Abstract :
Background: A number of non-invasive methods are currently available for use as an alternative to
liver biopsy, but their clinical value remains to be determined. The aim of this study was to determine the association
between serum immunoglobulin (Ig) and significant hepatic fibrosis (Metavir score ≥F2) in chronic hepatitis B
(CHB) and chronic hepatitis C (CHC) infections.
Method: Sixty patients with CHB and CHC who underwent liver biopsy at Ramathibodi Hospital,
Bangkok, between December 1, 2006 and November 30, 2007 were recruited. Biochemical, serologic, virologic
data, serum globulin, serum Ig (IgA, IgG, IgM and total Ig) determined by nephelometry, and liver biopsy histologic
findings were collected. In discriminating patients with significant histological fibrosis, serum globulin and
Ig provided the best area under the receiver operating characteristic curves (AUROC).
Results: There were 37 male and 22 female subjects, with a mean age of 45.8 ± 12.78 years. Thirty-five
patients (58.33%) had CHB, of whom 36 (60%) had significant liver fibrosis. The respective mean serum IgM,
IgG, IgA, total Ig and serum globulin levels were 1.4 ± 0.8,17.1 ± 4.5, 3.4 ± 1.8,21.9 ± 5.6 and 37.6 ± 6.2, and the
AUROCs were 0.57, 0.67, 0.72, 0.71 and 0.72 were significant fibrosis, respectively. By multivariate analysis,
three important predictors of significant fibrosis were serum globulin level (OR 5.10; 95% CI 1.07-24.22, p = 0.04),
aspartate aminotransferase to platelet count ratio index (APRI) (OR 9.99; 95% CI 2.45-40.73, p = 0.001) and serum
IgA (OR 5.35; 95% CI 1.29-22.17, p = 0.021).
Conclusion: Serum globulin, APRI and serum IgA can serve as noninvasive markers of significant
hepatic fibrosis. This observation, if confirmed, has important implications for the management of patients with
CHB and CHC infections. |
file/Thai-Journal-of-gastroenterology-vol-11-no-1-1427223.pdf