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Intêret du FibroScan® et des marqueurs biologiques de la fibrose hépatique, chez des sénégalais porteurs chroniques du virus de l’hépatite B faiblement réplicatifs

Interest FibroScan® and biochemical markers of liver fibrosis in Senegalese chronic hepatitis B patients with low-replicative viral

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  • Published:
Journal Africain d'Hépato-Gastroentérologie

Résumé

Contexte et objectifs

L’infection par le virus de l’hépatite B (VHB) est la cause la plus fréquente d’hépatopathies aigue et chronique dans le monde. Les patients avec une charge virale faible et des transaminases normales ont un moindre risque d’évolution vers la fibrose. Nous avons déterminé la proportion de patients porteurs chroniques du VHB sans cytolyse à faible réplication virale, ne répondant pas aux critères de traitement antiviral fondés sur les recommandations occidentales nécessitant néanmoins un traitement sur la base d’une fibrose significative au FibroScan®.

Patients et méthodes

Il s’agit d’une étude prospective transversale entre mars 2013 et novembre 2014 dans 3 hôpitaux de la région de Thiès. Etait inclus tout patient VHB+ ≥ 18 ans, avec des transaminases normales (<40UI/L), faiblement réplicateurs (charge virale < 20 000UI/ml), asymptomatique, mono infecté par VBH. Les patients porteurs du VIH ou du VHC ou ayant reçu un quelconque traitement antiviral étaient exclus. Le FibroScan® était réalisé chez tous les patients. Les scores APRI et FIB-4 étaient calculés.

Résultats

Au total 395 patients ont été évalués, dont 94 répondaient aux critères d’inclusion (53% sexe masculin). La valeur moyenne du Fibroscan® était de 5.64±1.72 kPa avec 17 patients (18.08%) qui avait une fibrose >7kPa. Pour éliminer une fibrose significative (FS <7kPa), les scores APRI et FIB-4 avaient des performances comparables avec respectivement (sensibilité 11.1%, spécificité 96.05%, VPP 40% et VPN 82%) et (sensibilité 11.11%, spécificité 90.79%, VPP 22.22 % et VPN 81.18 %).

Conclusion

Une bonne partie des patients infectés par le VHB avec des ALAT normales et une faible charge virale ont une maladie hépatique active. Les deux scores biologiques FIB-4 et APRI sont utiles pour identifier les personnes sans fibrose significative avec une bonne VPN >81%.

Abstract

Background and objectives

Infection with Hepatitis B Virus (HBV) is the most common cause of acute and chronic liver desease all over the world. Patients with low viral load and normal transaminases have a lesser risk of progression to fibrosis.We evaluated the proportion of chronic HBV patients without cytolysis with a low viral replication, not responding to antiviral treatment criteria founded on international recommendations; but requiring treatment based of significant fibrosis at FibroScan®.

Patients and methods

This is a prospective cross-sectional study between March 2013 and November 2014 in three hospitals in the region of Thies. Chronic hepatitis B patients who were at least 18 years of age, with HBV DNA levels below 20 000 IU/ml, normal liver enzymes (alanine transaminase < 40 U/l), mono infected by HBV were included. Patients with HIV or HCV or HBV antiviral treatment were excluded. Fibroscan® was performed in all patients. The APRI and FIB-4 scores were calculated.

Results

In total 395 patients were evaluated: 94met the inclusion criteria (53% male). The mean value Fibroscan® was 5.64 ± 1.72 kPa with 17 patients (18.08%) who had fibrosis > 7kPa. To exclude a significant fibrosis (FS <7kPa), the APRI and FIB-4 scores had similar performance (sensitivity 11.1%, specificity 96.05%, PPV 40% and NPV 82%) and (sensitivity 11.11%, specificity 90.79%, PPV 22.22% and NPV 81.18%) respectively.

Conclusion

Many patients infected with HBV with normal ALT and low viral load have active liver disease. Both biological scores FIB-4 and APRI are useful for distinguishing patients without significant fibrosis with a good negative predictive value> 81%.

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Authors and Affiliations

  1. UFR des sciences de la Santé, Université de Thiès, Thiès, Sénégal

    P. S. Touré, M. M. Diop, J. A. Da Veiga, M. M. Sarr, A. Berthé, P. Dioussé, B. M. Diop & M. M. Ka

  2. Laboratoire de bactériologie-virologie, Hôpital Aristide Le Dantec de Dakar, Dakar, Sénégal

    G. Lô, A. Sow-Sall, B. P. Ndiaye, N. C. Touré-Kane & S. Mboup

  3. Centre hospitalier national de Pikine Dakar, Dakar, Sénégal

    C. T. Tall

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  1. P. S. Touré
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Correspondence to P. S. Touré.

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Touré, P.S., Diop, M.M., Lô, G. et al. Intêret du FibroScan® et des marqueurs biologiques de la fibrose hépatique, chez des sénégalais porteurs chroniques du virus de l’hépatite B faiblement réplicatifs. J Afr Hepato Gastroenterol 10, 14–20 (2016). https://doi.org/10.1007/s12157-015-0634-4

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  • DOI: https://doi.org/10.1007/s12157-015-0634-4

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