A krónikus hepatitis C-vírus-infekció okozta necroinflammatio májfibrosisra és cirrhosisra hajlamosít, ami a végstádiumú májbetegség szövődményeihez vezet. A fibrosisstádium ismerete alapvető fontosságú mind az antivirális terápia indikálásában és a kórlefolyás alatti követésben, mind a prognózis előrejelzésében. Mivel a fibrosisdiagnosztikában „aranystandarnak” tekintett májbiopszia invazív és ismétlésének is korlátai vannak, előtérbe kerültek a fibrosisstádium meghatározását szolgáló nem invazív módszerek. A szérumbiomarkerek és a fizikai megközelítésen (a májtömöttség vizsgálatán) alapuló elasztográfiás eljárások, valamint ezek kombinációs algoritmusai képviselik azokat az eljárásokat, amelyek egyre inkább beépülnek a kezelési irányelvekbe, és alkalmazásuk révén csökkenthető a májbiopszia igénye. A dolgozat áttekintést ad a fibrosisdiagnosztika nem invazív módszereiről, azok szerepéről az antivirális kezelés elkezdésében, a terápiás válasz monitorozásában és a prognózis megítélésében krónikus hepatitis C-vírus-infekcióban szenvedő betegekben. Orv. Hetil., 2015, 156(21), 855–861.
Lavanchy, D.: Evolving epidemiology of hepatitis C virus. Clin. Microbiol. Infect., 2011, 17(2), 107–115.
World Health Organization: Guidelines for the screening, care and treatment of persons with hepatitis C infection. April 2014, pp. 1–122.
Infections. CotPaCoVH. Hepatitis and liver cancer: A National Strategy for Prevention and Control of Hepatitis B and C. In: Colvin, H. M., Mitchell, A. E. (eds.): Hepatitis and liver cancer: A National Strategy for Prevention and Control of Hepatitis B and C. Institute of Medicine of the National Academies, Washington, 2010.
Smith, B. D., Morgan, R. L., Beckett, G. A., et al.: Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945–1965. MMWR Recomm. Rep., 2012, 61(RR-4), 1–32.
Coffin, P. O., Scott, J. D., Golden, M. R., et al.: Cost-effectiveness and population outcomes of general population screening for hepatitis C. Clin. Infect. Dis., 2012, 54(9), 1259–1271.
Sebastiani, G., Gkouvatsos, K., Pantopoulos, K.: Chronic hepatitis C and liver fibrosis. World J. Gastroenterol., 2014, 20(32), 11033–11053.
Yano, M., Kumada, H., Kage, M., et al.: The long-term pathological evolution of chronic hepatitis C. Hepatology, 1996, 23(6), 1334–1340.
Pár, A., Pár, G.: Non-invasive fibrosis assessment in chronic hepatitis C: aspartate-aminotransferase to platelet ratio index (APRI) and transient elastography (FibroScan). [Nem invazív fibrosisdiagnosztika krónikus C-hepatitisben: aszpartát-aminotranszferáz/thrombocyta hányadosindex (APRI) és tranziens elasztográfia (FibroScan).] Orv. Hetil., 2010, 151(47), 1951–1955. [Hungarian]
Horváth, G.: New non-invasive tool for assessment of liver fibrosis: transient elastography. [A májfibrosis meghatározásának új, noninvazív módszere: tranziens elasztográfia (FibroScan).] Orv. Hetil., 2011, 152(22), 860–865. [Hungarian]
Pár, G., Trosits, A., Pakodi, F., et al.: Liver stiffness measurement selects patients with chronic liver diseases at risk of bearing large oesophageal varices. Z. Gastroenterol., 2013, 51(5), A52 (Abstract).
Pár, G., Vincze, Á., Berki, T., et al.: Serum fibrosis markers (procollagen-III-peptide, hyaluronic acid, transforming growth factor beta-1), aspartate-aminotransferase to platelet ratio index (APRI), and transient elastography (FibroScan) in patients with chronic HCV infection. Clin. Exp. Med. J., 2011, 5(2–3), 101–118.
Schaff, Z.: The value of liver biopsy in chronic hepatitis. [A májbiopszia értéke krónikus hepatitisben.] Orv. Hetil., 2011, 52(22), 856–858. [Hungarian]
Castera, L.: Noninvasive methods to assess liver disease in patients with hepatitis B or C. Gastroenterology, 2012, 142(6), 1293–1302.e4.
Wai, C. T., Greenson, J. K., Fontana, R. J.: A simple non-invasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology, 2003, 38(2), 518–526.
Sebastiani, G., Halfon, P., Castera, L., et al.: SAFE biopsy: a validated method for large-scale staging of liver fibrosis in chronic hepatitis C. Hepatology, 2009, 49(6), 1821–1827.
Armstrong, M. J., Corbett, C., Hodson, J., et al.: Operator training requirements and diagnostic accuracy of Fibroscan in routine clinical practice. Postgrad. Med. J., 2013, 89(1058), 685–692.
Papastergiou, V., Tsochatzis, E., Burroughs, A. K.: Non-invasive assessment of liver fibrosis. Ann. Gastroenterol., 2012, 25(3), 218–231.
Friedrich-Rust, M., Nierhoff, J., Lupsor, M., et al.: Performance of acoustic radiation force impulse imaging for the saging of liver fibrosis: a pooled meta-analysis. J. Viral. Hepat., 2011, 19(2), e212–e219.
Sporea, I., Bota, S., Jurchis, A., et al.: Acoustic radiation force impulse and supersonic shear imaging versus transient elastography for liver fibrosis assessment. Ultrasound Med. Biol., 2013, 39(11), 1933–1941.
Huwart, L., Sempoux, C., Vicaut, E., et al.: Magnetic resonance elastography for the noninvasive staging of liver fibrosis. Gastroenterology, 2008, 135(1), 32–40.
Castéra, L., Sebastiani, G., Le Bail, B., et al.: Prospective comparison of two algorithms combining non-invasive methods for staging liver fibrosis in chronic hepatitis C. J. Hepatol., 2010, 52(2), 191–198.
Boursier, J., de Ledinghen, V., Zarski, J. P., et al.: Comparison of eight diagnostic algorithms for liver fibrosis in hepatitis C: new algorithms are more precise and entirelly noninvasive. Hepatology, 2012, 55(1), 58–67.
European Association for the Study of the Liver: EASL Clinical Practice Guidelines: management of hepatitis C virus infection. J. Hepatol., 2014, 60(2), 392–420.
Tsochatzis, E., A., Crossan, C., Longworth, L., et al.: Cost-effectiveness of noninvasive liver fibrosis tests for treatment decisions in patients with chronic hepatitis C. Hepatology, 2014, 60(3), 832–843.
D’Ambrosio, R., Aghemo, A., Rumi, M. G., et al.: A morphometric and immunohistochemical study to assess the benefit of a sustained virological response in hepatitis C virus patients with cirrhosis. Hepatology, 2012, 56(2), 532–543.
Martinez, S. M, Foucher, J., Combis, J. M., et al.: Longitudinal liver stiffness assessment in patients with chronic hepatitis C undergoing antiviral therapy. PLoS ONE, 2012, 7(10), e47715. doi:10.1371/journal.pone.0047715.
Poynard, T., Moussali, J., Munteanu, M., et al.: Slow regression of liver fibrosis presumed by repeated biomarkers after virological cure in patients with chronic hepatitis C. J. Hepatol., 2013, 59(4), 675–683.
Fernández-Rodríguez, C. M., Alonso, S., Martinez, S. M., et al., Group for the Assessment of Prevention of Cirrhosis Complication and Virological Response (APREVIR): Peginterferon plus ribavirin and sustained virological response in HCV-related cirrhosis: Outcomes and factors predicting response. Am. J. Gastroenterol., 2010, 105(10), 2164–2173.
Hézode, C., Castéra, L., Roudot-Thoraval, F., et al.: Liver stiffness diminishes with antiviral response in chronic hepatitis C. Aliment. Pharmacol. Ther., 2011, 34(6), 656–663.
Pár, G., Szinku, Z., Haragh, A., et al.: Sustained virologic response to antiviral therapy for chronic hepatitis C vírus infection is associated with regression of liver fibrosis assessed by transient elastography. Z. Gastoenterol., 2014, 52, A50. DOI: 10. 1055/s-0034-1376110.
Vergniol, J., Foucher, J., Terrebonne, E., et al.: Noninvasive tests for fibrosis and liver stiffness predict 5-year outcomes of patients with chronic hepatitis C. Gastroenterology, 2011, 140(7), 1970–1979, 1979.e1–e3.
Castéra, L., Pinzani, M., Bosch, J.: Non invasive evaluation of portal hypertension using transient elastography. J. Hepatol., 2012, 56(3), 696–703.
Kazemi, F., Kettaneh, A., N’kontchou, G., et al.: Liver stiffness measurement selects patients with cirrhosis at risk of bearing large oesophageal varices. J. Hepatol., 2006, 45(2), 230–235.
Bosch, J.: Predictions from a hard liver. J. Hepatol., 2006, 45(2), 174–177.
Garcia-Tsao, G., Escorsell, A., Zakko, M.: Predicting the presence of significant portal hypertenison and oesophageal varices in compensated cirrhotic patients. Hepatology, 1997, 26, 360A (Abstract).
Giannini, E. G., Zaman, A., Kreil, A., et al.: Platelet count/spleen diameter ratio for the noninvasive diagnosis of esophageal varices: results of a multicenter, prospective validation study. Am. J. Gastroenterol., 2006, 101(11), 2511–2519.
Sebastiani, G., Tempesta, D., Fattovich, G., et al.: Prediction of oesophageal varices in hepatic cirrhosis by simple non-invasive markers: results of a multicenter, large-scale study. J. Hepatol., 2010, 53(4), 630–638.
Galvin, Z., O’Nill, M. T., Lowry, D., et al.: Transient elastography is a useful clinical tool to predict the presence of minimal hepatic encephalopathy in a cohort of compensated cirrhotic patients. Falk Symposium 191, London, Oct. 4–7, 2013.
Calvaruso, V., Di Marco, V., Bronte, F., et al.: High spleen stiffness is related to presence of esophageal varices in patients with HCV cirrhosis. J. Hepatol., 2012, 56(Suppl. 2), S409.
Colecchia, A., Montrone, L., Scaioli, E., et al.: Measurement of spleen stiffness to evaluate portal hypertension and the presence of esophageal varices in patients with HCV-related cirrhosis. Gastroenterology, 2012, 143(3), 646–654.
Berzigotti, A., Seijo, S., Arena, U., et al.: Elastography, spleen size and platelet count identify portal hypertension in patients with compensated cirrhosis. Gastroenterology, 2013, 144(1), 102–111.e1.
Feier, D., Lupsor Platon, M., Stefanescu, H., et al.: Transient elastography for the detection of hepatocellular carcinoma in viral C liver cirrhosis. Is there something else than increased liver stiffness? J. Gastrointest. Liver Dis., 2013, 22(3), 283–289.
Yousef, M., Elsharkawy, A., El Beshlawy, M., et al.: Use of ultrasonic transient elastography (Fibroscan) in the assessment of hepatic focal lesion stiffness. Open J. Gastroenterol., 2013, 3(2), 107–112.