Correlation entre la biopsie hépatique et le Fibrotest dans l’évaluation de la fibrose hépatique chez les patients atteints d’hépatite chronique C.
Mots-clés :
hepatite C, fibrose, foie, biopsie, marqueurs biologiquesRésumé
Buts: Déterminer la valeur diagnostique du Fibrotest en comparaison avec la biopsie hépatique dans l’évaluation de la fibrose hépatique chez les patients atteints d’hépatite chronique C.
Méthodes: Cette étude prospective menée sur 2 ans (2006-2007) a inclu des patients consécutifs atteints d’hépatite chronique C et naifs au traitement. Le Fibrotest et la biopsie hépatique ont été réalisés. les courbes ROC (Receiver operating characteristics), la sensibilité, la specificité, les valeurs prédictives positive et negative ont été utilisées pour évaluer la valeur diagnostique du Fibrotest par rapport à la classification de METAVIR.
Résultats: Nous avons inclu 65 patients: 28 hommes et 37 femmes (âge moyen : 50 years); 92% de nos patients avaient un génotype 1.
A l’histologie, les résultats de la fibrose étaient : 3. 1% F0; 24. 6% F1; 32. 3%F2; 29. 2%F3 et 10. 8 %F4. La valeur diagnostique du Fibrotest dans la détection de la fibrose significative (F2-F4) était de 0. 87. Un score >0. 5 avait une sensibilté de 85. 1%, une specificité de 72. 2%, une valeur prédictive positive de 88. 9%, et une valeur prédictive négative de 65 %. La valeur diagnostique du Fibrotest dans la detection de la cirrhosis (F4 ) était de 0. 85. Il a été noté 13/65 cas de discordance (20%) pour la fibrose, 4 cas ont été attribués à la biopsie et 6 cas au Fibrotest. La discordance était inexpliquée dans 3 cas. La taille de la biopsie <15mm [OR=2. 82, 95% CI, 1. 3–6. 07; p =0. 008] et le stade de fibrose F0, F1, F2 [OR =3. 35 , 95% CI, 1. 1–10. 2; p =0. 03] étaient considérés comme facteurs de risque de discordance en analyse multivariée.
Conclusion: cette étude prospective confirme la bonne valeur diagnostique du Fibrotest par rapport à l’examen histologique du foie.
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