ABSTRACT
Objective To establish a noninvasive diagnostic model for chronic hepatitis B (CHB) liver fibrosis based on LASSO regression using serological parameters, and to investigate the value of this model in the diagnosis of CHB liver fibrosis. Methods A total of 240 patients who were diagnosed with CHB in Changzhou Second People's Hospital, Nanjing Medical University, from September 2019 to September 2021 were enrolled as subjects, and according to the results of liver biopsy and pathology, they were divided into significant liver fibrosis (stage F2-F4) group with 175 patients and non-significant liver fibrosis (stage F0-F1) group with 65 patients. The two groups were compared in terms of sex, age, blood biochemical parameters, and liver stiffness measurement (LSM) measured by two-dimensional shear wave elastography, and LASSO regression and the multivariate logistic regression analysis were used screen out the risk factors for liver fibrosis. A nomogram model was established and then verified by the receiver operating characteristic (ROC) curve, calibration curve, and decision curve. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the least significant difference t -test was used for further comparison between two groups; the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. Results There were significant differences between the patients with stage F3/F4 liver fibrosis and those with stage F2/F0-F1 liver fibrosis in age, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma-glutamyl transpeptidase, total bilirubin, platelet count, procollagen type Ⅲ, type Ⅳ collagen, hyaluronic acid, and LSM (all P < 0.05). Five important variables were screened out by LASSO regression, and the logistic regression analysis showed that hyaluronic acid (odds ratio [ OR ]=1.432, P < 0.05), type Ⅳ collagen ( OR =1.243, P < 0.05), procollagen type Ⅲ( OR =1.146, P < 0.05), and LSM ( OR =1.656, P < 0.05) were the independent risk factors for liver fibrosis, while platelet count ( OR =0.567, P < 0.05) was a protective factor. Compared with the patients with stage F2/F0-F1 liver fibrosis, the patients with stage F3/F4 liver fibrosis had significantly higher score of the nomogram model, LSM, aspartate aminotransferase-to-platelet ratio index (APRI), King score, Forns index, and fibrosis-4 (FIB-4) index (all P < 0.05). The ROC curve was used to analyze the predictive value of the nomogram model, and the results showed an area under the ROC curve of 0.876, which was significantly higher than that of LSM, APRI, King score, Forns index, and FIB-4 (all P < 0.05). Calibration curve and decision curve showed that the nomogram model had acceptable consistency and benefit. Conclusion The noninvasive nomogram model based on LASSO regression is established by using serum parameters including hyaluronic acid, type Ⅳ collagen, procollagen type Ⅲ, platelet count, and LSM, and as a quantitative tool for the clinical diagnosis of CHB liver fibrosis, it has a high diagnostic efficiency and thus holds promise for clinical application.
ABSTRACT
Objective To investigate the metabolism characteristics and the potetial biomarker candidates of osteonecro?sis of the femoral head (ONFH) using metabolomic technology. Methods The femoral head specimens from 23 ONFH patients (25 necrotic femoral heads) and 18 normal femoral heads from femoral neck fracture patients were collected for histopathological examination to confirm the diagnosis of all samples. All the metabolites of bone trabecula were extracted for ultra-high perfor?mance liquid chromatography-MS/MS analyzed. The measured variables was pretreat, and PCA (principal component analysis), PLS?DA (partial least squares?discriminant analysis) and OPLS?DA (orthogonal?partial least squares?discriminant analysis) models were employed to confirm the difference between these two groups after UPLC?MS/MS (ultra?high performance liquid chromatogra?phy?mass spectrometry/mass spectrometry) analysis. At last, the differential variables were screened out by PLS?DA and variate analysis (Kruskal?Wallis H test). The changed metabolites were confirmed by MS and MS/MS aligned in HMDB (human metabolo?mic database) and Massbank. The changed metabolites with the most obviously changed peak abundance, D?arginine, L?proline and L?glutamine, were picked out as the potential diagnostic biomarkers. After binary logistic regression analysis, the combined biomarkers candidates were further analyzed by receiver operating characteristic (ROC) curve to evaluate the significance of the combined biomarkers. Results Significant distinction of metabolites expression mode can be seen in PCA, PLS?DA and OPLS?DA models scoring plots between ONFH and control groups. Twelve changed metabolites in ONFH bone trabeculas were con?firmed by multi?variate statistical analysis and variate statistical analysis. Compared with the femoral neck fracture patients, the in?creased metabolites included D?arginine, L?proline, L?glutamine, creatine, uracil, uridine, LysoPC(20∶4(5Z, 8Z, 11Z, 14Z)), Ly?soPC(16∶0), PC(20∶1(11Z)/18∶3(6Z, 9Z, 12Z)) and PE(P?16∶0e/0∶0). The decreased metabolites were reticulataxanthin and β?cryptoxanthin. According to the change fold of peak abundance and variable weight projection in PLS?DA, the most obviously dif? ferential metabolites were picked out as the biomarker candidates of ONFH. The potential biomarkers candidates were identified as D?arginine, L?proline and L?glutamine. The area under the curve of D?arginine, L?proline and L?glutamine ROC were 0.873, 0.712 and 0.862. The area under the curve of ROC was 0.946 after combining D?arginine, L?proline, L?glutamine using binary lo?gistic regression analysis. Conclusion PCA, PLS?DA and OPLS?DA models were used to find out the differential variables in the metabolites of bone trabeculas in ONFH and femoral neck fracture patients. Twelve metabolites were identified by MS/MS, and 3 obviously changed metabolites, D?arginine, L?proline, L?glutamine, were indicated as biomarker candidates. These 3 obviously changed metabolites showed a good diagnostic significance.
ABSTRACT
Objective To evaluate the efficacy of PGE_1 for the treatment of hyperbilirubinemia due to viral hepatitis.Methods A prospective,randomized,single blind and parallel control clinical study enrolled 100 patients with icterohepatitis,who were randomized 1∶1 to two treatment groups;Each group was intravenously infused daily over a six-week treatment period:(1)200?g of PGE_1 injection;(2)20ml of potassium-magnesium aspartate injection.Results The PGE_1 treated patients were more superior in the recoveries of physical characteristics,icteric index and liver functions to the control group.The statistical difference of the PGE_1 group from the potassium-magnesium aspartate in the treatment of icterohepatitis occurred in the 3rd week of the therapy(P0.05).Conclusion PGE_1 is effective in the treatment of the acute or chronic viral hepatitis and the hyperbilirubinemia caused by early stage severe hepatitis.
ABSTRACT
Objective To study clinical features and its diagnosis and treatment of alcoholic cirrhosis.Methods 68 cases with alcoholic cirrhosis were retrospectively analyzed,with cirrhosis from hepatitis B as control.Results Alcoholic cirrhosis accounted for 8.5% of in-patient cirrhosis in the correspomding period,mean age being(53.5?14.6),and with more than 135g alcohol intake per day which persisted over 10 years.Such signs significantly increased as dark complexion,liver palms,spider naevi,hepatomegaly,ynecomastia,hypertrophy of parotid gland,?-glutamyltansferase(GGT),ratio of aspartate aminotransferase(AST) to alanine aminotransferase(ALT),mean corpuscular volume(MCV),uric acid(UA),serum ferritin(SF) rose apparently,usually combined with hepatogenic diabetes,peptic ulcer,hyperuricemia,hyperlipemia.Peculiar complication were alcohol withdrawal syndrome,gort,gouty arthritis,aseptic necrosis of femur.Among them,53 cases(77.9%) improved clinically,9 cases(13.2%) showed no effect,6 cases(8.8%) died.Conclusions Occurrence of dark complexion,liver palms,spider naevi,hepatomegaly,ynecomastia,hypertrophy of parotid gland and test of GGT,AST/ALT,MCV,UA,SF are helpful to clinic and differentiation diagnosis of alcoholic cirrhosis,abstinence are not able to prevent its development.Long-term therapy aiming at endotoxin toxemia might improve prognosis of alcoholic cirrhosis.