RESUMEN
BACKGROUND: Hepatocellular carcinoma (HCC) is the most common primary liver cancer in the world. Clinical and laboratory evaluation of a cirrhotic patient with a liver nodule may show alterations suggesting malignancy. There is a lack of questions related to diagnosis of HCC and evaluation of liver imaging reporting and data system (LI-RADS) could be a tool for early diagnosis of HCC. This aims to confirm an association between clinical and laboratory characteristics in cirrhotic patients with hepatic nodule after LI-RADS categorization. METHODS: A cross-sectional retrospective study was performed with 62 patients grouped according to LI-RADS algorithm. Differences between groups were confirmed using association tests and the Kappa test was employed to provide further confirmation. RESULTS: Associations were observed after univariate analysis with higher values of aspartate aminotransferase (AST) (P=0.008), alanine aminotransferase (ALT) (P=0.019), alkaline phosphatase (ALP) (P=0.0052), gamma glutamyl transferase (GGT) (P=0.0023), alpha-fetoprotein (AFP) (P=0.0001), nodule size (P=0.0001) and age (P=0.007) in LR 5 group compared to LR 3. Univariate analysis also revealed higher levels for the LR5 group of ALP (P=0.0228), AFP (P=0.022) and age (P=0.046) in relation to LR 1+2 group. AFP also had higher serum levels in the LR 4 group compared to LR 1+2 (P=0.004). After multivariate analysis, higher levels in LR5 group of nodule size (P=0.047) and ALP (P=0.027) were observed in relation to LR3, and were therefore considered predictors of HCC diagnosis. CONCLUSIONS: The study suggests that the combination of clinical-laboratory and radiological factors, such as heightened serum levels of ALP and hepatic nodule size, may support the screening of HCC in cirrhotic patients with hepatic nodules using the LI-RADS algorithm.
RESUMEN
Com o objetivo de estudar a perda protéica instestinal, em adolescentes e adultos jovens, com esquistossomose mansônica, por meio da excreção fecal de alfa-1-at, foram analisados, 56 indivíduos, alocados em2 grupos: G1- 27 pacientes da forma hepatoesplênica, submetidos a esplenectomia, ligadura da veia gástrica esquerdae auto-implante esplênico; G2 -29 indivíduos sem esquistossomose (grupo de comparação). Como objetivos secundários, investigou-se a possível correlação entre alfa-1-at fecal e: o número de ovos de S. mansoni nas fezes e os graus de fibrose periportal, nos pacientes do G1. Foram excluídos do estudo pacientes comcardiopatias, nefropatias, outras hepatopatias, e positividade para o AgHBs. A alfa-1- at fecal foi dosada, pela técnica de imunodifusão radial, em placas de gel, LC Partigen Dade Behing, em amostras de fezes coletadas durante 48 horas, em todos os indivíduos. A análise estatística dos dados demonstrou que: não houve diferençã estatisticamente significante entre as média de alfa 1-at fecal, nos dois grupos estudados (t de Student: p>0,05); não houve correlação entre o valor de alfa-1 at fecal e a carga parasitária dos pacientes do G1 (coeficiente de correlação de Pearson: r=0,20: p=0,321), bem como as diferenças entre as médias de alfa-1-at fecal, segundo os graus de fibrose periportal, não foram estatisticamente significantes (ANOVA, p=0,225)
