Элэгний фиброзын зэргийг хатгалтын бус сийвэнгийн биомаркерын болон элэгний бүтэц зүйн шинжилгээгээр харьцуулан судалсан дүн

Abstract

Introduction: The golden standard for diagnosing liver fibrosis is a biopsy. Knodell, Metavir, and Isaac scores have been used for grading liver fibrosis, though Metavir score is used more often. Currently, direct and indirect biomarkers are being used for assessing the liver fibrosis grade. In 2007 Larrousse et al found liver fibrosis grades, evaluated by using hyaluronic acid and tissue inhibitors of metalloproteinase-1 ratio, showing the same result as Metavir score. In 2003 APRI test was used to determine liver fibrosis grade for the first time. APRI >1.5 equal to METAVIR moderate liver fibrosis and in contrast if it is <0.6 it can exclude liver fibrosis. FibroQ test is calculated by using ASTALT, PLT count, and INR. Elevated portal pressure results decreased thrombopoietin synthesis and increased platelet destruction in the spleen would increase which are the fundamental principle of this test. It is quite challenging to diagnose liver fibrosis at an early stage because the process of fibrosis takes a long time and it would take 6-8 years to show any symptoms. To diagnose and treat, the liver fibrosis grade should be measured appropriately and it is essential to evaluate it in a certain period to assess whether it’s reversible. Objectives: Assessing liver fibrosis grade using direct and indirect serum biomarkers. Methods: Randomized cross-sectional study enrolling a total of 81 patients who have been admitted to the department of gastroenterology, third state central hospital of Mongolia. Biopsy was done on all patients. Statistical analysis was performed using STATA12. Mann-Whitney U test and 2 sample t-test were done. A p-value less than 0.05 is statistically significant. Results: APRI score, an indirect biomarker, the average was 1.30 and lowest for those patients with Matavir F0 was 0.24±0.12, whereas highest for patients with F4 was 2.75±1.30 (p<0.001). Fibrosis lower than grade I, fibrosis grade IIIII and liver cirrhosis results were <0.5, 0.5-1.5, and >1.51, respectively. Metavir classification and APRI score shown a positive correlation (r=0.73, p<0.001). There was a significant statistical difference between the APRI score’s value of those patients without fibrosis, with fibrosis, and cirrhosis. Fibrosis changes were noted in a total of 57 (70.45) patients’ biopsy. APRI score values for the non-fibrosis group were 0.30±0.17. Whereas, APRI score average value for patients with fibrosis changes was 1.72±1.34 (p<0.005). Using the “Youden index”, the APRI score cut-off value of 0.71 had 80.7% sensitivity and 100.0% specificity. For cut-off value, 1.77 had 84.6% sensitivity and 100.0% specificity. FibroQ score average was 8.65 and for Metavir 0 group had the lowest 1.16±0.90, whereas the F4 group had the highest value of 15.56±10.96 (p<0.001) (Table. 12). Fibrosis lower than I group, fibrosis II-III group, cirrhosis group’s result was <3.75, 3.75-14.5, >14.51, respectively. Metavir classification and FibroQ score shown positive correlation (r=0.59, p<0.001). Conclusion: Evaluating liver fibrosis grade be usind indirect serum biomarkers, a direct moderate correlation was shown between APRI and Fibro-Q scores. The F2 grade was the most abundant according to Matevir classification.