Dissertação (mestrado)—Universidade de Brasília, Faculdade de Medicina, 2010. / Submitted by Larissa Ferreira dos Angelos (ferreirangelos@gmail.com) on 2011-05-10T19:33:03Z
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2010_MarceloAbrahãoCosta.pdf: 4749695 bytes, checksum: 1b035f8db97056a2edd6efb3c2d337c1 (MD5) / INTRODUÇÃO: Para a infecção crônica pelo vírus da hepatite B (HBV) HBeAg negativo, a aplicabilidade clinica da quantificação do HBVDNA (carga viral) ficou mais clara nos últimos cinco anos, principalmente quanto ao diagnostico, a evolução e ao tratamento da infecção, influenciando, sobremaneira, a decisão de tratar. OBJETIVOS: Analisar a concordância dos títulos de carga viral quantificados por dois métodos distintos de biologia molecular e estimar as associações existentes entre carga viral e achados histológicos, ajustando por variáveis clinicas e laboratoriais selecionadas. MÉTODOS: Portadores de hepatite B crônica HBeAg negativo foram estudados quanto as suas características clinicas, laboratoriais, ecográficas e histológicas. Analises de correlação entre essas variáveis e as cargas virais – quantificadas com Amplicor (AMPL) e Taqman (TQM) foram realizadas. As concordâncias brutas e ajustadas por chance (índice Kappa) entre cargas virais obtidas pelas técnicas baseadas na reação de cadeia de polimerize (PCR) foram analisadas. RESULTADOS: Avaliados 54 pacientes (homens=33, 61,1%), a media de idade foi de 41,22 anos. Consumo de etanol era nulo em 66,7% (36/54). TGO estava aumentada em 48% (26/54) dos pacientes, com media de 30,83 ui/ml. TGP apresentava-se aumentada em aproximadamente 60% (32/54) dos pacientes estudados, com valor médio de 39,17 ui/mL. Quando os dois testes foram simultâneos em amostras pareadas, a media das cargas virais aferidas pelo TQM foi superior a media daquelas aferidas pelo AMPL (p<0,0001). AMPL detectou cargas virais < 2.000ui/ml em 74% dos pacientes (37/50). Para esse grupo, TQM detectou cargas virais ≥2.000ui/ml em 46% (17/37) dos pacientes. As variáveis independentes associadas a fibrose foram: idade, plaquetas, bilirrubina total e carga viral TQM. CONCLUSÃO: A concordância Kappa=0,31 entre os dois testes quantitativos de carga viral foi considerável (p<0,0001). Sem os resultados do teste TQM, mais da metade (54,8%) dos pacientes que tivessem sua avaliação limitada ao teste AMPL nao seriam considerados candidatos a tratamento. _______________________________________________________________________________________ ABSTRACT / INTRODUCTION: In chronic hepatitis B virus (HBV) infected patients with hepatitis B e antigen (HBeAg) negative strand, the clinical relevance of serum HBV DNA measurement became clearer in the past five years regarding diagnosis, evolution and treatment. Starting therapy is directly influenced by quantitative evaluation of HBV viral load among other relevant variables. AIM: evaluate HBVDNA quantification concordance using two distinct PCR assays, Amplicor (AMPL) and Taqman (TQM), and estimate associations between viral load and biopsy findings, adjusting for clinical and laboratory variables. METHODS: 54 patients with HBeAg-negative chronic HBV infection were studied. Correlations between demographic, clinical, laboratory and HBVDNA variables were estimated. Serum HBV DNA quantification was obtained using two distinct assays. The concordance between these tests was estimated by Kappa index. RESULTS: Mean age was 41,9years, male patients predominant (61,1%). Ethanol use was absent in 36 individuals (66,7%), and less than 40g/day for all subjects enrolled. AST activity and ALT activity were abnormal at baseline in 48% (26/54) and in 60% (32/54), with mean values of 30,83 iu/ml and 39,17 iu/ml, respectively. For simultaneous quantification of HBVDNA, the mean viral load obtained with TQM assay was greater compared to AMPL assay (p<0,0001). Viral load obtained with AMPL was less than 2,000 iu/ml in 74% of patients (37/50). The TQM assay was able to detect HBVDNA levels greater than 2,000 iu/ml in 46% (17/37) of patients in this group. Independent variables associated with fibrosis were: age, platelets, total bilirubin and TQM viral load. CONCLUSION: The concordance of 0.31 between TQM and AMPL quantitative tests estimated by Kappa was considered considerable (p<0,0001). However, without simultaneous testing using TQM assay approximately half of patients with their evaluation limited to AMPL testing would not be adequately considered candidates for therapy.
| Identifer | oai:union.ndltd.org:IBICT/oai:repositorio.unb.br:10482/7665 |
| Date | January 2010 |
| Creators | Costa, Marcelo Abrahão |
| Contributors | Duarte, Elisabeth Carmen, Souto, Francisco José Dutra |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Source | reponame:Repositório Institucional da UnB, instname:Universidade de Brasília, instacron:UNB |
| Rights | info:eu-repo/semantics/openAccess |
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