research Hospital, Clinic of Infectious Diseases and Clinical Microbiology, Izmir, Turkey.
University of Health Science, Izmir Tepecik Education and Research Hospital, Pathology, Izmir, Turkey.
Acta Medica (Hradec Kralove). 2017;60(2):71-75. doi: 10.14712/18059694.2017.96.
The aim of this study is to investigate the association between hepatic activity index (HAI) and fibrosis score (FS) with inflammation biomarkers in non-uremic and uremic hepatitis C positive patients.
Fifty chronic hepatitis C (cHepC) positive patients, having a liver biopsy were included in this study. Liver biopsies were scored according to modified ISHAC scoring system. 25 healthy controls of similar age and gender were also enrolled as control group. Serum YKL-40, neutrophil/lymphocyte ratio (NLR), thrombocyte/lymphocyte ratio (PLR), CRP and Immunoglobulin (IgG, A and M) levels were used to determine inflammation. AST to Platelet Ratio Index (APRI) score was also evaluated. According to biopsy findings patients were divided into 2 groups: low (0-2) and severe (3-6) FS.
Patients with cHepC had increased inflammation compared to the healthy controls. End-stage renal disease (ESRD) patients had higher levels of inflammation markers (NLR, IgG, CRP and YKL-40) and lower HCV RNA levels, HAI and FS compared to non-uremic patients. When patients were grouped into 2 according to FS as mild and severe, IgG (p < 0.001), YKL-40 (p = 0.02) levels and APRI score (p = 0.002) were significantly higher compared to mild FS (p = 0.002). YKL-40 levels (t value: 3.48; p = 0.001) and APRI score (t value: 4.57, p < 0.001) were found as independent associated with FS in non-uremic patients. However, in adjusted models, only APRI score (t value: 3.98, p = 0.002) was an independent associated with FS in ESRD patients.
In non-uremic cHepC patients, YKL-40 levels and APRI score may be valuable markers of FS. In ESRD patients, there is not sufficient data for prediction of HAI and FS. In these patients, APRI score may provide better information.
本研究旨在调查非尿毒症和尿毒症丙型肝炎阳性患者的肝脏活动指数（HAI）和纤维化评分（FS）与炎症生物标志物之间的关联。
本研究纳入了50例接受肝脏活检的慢性丙型肝炎（cHepC）阳性患者。肝脏活检根据改良的ISHAC评分系统进行评分。还纳入了25例年龄和性别相似的健康对照作为对照组。使用血清YKL-40、中性粒细胞/淋巴细胞比值（NLR）、血小板/淋巴细胞比值（PLR）、CRP和免疫球蛋白（IgG、A和M）水平来确定炎症情况。还评估了AST与血小板比值指数（APRI）评分。根据活检结果，患者被分为两组：低纤维化评分（0-2）组和严重纤维化评分（3-6）组。
与健康对照相比，cHepC患者的炎症增加。与非尿毒症患者相比，终末期肾病（ESRD）患者的炎症标志物（NLR、IgG、CRP和YKL-40）水平更高，而HCV RNA水平、HAI和FS更低。当根据FS将患者分为轻度和重度两组时，与轻度FS相比，重度FS患者的IgG（p < 0.001）、YKL-40（p = 0.02）水平和APRI评分（p = 0.002）显著更高（p = 0.002）。在非尿毒症患者中，发现YKL-40水平（t值：3.48；p = 0.001）和APRI评分（t值：4.57，p < 0.001）与FS独立相关。然而，在调整模型中，在ESRD患者中只有APRI评分（t值：3.98，p = 0.002）与FS独立相关。
在非尿毒症cHepC患者中，YKL-40水平和APRI评分可能是FS的有价值标志物。在ESRD患者中，没有足够的数据来预测HAI和FS。在这些患者中，APRI评分可能提供更好的信息。
