Surveillance of the progression and assessment of treatment endpoints for nonalcoholic steatohepatitis

Nonalcoholic steatohepatitis (NASH) is an aggressive form of nonalcoholic fatty liver disease (NAFLD) characterized by steatosis-associated inflammation and liver injury. Without effective treatment or management, NASH can have life-threatening outcomes. Evaluation and identification of NASH patients at risk for adverse outcomes are therefore important. Key issues in screening NASH patients are the assessment of advanced fibrosis, differentiation of NASH from simple steatosis, and monitoring of dynamic changes during follow-up and treatment. Currently, NASH staging and evaluation of the effectiveness for drugs still rely on pathological diagnosis, despite sample error issues and the subjectivity associated with liver biopsy. Optimizing the pathological assessment of liver biopsy samples and developing noninvasive surrogate methods for accessible, accurate, and safe evaluation are therefore critical. Although noninvasive methods including elastography, serum soluble biomarkers, and combined models have been implemented in the last decade, noninvasive diagnostic measurements are not widely applied in clinical practice. More work remains to be done in establishing cost-effective strategies both for screening for at-risk NASH patients and identifying changes in disease severity. In this review, we summarize the current state of noninvasive methods for detecting steatosis, steatohepatitis, and fibrosis in patients with NASH, and discuss noninvasive assessments for screening at-risk patients with a focus on the characteristics that should be monitored at follow-up.

Preparation of Chinese national potency reference for hepatitis E vaccine / 中国生物制品学杂志

@#ObjectiveTo prepare the hepatitis E vaccine national potency reference for the quality control of hepatitis E vaccine.MethodsA batch of hepatitis E vaccine was selected as the row material,and the screened lyoprotectant was added. After aliquot and freeze-drying,it was prepared as candidate reference material,and the homogeneity and stability were investigated,which was distributed to four laboratories for collaborative calibration and applicability study.Results The 5% trehalose + 2% dextran was selected as the lyoprotectant to prepare the candidate reference material. The aliquot accuracy of candidate reference material was 0. 7%;The coefficient of variation(CV)of antigen content homogeneity was9. 0%;The CV of aluminum content homogeneity was 4. 0%. Moisture content was 1. 7%. The candidate reference material showed good acceleration stability and reconstituted stability. A total of 18 valid data were obtained from the collaborative calibration. The results showed that the average value of median effective dose(ED50)was 0. 15 μg(95% confidence interval of 0. 12 ～ 0. 18 μg)with the intra-laboratory CV of 30. 8% ～ 64. 2%,and the inter-laboratory CV of 32. 6%. Two hepatitis E vaccines produced by two laboratories themselves and the candidate reference material showed good dose-response relationship,of which the seroconversion rate decreased with the decrease of vaccine antigen content and the curve change trend was similar.ConclusionThe first Chinese national potency reference for hepatitis E vaccine(300031-201801)was prepared,which can be used for the quality control of potency ED50detection of hepatitis E vaccine.

Association between low vision and sleep duration among primary and middle school students / 预防医学

Objective @#To understand the relationship between sleep duration and low vision among primary and middle school students, so as to provide the reference for promoting eye health of primary and middle school students.@* Methods @#Using stratified cluster sampling method, the students were selected from four primary schools, four junior high schools and three senior high schools in Dinghai, Putuo, Daishan and Shengsi of Zhoushan. The questionnaire for the influencing factors of myopia in the national monitoring and intervention project of common diseases and influencing factors among students in 2019 was used to collect their demography, video display terminal use, outdoor activity, parents'myopia and sleep duration. The multivariate logistic regression model was established to analyze the relationship between sleep duration and low vision among the students. @*Results @#A total of 3 016 questionnaires were sent out, and 2 932 valid ones were returned. The effective rate was 97.21%. There were 1 537 ( 52.42% ) males and 1 395 females ( 47.58% ); 947 ( 32.30% ) primary school students and 1 985 ( 67.70% ) middle school students; 2 328 ( 79.40% ) students with low vision. There were 1 022 ( 34.85% ), 903 (30.80%), 697 ( 23.77% ) and 310 ( 10.57% ) students with the daily sleep duration of <8 hours, 8-<9 hours, 9-<10 hours and ≥10 hours, respectively. The multivariate logistic regression analysis showed that the risk of low vision was lower when the daily sleep duration of students was 8-<9 hours ( OR=0.735, 95%CI: 0.561-0.963 ) and 9-<10 hours ( OR=0.605, 95%CI: 0.446-0.825 ). @*Conclusion @#Adequate sleep duration is conducive to reduce the risk of low vision among primary and middle school students.

Anxiety and depression in junior high school students with myopia and their influencing factors in Zhoushan / 预防医学

Objective@#To learn anxiety and depression status in junior high school students with myopia in Zhoushan and their influencing factors,so as to provide reference for vision care and mental health intervention.@*Methods@#A stratified cluster random sampling method was used to select students from two junior high school in Zhoushan. A self-designed questionnaire,self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were employed to collect the demographic information,and to evaluate anxiety and depression status.The logistic regression analysis was used to select the influencing factors for anxiety and depression in myopia students.@*Results @#A total of 775 questionnaires were sent out and 766 valid ones were recovered,with an response rate of 98.84%. There were 662 students with myopia.The rates of anxiety,depression and the two combined in myopic students were 22.36%,25.38% and 14.35%,respectively.The results of the multivariate logistic regression analysis showed that the risk factors for anxiety of myopic students were females (OR=1.514,95%CI:1.054-2.183),the third grade (OR=2.246,95%CI:1.408-3.619),high myopia (OR=1.839,95%CI:1.126-3.017) and wearing glasses for two years or above (OR=2.504,95%CI:1.464-4.306); the risk factors for depression were females (OR=1.182,95%CI:1.253-2.536),above average of school record (OR:1.614-2.026,95%CI:1.034-3.153),high myopia (OR=2.284,95%CI:1.513-3.436) and wearing glasses for two years or above (OR=4.602,95%CI:2.035-10.372). @*Conclusions@#The prevalence rates of anxiety and depression are higher in junior high school students with myopia in Zhoushan. The students who are females,are in the third grade,have above average of school record,have high myopia and wearing glasses for two years or above are more likely to suffer from anxiety or depression.

Interpretation of Chinese and foreign guidelines for the diagnosis and management of nonalcoholic fatty liver disease / 中国实用内科杂志

With the prevalence of obesity and metabolic syndrome(MetS), nonalcoholic fatty liver disease(NAFLD) instead of chronic hepatitis B has been the most common cause of chronic liver disease in China. In order to standardize the diagnosis and treatment of NAFLD, the Fatty Liver Expert Committee of Chinese Medical Association issued “The guideline of prevention and treatment for nonalcoholic fatty liver disease” in March 2018, which was similar to the latest NAFLD Guidelines published by the AASLD, EASL and Asia-Pacific working party in the recent two years, but was different in details owing to the distinct condition of different countries. The purpose of the article is to help clinicians understand the guidelines more comprehensively and profoundly and guide their clinical work according to the interpretation of Chinese and overseas NAFLD guidelines.

Exercise prescription for non-alcoholic fatty liver disease / 中国实用内科杂志

Non-alcoholic fatty liver disease(NAFLD), which is a risk factor for multiple cardiovascular diseases, diabetes mellitus and chronic kidney disease, is the most common cause of chronic liver disease worldwide. The morbidity of NAFLD is increasing gradually.Therefore,it becomes more and more important to prevent and treat nonalcoholic fatty liver disease. Exercise therapy, as a therapeutic method, has been proven to improve nonalcoholic fatty liver disease by a large number of studies. This article reviews the effect of exercise therapy on non-alcoholic fatty liver, the formulation principle of exercise prescription and the therapeutic effect of exercise therapy on non-alcoholic fatty liver related risk factors,which may provide reference for exercise intervention in the treatment of nonalcoholic fatty liver disease.

Clinical dilemmas in non-alcoholic fatty liver disease / 中国实用内科杂志

With global epidemic of obesity and metabolic syndrome, nonalcoholic fatty liver disease(NAFLD) has becoming the most common cause of abnormal liver tests and chronic liver disease in the world including China. The editorial is focused on the clinical dilemmas of NAFLD, with the latest and most critical information regarding the pathogenesis and nature of the condition, the factors that lead to disease progression, how best to diagnosis and assess value of currently available different treatment measures.

Evaluation of the early effects of hyaluronate sodium eye drops combined with soft corneal contact lenses after pterygium excision surgeries / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To investigate the early effects of 3g/L sodium hyaluronate eye drops combined with soft contact lenses on corneal epithelial healing and local comfort.·METHODS: Totally 90 patients ( 90 eyes ) with primary monocular pterygium were randomly divided into three groups after pterygium excision surgeries ( n = 30, for each) . Each group received pterygium excision combined with limbal stem cell autograft transplantation. The research group wore soft corneal contact lens for 7d after the surgery, and the next day all of them were given 3g/L sodium hyaluronate and levofloxacin eye drops four times a day, tobrmycin and dexamethasone ophthalmic ointment once every night. The Group B did not wear the corneal contact lens, they were given levofloxacin eye drops four times a day and tobrmycin and dexamethasone ophthalmic ointment once every night. About the Group C, the 3g/L sodium hyaluronate eye drops was added on the basis of conventional medication of Group B. The time of corneal epithelial healing after surgery and the ocular pain score in different times were observed and contrasted.· RESULTS: Mean pain score of Group A were significantly lower than Group B and C at 6h, the first day and the third day after operation(P<0. 001), but there was no significant difference between the three groups at the fifth day and the seventh day (P>0. 05). The first day after the surgery, there were no eyes of corneal epithelium completely healed, but the complete healing rate of Group A were significantly higher than the other two group at the second day and the third day. (P<0. 05).·CONCLUSION: Early use of 3g/L hyaluronate sodium eye drops combined with soft corneal contact lenses after pterygium excision surgeries will not only accelerate corneal epithelial wound healing, but also relieve local pain, improve ocular comfort significantly.

Long-term use of first-line highly active antiretroviral therapy is not associated with carotid artery stiffness in human immunodeficiency virus-positive patients

Objective: To evaluate whether or not highly active antiretroviral therapy is associated with carotid artery stiffness in human immunodeficiency virus-positive patients in Henan Province, China. Method: Fifty human immunodeficiency virus-positive patients with at least a 5-year history of highly active antiretroviral therapy use and 50 human immunodeficiency virus-positive patients without a history of highly active antiretroviral therapy use were enrolled in this study. Carotid artery intima-media thickness and stiffness were determined by quantitative inter-media thickness and quantitative artery stiffness, respectively. Results: No statistically significant difference in carotid artery intima-media thickness and stiffness was observed between groups. A significant association between human immunodeficiency virus infection time and carotid artery stiffness was observed, but no significant association between human immunodeficiency virus infection time and intima-media thickness was found. No significant association between intima-media thickness, stiffness, and CD4+ and CD8+ T-cell counts were observed. Conclusion: The first-line highly active antiretroviral therapy currently used in China is not associated with carotid artery stiffness in human immunodeficiency virus-positive patients with good highly active antiretroviral therapy compliance. Human immunodeficiency virus may play a role in the development of atherosclerosis. .

An epidemiologic study on functional constipation among adult communities in Shanghai / 中华流行病学杂志

Objective To determine the prevalence and risk factors of functional constipation (FC) by using Rome Ⅲ criteria in the local adult communities.Methods A stratified randomized and community-based study by multi-stage cluster sampling was employed.A household survey was conducted from April to May 2010.All of the participants were interviewed face-to-face by filling out the self-administered questionnaires which based on Rome Ⅲ criteria for the diagnosis of FC.Self-rating anxiety scale (SAS),self-rating depression scale (SDS) and Athens insomnia scale (AIS) were carried out to evaluate the psychological characteristics and qualities of sleep.Results A total of 7648 subjects fulfilled the questionnaires,with the response rate as 90.0％.211 patients met the Rome Ⅲ criteria,including 90 males and 121 females.The adjusted prevalence rates of FC were 2.5％ in males,3.3％ in females and with an overall rate as 2.9％.The ratio of men to women was 1∶1.32,with significant difference between males and females (P=0.043).The most common group was in the 18-29 year-olds (x2=37.359,P=0.000).FC patients were more likely to be detected in the group with normal BMI (x2=16.087,P=0.002),having received high education (x2=27.604,P=0.000),being intelectuals ( x2=6.922,P=0.031 ) and divorced ( x2=22.000,P=0.000) than in other groups. Multivariate analysis showed that excessive intake of high-fat food was significantly associated with the presence of FC (odds ratio as 1.253,P=0.000),whereas foods with high-fiber (odds ratio as 0.854,P=0.029) might serve as protective factors.Significant differences between FC groups and control groups were found in the incidence of anxiety (with odds ratio as 2.583,P=0.000) and insomnia (odds ratio as 2.443,P=0.000).Conclusion The prevalence of FC in adult communities in Shanghai Songjiang district was not higher than that in other parts of the communities.Excessive intake of high-fat food,anxiety and insomnia might be risk factors for FC and foods with high-fiber contents might serve as protective factors.

Impact of liver steatosis on antiviral effects of pegylated interferon-alpha in patients with chronic hepatitis B / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate the impact of hepatic steatosis on virologic response in chronic hepatitis B (CHB) patients treated with pegylated interferon-alpha (PEG-IFNa).</p><p><b>METHODS</b>Ninety-six naive patients positive for hepatitis B e antigen (HBeAg) and with biopsy-proven CHB were administered PEG-IFNa-2a or PEG-IFNa-2b for 48 weeks. Virologic response (HBeAg clearance and hepatitis B virus (HBV) DNA less than 5 log10 copies/ml) and biochemical response (alanine transaminase (ALT) normalization) were compared between patients with (n=34) and without (n=62) steatosis.</p><p><b>RESULTS</b>The HBV DNA titer in the steatosis group was significantly lower than that of the non-steatosis group (6.961.27 vs. 7.541.28 log10 copies/ml; t=2.161, P=0.033). After 48 weeks of PEG-IFNa treatments, there was no significant difference in HBeAg seroconversion or the percentage of undetectable HBV DNA (less than 3 log10 copies/ml) between steatosis and non-steatosis patients. However, the steatosis patients presented with a significantly lower complete response rate (virologic response plus biochemical response) compared to non-steatosis patients (26.5% vs. 48.4%; x² =4.373, P=0.037). Of the 45 CHB patients with undetectable HBV DNA after 48 weeks of treatment, seven did not achieve ALT normalization. The rate of patients with non-biochemical response was significantly higher in the steatosis group than in the non-steatosis group (33.3% vs. 6.67%; P=0.032).</p><p><b>CONCLUSION</b>Hepatic steatosis does not affect the virologic response, but does affect the biochemical response in CHB patients treated with PEG-IFNa for 48 weeks.</p>

Establishment and identification of non-alcoholic fatty liver disease in chronic hepatitis B virus infected mice / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To establish and identify an animal model of non-alcoholic fatty liver disease in chronic HBV infected mice.</p><p><b>METHODS</b>Transgenic mice with sustaining HBV production were established by microinjection of ocyte. Then they were randomly assigned into 4 groups (male control, male NAFLD model, female control and female NAFLD model) and treated with high fat diet (2% cholesterol, 10% lard, 88% forage) and common forage, respectively. NAFLD-related physical indexes, liver and kidney function, glucose and lipid metabolism were investigated at the time points of 8 weeks, 16 weeks and 24 weeks. Meanwhile, HBV type, serum levels of HBV DNA and HBeAg, immunohistochemical staining of hepatic HBsAg were detected. The establishment of NAFLD was evaluated by serum levels of total cholesterol (TC), triglycerides, glucose, aspartate aminotransferase (AST), alkaline phosphatase (ALP), alanine aminotransferase (ALT), gamma-glutamyltransferase (GGT), etc. Histological changes were also analyzed by HE, oil red O and Masson's trichrome staining. The status of CHB was assessed on the basis of immunohistochemistry and real-time PCR.</p><p><b>RESULTS</b>The body and liver weights, liver index in HBV transgenic mice were significantly increased in regardless of the gender of HFD feeding, and the levels of serum ALT, AST, ALP, GGT, TBIL, TBA, TC, TG, HDL-C, LDL and FBG were higher in HFD groups as compared with the control mice. Lipid droplets, cytologic ballooning and liver steatosis could be observed in most lobules of HFD groups after 8-week administration, fatty degeneration of hepatocytes, patch necrosis, mild to moderate chronic inflammatory infiltration were also observed in some of HFD feeding, reflecting the emerge of steatohepatitis. At the time point of 24-week perisinusoidal fibrosis and local fibrosis occurred in HFD groups. Immunohistochemical staining and real-time PCR analysis of the liver tissues showed positive signal of HBsAg in all groups of mice, although no significant difference was documented.</p><p><b>CONCLUSION</b>Our study suggests that animal model of NAFLD can be established in HBV transgenic mice and provide a nice animal model for further studies on NAFLD with chronic hepatitis B infection.</p>

Effect of body weight mass and its change on the incidence of nonalcoholic fatty liver disease / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To determine the effect of body mass index (BMI) at baseline and its change during follow-up on the incidence of non-alcoholic fatty liver diseases (NAFLD) in apparently healthy adults.</p><p><b>METHODS</b>Subjects free of previous liver injury, alcohol consumption of more than 140 g/week and hepatitis B virus infection were identified from employees of Shanghai BaoSteel Group who underwent voluntary medical checkups at a 2-year interval. The analyzed population consisted of 5402 non-drinking subjects (4633 men) of age 36.5+/-9.3 years (18-65 years), who had normal livers at baseline. Among them 327 subjects (6.05%) developed fatty liver in 2 years. Those who developed NAFLD showed advanced age (especially in females), elevated BMI, high levels of serum triglyceride and total cholesterol, high prevalence rates of obesity, hyperlipidemia, hypertension and hyperglyceridemia at baseline, more weight gain and increase of serum triglycerides during the 2-year period. The incidence of NAFLD increased significantly with the changes of BMI at baseline, from 1.4% in subjects with normal weight, 6.4% in overweight, 16.8% in obese patients to 24.5% in severe obesity (Chi2 test = 389.01, P = 0.000 in trend analysis). Logistic regression analysis showed a significant interaction occurred between NAFLD age, BMI and serum triglyceride at baseline, and subtle gain of BMI and triglyceride during follow-up.</p><p><b>CONCLUSIONS</b>There is a high incidence of NAFLD in a Chinese workplace. Obesity and related metabolic disorders at baseline, and more weight gain and increased serum triglyceride during follow-up are important predictors for the development of NAFLD.</p>

Effect of silencing connective tissue growth factor on the liver fibrosis in rats / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate the anti-fibrogenesis property of intraportal vein small interfering RNA (siRNA) injection targeting connective tissue growth factor (CTGF) in a rat model of liver fibrosis induced by carbon tetrachloride (CCl4) and its effect on hepatic stellate cell (HSC) activation.</p><p><b>METHODS</b>24 male rats were randomly divided into four group. rats received CCl4 by subcutaneous injections every three days for 6 consecutive weeks, and meantime they also obtained either siRNA targeting CTGF (as CTGF siRNA group), saline (as model group) or a control siRNA (as control siRNA group) by intraportal vein injection to rats liver at the same approach. Other rats received saline intraportal vein injection for 6 weeks (as normal control group). The expressions of CTGF and a-SMA protein were detected by Western blot. Hepatic histology was evaluated by HE staining and Sirius red staining. The collagen staining areas were measured quantitatively using a computer-aided manipulator with slight modifications. The number of active HSC were evaluated by immunohistochemistry.</p><p><b>RESULTS</b>Six weeks after CCl4 injection, prominent upregulations were observed in the expressions of CTGF and a-SMA protein in saline or control siRNA-treated rats livers. In rats with CTGF siRNA treatment, the protein expressions of CTGF and a-SMA in liver decreased by 95%+/-2% and 86%+/-11% (F=21.234 and 12.473, P<0.01) respectively, the number of active HSC in liver decreased by 76%+/-9% (F=9.179, P<0.01) as compared to the model group. The attenuation of liver fibrosis was also observed in rats with CTGF siRNA treatment.</p><p><b>CONCLUSION</b>Intraportal vein siRNA injection targeting CTGF could significantly inhibit CTGF gene expression in rats, thereby attenuate liver fibrosis by decreasing the number of active HSCs.</p>

Clinical and histological features of non-alcoholic fatty liver disease / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate the clinical and histological features in Chinese patients with non-alcoholic fatty liver disease (NAFLD).</p><p><b>METHODS</b>108 patients with biopsy-proven NAFLD were enrolled in this study. Clinical, demographic, and biochemical data were compared between NAFLD patients with abnormal ALT and those with normal ALT.</p><p><b>RESULTS</b>Simple fatty liver, nonalcoholic steatohepatitis(NASH) and cirrhosis were diagnosed in 49 (45.4%), 57(52.7%) and 2 (1.9%) patients, respectively. ALT and AST levels of NASH group were higher than those of simple fatty liver group (t = 2.55, 3.13; P = 0.01, 0.00). Fifty of the 77 patients (64.9%) with abnormal ALT levels were diagnosed as non-alcoholic steatohepatitis (NASH), and twenty-six were diagnosed as simple fatty liver, according to liver histology. Among the 31 patients with normal ALT levels, nine (29%) had NASH and twenty-two had simple fatty liver (P = 0.00). The patients with normal ALT had lower necroinflammatory grade than patients with abnormal ALT (x2 = 10.30, P = 0.01), but they had similar degree of steatosis and fibrosis (x2 = 5.52, 6.12; P = 0.12, 0.01). AST, g-glutamyltransferase, total cholesterol, apolipoprotein A1, apolipoprotein B and systolic blood pressure of patients with normal ALT were all lower than those of patients with abnormal ALT (t = 5.91, 2.00, 2.30, 2.10, 3.14, 2.43; P = 0.00, 0.05, 0.02, 0.04, 0.00, 0.02), while spleen thickness and AST/ALT ratio in patients with normal ALT were higher than those with abnormal ALT significantly (t = 3.70, 2.95; P = 0.00, 0.01). Multivariate analysis revealed that ALT (OR = 2.78, 95% CI 1.06-7.3, P = 0.04) was the only independent predictor of NASH, and ALT had low accuracy in predicting NASH, the area under the receiver operating characteristics curves of ALT to predict NASH was 0.69 (95% CI 0.59-0.8, P = 0.00).</p><p><b>CONCLUSION</b>NAFLD patients have higher ALT level, and elevated serum level of ALT is independent predictor of the degree of inflammation, but not of steatosis and fibrosis.</p>

Analysis of clinical and pathological features of chronic hepatitis B with hepatic steatosis / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To explore clinical and pathological features of chronic hepatitis B (CHB) with hepatic steatosis.</p><p><b>METHODS</b>Retrospective analysis of hepatic steatosis in patients with liver biopsy-proven CHB between January 2005 and June 2008. Detailed clinical, laboratory and pathological data of CHB patients with steatosis were compared with those in sex-, age- matched CHB patients without steatosis. Patients co-infected hepatitis C virus or HIV or suffering from liver diseases of other causes were excluded.</p><p><b>RESULTS</b>Histological hepatic steatosis was found in 33.4% of the 1263 CHB patients. The prevalence of steatosis was increased with time in the study period (20.3%, 28.2%, 32.6%, 65.4%, in trend analysis, P values less than 0.05). Body mass index, fasting plasma glucose, serum triglyceride and total cholesterol level in CHB patients with hepatic steatosis (n = 114) were significantly higher than those in 113 patients without steatosis (t values were 6.811, 2.733, 3.063, 2.340, respectively, P values less than 0.01 or 0.05). Compared to patients without steatosis, serum hepatitis B virus DNA titer in patients with steatosis was significantly lower (x2 = 6.154, P less than 0.05) and reduced sharply with the increased degree of hepatic steatosis (x2 = 4.941, P less than 0.05). There were no differences in liver biochemical test (t values were 0.744, 1.390, -0.029, -1.175, 1.393, respectively, P values more than 0.05), hepatic inflammation grade and fibrosis stage between CHB patients with and without steatosis (x2 = 1.434, 0.106, respectively, P more than 0.05), and these parameters were not associated with different degree of hepatic steatosis (x2 = 2.447, 2.911, respectively, P more than 0.05).</p><p><b>CONCLUSIONS</b>Hepatic steatosis is common in patients with CHB, and is related to metabolic disorders. Hepatic steatosis does not affect the severity of CHB. The reverse association of hepatitis B virus titer with the degree of hepatic steatosis needs further investigation.</p>

Hepatic steatosis: a common reason for elevated alanine aminotransferase levels in HBsAg-positive chronic hepatitis B patients with low HBV DNA loads / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To evaluate the causes of alanine aminotransferase (ALT) level elevation in HBsAg-positive chronic hepatitis B (CHB) patients with low HBV DNA loads.</p><p><b>METHODS</b>One hundred nineteen HBsAg positive CHB patients with both serum HBV DNA loads less than 1000 copies/ml and ALT more than 1.25 upper limits of normal (ULN) lasting for at least 6 months were enrolled in this study. Patients co-infected with hepatitis C virus or HIV or suffering from other liver diseases were not included. HBV DNA loads were assayed by PCR. Serological biochemistry and liver biopsy histopathological changes and clinical characteristics of the patients were analyzed.</p><p><b>RESULTS</b>Of the 119 patients 102 were males and 17 were females. The mean age of the patients was (33.9+/-9.7) years and their body mass index (BMI) was (23.4+/-3.7) kg/m2. Mean ALT levels were (150.0+/-166.6) U/L and AST levels were (102.4+/-193.2) U/L. Liver biopsies showed hepatic steatosis in 26.9 % (32/119) of the cases, chronic hepatitis in 53.8% (64/119), non-specific changes in 12.6% (15/119), and 1 without any change. However, hepatic steatosis was more frequently seen in patients taking nucleoside analogs (56.7%), x2=10.394, Probability value less than 0.01. BMI, apolipoprotein B (APO-B), triglyceride, cholesterol and uric acid were all significantly higher in patients with hepatic steatosis than those without (t values were 5.369, 4.276, 3.216, 4.223 and 2.438 respectively, all P less than 0.05) while ALT, AST and apolipoprotein A were much lower in those with steatosis than those without (t values were -2.234, -3.877 and -2.956 respectively, all P less than 0.05). Obesity, dyslipidemia and hyperuricemia were more frequently seen in patients with steatosis than in patients without it (x2 value 3.829, 7.659, 13.389, 0.549, all P less than 0.05). The severity of inflammation and fibrosis were also more significant in patients with steatosis (x2 value 20.978, 17.550, all P less than 0.05). As compared to those patients without specific changes, serum levels of ALT, AST, GGT in patients with chronic hepatitis were obviously higher, all P less than 0.05. In contrast, there were no significant differences in mean age, BMI, male preference, obesity, diabetes, dyslipidemia or hyperuricemia, and the levels of triglyceride, cholesterol, and fasting plasma glucose between the two groups.</p><p><b>CONCLUSION</b>Our data indicate that hepatic steatosis might be a factor associated with elevated ALT levels in HBsAg-positive CHB patients with low HBV DNA loads, especially in patients treated with nucleoside analogs.</p>

Viral and host causes of hepatosteatosis in Chinese patients with chronic hepatitis B / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To explore the viral and host causes of hepatosteatosis in Chinese patient with chronic hepatitis B.</p><p><b>METHODS</b>A total of 562 patients (450 males and 112 females, age range 13-80 years) with biopsy-proven chronic hepatitis B were enrolled in the study. The patients were divided into two groups: group without steatosis (460 patients) and group with steatosis (102 patients). The groups were compared in terms of age, gender, body mass index (BMI), liver enzymes, cholesterol, triglyceride, APO-A, APO-B, urine acid (UA), fasting serum glucose (FSG) and HBeAg, viral load.</p><p><b>RESULTS</b>Steatosis was present in 102 patients (18.15%). The degree of liver steatosis in 97 (95.10%) patients were less 30%. Steatosis was found in 98 (21.78%) of male patients and 4 (3.75%) of female patients (P < 0.01). In the group of chronic hepatitis B with steatosis, the prevalence of obesity, diabetes mellitus, dyslipidaemia, alcoholic consumption, the BMI, cholesterol, triglyceride, UA and FSG levels were significantly higher than those in the group without steatosis (P < 0.01). No significant difference was found in the mean age, HBeAg, viral load between the two groups (P > 0.05). Logistic regression analysis demonstrated that the present of steatosis was positively correlated to BMI, TG and UA.</p><p><b>CONCLUSION</b>Hepatosteatosis in chronic hepatitis B appears to be a result of metabolic factors of the host rather than the effect of viruses.</p>

Prevalence and risk factors of hepatic steatosis in patients with chronic hepatitis B / 中华肝脏病杂志

<p><b>OBJECTIVES</b>To investigate the prevalence and risk factors of hepatic steatosis in patients with biopsy-proven chronic hepatitis B (CHB).</p><p><b>METHODS</b>One thousand nine hundred and fifteen patients with CHB who had liver biopsies seen between January 2005 and June 2007 in our department were reviewed. Patients co-infected with hepatitis C virus or HIV or suffering from liver diseases of other causes were not included. The prevalence of hepatic steatosis and its trend during the study period were determined, and the relationships among their hepatic steatosis with clinical data, serum biochemistry, HBV viral load, and the degree of liver inflammation and fibrosis stage were studied.</p><p><b>RESULTS</b>The mean age of the patients was 30.7+/-9.5 years; 1,497 men and 418 women. Histological hepatic steatosis was present in 260 patients (13.6%), and the annual prevalence of steatosis increased with time (11.2% in 2005, 14.3% in 2006, and 17.9% in 2007). The prevalence of steatosis in male patients was significantly higher than that in female patients (15.2% vs. 7.7%, chi2 = 15.98, P less than 0.01). Body mass index (BMI), age, fasting plasma glucose (FPG) were all significantly higher in CHB patients with hepatic steatosis than in patients without steatosis (t values were 6.01, 3.60, 4.72 and 9.55, respectively, all P less than 0.01). The prevalence of overweight, obesity, diabetes, dyslipidemia and hyperuricemia were also significantly higher in patients with steatosis than those without it (chi2 values 17.00, 169.45, 6.12, 116.67 and 76.34, all P less than 0.05). Prevalence of hepatic steatosis was higher in patients with mild CHB (17.8%) than in chronic inactive HBsAg carriers (8.6%), patients with moderate CHB (9.4%) and with severe CHB (7.7%). Similarly, prevalence of steatosis was higher in patients with inflammation grade 1 (19.8%) and fibrosis stage 1 (19.1%) than in patients with inflammation grade 0 (10.3%), grade 2 (11.5%), grade 3 (9.3%) and grade 4 (7.3%), and in patients with fibrosis stage 0 (10.8%), stage 2 (13.3%), stage 3 (7.1%) and stage 4 (7.4%), respectively. No close relationship was found between hepatic steatosis and serum HBeAg status or HBV DNA titer in patients with CHB. Logistic regression analysis demonstrated that the presence of steatosis was positively correlated to BMI, serum triglyceride, apolipoprotein B, uric acid and FPG.</p><p><b>CONCLUSION</b>Hepatic steatosis is not uncommon in patients with CHB. It is associated with metabolic factors of the hosts and not related to the virus itself. It is also not related to the degrees of liver inflammation and fibrosis.</p>

Study on the prevailing trend of overweight and obesity in Shanghai Bao-Steel Company based population from 1995 to 2002 / 中华预防医学杂志

<p><b>OBJECTIVE</b>To explore the change of the prevalence rates of overweight and obesity in Shanghai Bao-Steel Company population.</p><p><b>METHODS</b>We retrospectively analyzed the medical records of all employees undergoing health examination biennially from 1995 to 2002. Overweight and obesity were respectively diagnosed when body mass index (BMI) > or = 24 kg/m2 but still less than 28 kg/m2 and > or = 28 kg/ m2. SPSS 11.5 and SAS of statistical software were used for data analysis.</p><p><b>RESULTS</b>During the period studied, in 59 131 times of medical check-up, 27.1% participants received four times check-up, 26.6% thrice and 24.0% twice. After adjusted by sex and age, the total prevalence rates of overweight and obesity increased from 26.50% and 4.10% to 34.60% and 7.70% between 1995 to 1996 and 2001 to 2002, respectively. After adjusted by age, the prevalence rates of overweight and obesity in men increased from 28.20% and 4.20% to 37.90% and 8.40%; less significantly in women from 19.60% and 3.70% to 21.10% and 5.20%. Among men, the prevalence rates of overweight and obesity in men younger than 60 years old increased along with time. While in women, only the overweight prevalence in women younger than 30 years old and the obesity prevalence in women between 50 years old and 60 years old increased along with time, with unchanged prevalence in other age sub-group.</p><p><b>CONCLUSION</b>The prevalence rates of overweight and obesity have been growing rapidly in Bao-Steel Company employees, primarily in middle-aged and young men, who should be paid more attention.</p>