ABSTRACT
BACKGROUND/AIM: The main objective of this study was to describe the profile of patients who were benefitted in a collective effort to perform liver biopsies in Bahia, Brazil. METHOD: A cross-sectional study was conducted with a sample composed of all the patients who were submitted to liver biopsy during a collective effort carried out in Bahia between July 2007 and November 2009. At the time of the procedure, date on the age and gender of patients and the reason for performing the biopsy were recorded. Data on the degree of fibrosis and the presence of co-morbidities. Following statistical analysis, the frequency of the liver diseases that led to the biopsy procedure was described, and the profile of the patients was stratified into groups according to the most prevalent etiologies. RESULTS: Of the 550 patients evaluated, 55.3% were men and 44.7% women. Mean age was 46.63 ± 11.59 years and there was no statistically significant difference in age between males and females. Of the 550 patients, 72% had hepatitis C and the mean age of these patients was 48.49 ± 10.1 years, significantly higher than the mean age of the patients with hepatitis B (40.41 ± 12.43 years). Furthermore, 70.7% of the patients with hepatitis C were between 41 and 60 years of age. The most frequent fibrosis grade was F2 (44%) and the prevalence of advanced fibrosis was 27.7%. Overall, 85 patients, most of them men, had some degree of iron overload. With respect to the safety of the biopsy procedure, severe complications occurred in only two patients. CONCLUSION: Hepatitis C is the predominant liver disease that demanded liver biopsy. The profile of the patients who benefitted from this collective effort is similar to that of patients in the rest of the country. Moreover, non-Ultrasonography guided liver biopsy is safe and the collective effort to carry out liver biopsies in Bahia was found to be a viable venture.
Subject(s)
Biopsy/standards , Liver Diseases/epidemiology , Liver/pathology , Adult , Biopsy/adverse effects , Brazil/epidemiology , Chi-Square Distribution , Comorbidity , Cross-Sectional Studies , Female , Hepatitis B/epidemiology , Hepatitis B/pathology , Hepatitis C/epidemiology , Hepatitis C/pathology , Hepatitis, Autoimmune/epidemiology , Hepatitis, Autoimmune/pathology , Humans , Hypertension, Portal/epidemiology , Hypertension, Portal/pathology , Liver Cirrhosis/epidemiology , Liver Cirrhosis/pathology , Liver Diseases/diagnosis , Liver Diseases/pathology , Male , Middle Aged , Predictive Value of Tests , Referral and Consultation/standards , Risk Assessment , Risk Factors , Severity of Illness Index , Time FactorsABSTRACT
INTRODUÇÃO: Esteatose ocorre com freqüência na hepatite crônica pelo vírus C (HCV) e parece estar relacionada a fatores clínicos e/ou virológicos. Contudo, a presença de esteato-hepatite, uma condição indutora de fibrose, tem sido pouco estudada. OBJETIVO: Estudar a associação de HCV com esteato-hepatite em material de biópsia hepática, correlacionando-a com dados clínicos. MÉTODOS: As biópsias hepáticas de pacientes com HCV foram avaliadas quanto a atividade, estádio e presença de alterações morfológicas de esteato-hepatite. Os dados morfológicos foram correlacionados a parâmetros clínicos que incluíam: consumo alcoólico, IMC, colesterol, triglicérides, glicemia, exposição a petroquímicos e genótipo viral. RESULTADOS: Esteato-hepatite foi encontrada em 42 de 252 (16,6 por cento) pacientes com HCV. Entre os 42 casos, critérios para obesidade, diabetes e dislipidemia foram encontrados em 16,7 por cento; 16,7 por cento e 21,4 por cento, respectivamente. O genótipo 3 esteve presente em 38,1 por cento dos casos. Fatores de risco para esteato-hepatite não-alcoólica (NASH) foram encontrados em 73 por cento dos casos em genótipos diferentes do 3, enquanto tais fatores foram presentes em 37,5 por cento dos casos com genótipo 3 (p = 0,05). O padrão morfológico mais freqüente foi a esteatose macrovacuolar de moderada intensidade (61,9 por cento) com distribuição difusa (64,3 por cento). Tanto o padrão de fibrose de NASH quanto o de HCV foram notados: fibrose perissinusoidal (87,8 por cento), portal (87,8 por cento), septal (69,0 por cento) e cirrose (30,9 por cento). CONCLUSÕES: Esteato-hepatite é freqüente em pacientes com HCV, apresentando padrão peculiar de distribuição da esteatose e alta freqüência de cirrose. Em genótipos diferentes do 3, a esteato-hepatite parece estar relacionada à sobreposição de fatores de risco para NASH.
