fa بررسی ارزش بالینی شاخص‌های غیرتهاجمی در پیشگویی فیبروز کبدی پیشرفته در کودکان مبتلا به هپاتیت خودایمن گوارش و کبد Gastroenterology and Hepatology پژوهشي-کامل Research(Original) <span style="font-size:12pt"><span style="line-height:200%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><span lang="FA" style="line-height:200%"><span b="" nazanin="" style="font-family:"><strong>&nbsp;</strong></span></span></span></span></span></span><span style="line-height:90%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><span lang="FA" style="line-height:90%"><span b="" koodak="" style="font-family:"><span style="color:black"><span style="letter-spacing:-.1pt">سابقه</span></span></span></span><span lang="AR-SA" style="line-height:90%"><span b="" koodak="" style="font-family:"><span style="color:black"><span style="letter-spacing:-.1pt"> و هدف:</span></span></span></span> <span b="" style="font-family:" zar=""><span style="letter-spacing:-.2pt">بیوپسی معیار استاندارد تشخیص فیبروز کبدی است، اما به‌دلیل تهاجمی بودن، خطر عوارض و خطاهای</span></span><span b="" style="font-family:" zar=""> <span style="letter-spacing:-.2pt">نمونه</span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="color:black"><span style="letter-spacing:-.2pt">‌</span></span></span></span><span b="" style="font-family:" zar=""><span style="letter-spacing:-.2pt">گیری، به‌طور گسترده برای پایش فیبروز کبد استفاده نمی‌شود. این مطالعه با هدف ارزیابی اهمیت بالینی چندین شاخص</span></span><span b="" style="font-family:" zar=""> غیرتهاجمی در تشخیص بیماری و در پیش‌بینی فیبروز پیشرفته کبد درکودکان مبتلا به هپاتیت خودایمن(</span><span dir="LTR" lang="EN-CA" style="font-size:10.0pt"><span style="line-height:90%">AIH</span></span><span b="" style="font-family:" zar="">) انجام شد.</span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="color:#0e101a"></span></span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="line-height:90%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><span lang="AR-SA" style="line-height:90%"><span b="" koodak="" style="font-family:"><span style="color:black"><span style="letter-spacing:-.1pt">مواد و روش</span></span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="color:black"><span style="letter-spacing:-.1pt">‌</span></span></span></span><span lang="AR-SA" style="line-height:90%"><span b="" koodak="" style="font-family:"><span style="color:black"><span style="letter-spacing:-.1pt">ها:</span></span></span></span> <span lang="AR-SA" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="color:black"><span style="letter-spacing:-.1pt">در این مطالعه مقطعی آینده نگر، برای 40 کودک مبتلا به </span></span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%"><span style="color:black"><span style="letter-spacing:-.1pt">AIH</span></span></span></span><span lang="AR-SA" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="color:black"><span style="letter-spacing:-.1pt">، شمارش کامل خون و آزمایش‌های عملکرد کبد انجام شد و شاخص</span></span></span></span><span lang="AR-SA" style="line-height:90%"><span b="" style="font-family:" zar="">‌<span style="color:black"><span style="letter-spacing:-.1pt">های مشتق از آن</span></span>‌<span style="color:black"><span style="letter-spacing:-.1pt">ها محاسبه شد. تمامی بیماران مبتلا به </span></span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%"><span style="color:black"><span style="letter-spacing:-.1pt">AIH</span></span></span></span><span lang="AR-SA" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="color:black"><span style="letter-spacing:-.1pt"> بر اساس بیوپسی کبد به دو گروه فاقد فیبروز/فیبروز خفیف و فیبروز متوسط/شدید (فیبروز پیشرفته) تقسیم شدند.</span></span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="color:black"></span></span></span></span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="line-height:90%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><span lang="AR-SA" style="line-height:90%"><span b="" koodak="" style="font-family:"><span style="color:black"><span style="letter-spacing:-.2pt">یافته</span></span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="color:black"><span style="letter-spacing:-.2pt">‌</span></span></span></span><span lang="AR-SA" style="line-height:90%"><span b="" koodak="" style="font-family:"><span style="color:black"><span style="letter-spacing:-.2pt">ها:</span></span></span></span> <a name="_Hlk135830633"><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar="">در بیماران مبتلا به </span></span></a><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%">AIH</span></span><span style="line-height:90%"><span b="" style="font-family:" zar=""> میزان شاخص نسبت آسپارتات آمینوترانسفراز به پلاکت (</span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%">APRI</span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar="">) و شاخص فیبروز بر اساس چهار فاکتور (</span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%">FIB-4</span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar="">)، افزایش معنی<span style="color:black">‌</span>دار (0/001</span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%">P<</span></span><span b="" style="font-family:" zar="">) </span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar="">و میزان شاخص نسبت نوتروفیل به لنفوسیت (</span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%">NLR</span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar="">)، کاهش معنی<span style="color:black">‌</span>دار (0/041</span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%">P=</span></span><span b="" style="font-family:" zar="">) </span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar="">در مقایسه با افراد سالم داشت. در بیماران مبتلا به فیبروز پیشرفته، میزان بیلی روبین مستقیم (</span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%">DBIL</span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar="">) و </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%">APRI</span></span><span style="line-height:90%"><span b="" style="font-family:" zar=""> به‌طور قابل توجه بیش</span></span><span lang="AR-SA" style="line-height:90%"><span b="" style="font-family:" zar="">‌</span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar="">تر و میزان آلبومین به طور قابل توجه کم</span></span><span lang="AR-SA" style="line-height:90%"><span b="" style="font-family:" zar="">‌</span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar="">تر در مقایسه با گروه فاقد فیبروز/فیبروز خفیف بود. <span style="letter-spacing:-.1pt">تجزیه و تحلیل سطح زیر منحنی مشخصه عملکرد گیرنده (</span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%"><span style="letter-spacing:-.1pt">AUC</span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.1pt">) نشان داد که </span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%"><span style="letter-spacing:-.1pt">FIB-4</span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.1pt"> و </span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%"><span style="letter-spacing:-.1pt">APRI</span></span></span><span style="line-height:90%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.1pt"> برای تشخیص بیماری </span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%"><span style="letter-spacing:-.1pt">AIH</span></span></span> <span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar="">در کودکان و </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%">DBIL</span></span><span style="line-height:90%"><span b="" style="font-family:" zar=""> و </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%">APRI</span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""> برای تشخیص فیبروز پیشرفته کبدی در کودکان مبتلا به </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%">AIH</span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""> دارای ارزش بالینی هستند.</span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="color:black"></span></span></span></span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="line-height:90%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><span lang="AR-SA" style="line-height:90%"><span b="" koodak="" style="font-family:"><span style="color:black"><span style="letter-spacing:-.2pt">استنتاج:</span></span></span></span> <span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%">APRI</span></span><span style="line-height:90%"><span b="" style="font-family:" zar=""> می‌تواند به‌عنوان شاخص‌ مرجع برای تشخیص بیماری </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%">AIH</span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""> در کودکان و نیز پایش فیبروز کبدی در کودکان مبتلا به </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%">AIH</span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""> مورد استفاده قرار گیرد.</span></span><span lang="AR-SA" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="color:black"><span style="letter-spacing:-.2pt"></span></span></span></span></span></span></span></span></span></span></span><br> &nbsp; <b><span lang="EN" style="font-size:12.0pt"><span style="line-height:115%"><span new="" roman="" style="font-family:" times="">&nbsp;</span></span></span></b><span style="font-size:12pt"><span style="line-height:135%"><span new="" roman="" style="font-family:" times=""><b><span style="font-size:10.0pt"><span style="line-height:135%"><span arial="" style="font-family:"><span style="letter-spacing:-.2pt">Background and purpose:</span></span></span></span></b> <span style="font-size:10.0pt"><span style="line-height:135%"><span style="letter-spacing:-.2pt">Biopsy is the standard criterion for the diagnosis of liver fibrosis, but it is not widely used for liver fibrosis monitoring due to its invasive nature, risk of complications, and sampling </span></span></span><span style="font-size:10.0pt"><span style="line-height:135%">errors. This study aimed to evaluate the clinical significance of several noninvasive indices in diagnosis of the disease and in prediction of advanced liver fibrosis in children with autoimmune hepatitis (AIH).</span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="line-height:135%"><span style="text-autospace:none"><span new="" roman="" style="font-family:" times=""><b><span style="font-size:10.0pt"><span style="line-height:135%"><span arial="" style="font-family:">Materials and methods:</span></span></span></b><b> </b><span style="font-size:10.0pt"><span style="line-height:135%">In a prospective cross-sectional study, in 40 children with AIH, complete blood count and liver function tests were performed and their derived indices were calculated. Based on liver biopsy, all patients with AIH were divided into two groups: absent/mild fibrosis and moderate/severe fibrosis (advanced fibrosis).</span></span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="line-height:135%"><span new="" roman="" style="font-family:" times=""><b><span style="font-size:10.0pt"><span style="line-height:135%"><span arial="" style="font-family:">Results:</span></span></span></b><b> </b><span style="font-size:10.0pt"><span style="line-height:135%"><span style="letter-spacing:-.2pt">In patients with AIH, aspartate aminotransferase to platelet ratio index (APRI) and fibrosis </span></span></span><span style="font-size:10.0pt"><span style="line-height:135%">index based on four factors (FIB-4) increased significantly (P<0.001) and neutrophil to lymphocyte ratio <span style="letter-spacing:-.2pt">index (NLR) decreased significantly (P=0.041) compared to healthy individuals</span></span></span><span lang="EN-GB" style="font-size:8.0pt"><span style="line-height:135%"><span style="letter-spacing:-.2pt">. </span></span></span><span style="font-size:10.0pt"><span style="line-height:135%"><span style="letter-spacing:-.2pt">In patients with advanced</span></span></span><span style="font-size:10.0pt"><span style="line-height:135%"> fibrosis, direct bilirubin (DBIL) and APRI levels were considerably higher and albumin levels were considerably lower compared to the absent/mild fibrosis group. Analysis of the area under the receiver operating characteristic curve (AUC) showed that FIB-4 and APRI have clinical value for the diagnosis of AIH in children while DBIL and APRI had clinical value in diagnosis of advanced liver fibrosis in these children.</span></span></span></span></span><br> <span style="font-size:12pt"><span style="line-height:135%"><span style="vertical-align:top"><span new="" roman="" style="font-family:" times=""><b><span style="font-size:10.0pt"><span style="line-height:135%"><span arial="" style="font-family:">Conclusion:</span></span></span></b> <span style="font-size:10.0pt"><span style="line-height:135%">APRI can be used as a reference index in diagnosis of AIH in children and to monitor liver fibrosis in children with autoimmune hepatitis.</span></span><i><span style="font-size:10.0pt"><span style="line-height:135%"></span></span></i></span></span></span></span><br> &nbsp; هپاتیت خودایمن, شاخص غیرتهاجمی, بیوپسی کبد, فیبروز کبد, APRI autoimmune hepatitis, noninvasive index, liver biopsy, liver fibrosis, APRI 65 76 http://jmums.mazums.ac.ir/browse.php?a_code=A-10-16339-1&slc_lang=fa&sid=1 Soudabeh Hamedi-Shahraki سودابه حامدی شهرکی s.hamedy1@gmail.com 1003194753284600154912 1003194753284600154912 No Assistant Professor, Department of Epidemiology and Biostatistics, Faculty of Public Health, Zabol University of Medical Sciences, Zabol, Iran استادیار، گروه اپیدمیولوژی و آمار، دانشکده بهداشت، دانشگاه علوم پزشکی زابل، زابل، ایران Farshad Amirkhizi فرشاد امیرخیزی amirkhizi.f@gmail.com 1003194753284600154913 1003194753284600154913 No Assistant Professor, Department of Nutrition, Faculty of Public Health, Zabol University of Medical Sciences, Zabol, Iran استادیار، گروه تغذیه، دانشکده بهداشت، دانشگاه علوم پزشکی زابل، زابل، ایران Soheil Pourheidar سهیل پورحیدر science8mind@gmail.com 1003194753284600154914 1003194753284600154914 No Medical Student, Student Research Committee, Faculty of Medicine, Zabol University of Medical Sciences, Zabol, Iran دانشجوی پزشکی، مرکز تحقیقات دانشجویی، دانشکده پزشکی، دانشگاه علوم پزشکی زابل، زابل، ایران Abbas Pishdadian عباس پیشدادیان pishdadian_44@yahoo.com 1003194753284600154915 1003194753284600154915 Yes Assistant Professor, Department of Immunology, Faculty of Medicine, Zabol University of Medical Sciences, Zabol, Iran استادیار، گروه ایمونولوژی، دانشکده پزشکی، دانشگاه علوم پزشکی زابل، زابل، ایران