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Marqueurs non-invasifs de stéatose et fibrose hépatique

Abstract : Several non-invasive methods have been proposed to replace liver biopsy. Transient elastography and FibroTest are the most widely used and best validated non-invasive methods to assess liver fibrosis. Subjects with metabolic disorders such as type-2 diabetes or dyslipidemia, have a high risk of non-alcoholic fatty liver disease (NAFLD). Evidence was previously provided to indicate that NAFLD is associated with an increased risk of cardiovascular disease and overall mortality. The aims of this thesis were. 1) to evaluate the main limitations of non-invasive methods to assess liver fibrosis. 2) to evaluate the prognostic value of liver biomarkers, such as FibroTest and SteatoTest, in patients with type-2 diabetes and/or dyslipidemia. We demonstrated a marked interobserver variability of transient elastography between two experienced operators in chronic hepatitis C. Hepatic steatosis, estimated by SteatoTest, was identified as an independent factor associated with an overestimation of liver fibrosis by transient elastography in patients with type-2 diabetes. We could also show the variability of the APRI test, based on the expression of aspartate aminotransferase relative to the upper limit of normal and the risk of overestimating fibrosis stage by this test due to necro-inflammatory activity in chronic hepatitis C. We reported that FibroTest and SteatoTest had a 10-year prognostic value for prediction of overall mortality independently of metabolic factors in patients at high risk of NAFLD. FibroTest was also predictive of liver-related death and incidence of cardiovascular events. In addition, SteatoTest had a prognostic value for cardiovascular-related death.
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https://tel.archives-ouvertes.fr/tel-00989999
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Submitted on : Monday, May 12, 2014 - 6:23:08 PM
Last modification on : Saturday, December 4, 2021 - 4:02:11 AM
Long-term archiving on: : Tuesday, August 12, 2014 - 12:16:07 PM

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Hugo Perazzo Pedroso Barbosa. Marqueurs non-invasifs de stéatose et fibrose hépatique. Sciences agricoles. Université Pierre et Marie Curie - Paris VI, 2014. Français. ⟨NNT : 2014PA066046⟩. ⟨tel-00989999⟩

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