Long-term prognosis and quality of life of survivors with hepatitis B virus-related acute-on-chronic liver failure / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the long-term prognosis and health-related quality of life of patients surviving hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF).</p><p><b>METHODS</b>The clinical data were collected from patients with HBV-ACLF, who were hospitalized in our department between November, 2011 and October, 2016 and survived for more than 90 days. The patients were followed for occurrence of newly diagnosed cirrhosis, decompensation events, hepatocellular carcinoma and death. The quality of life of the patients was evaluated using SF-36 score, and the patients with chronic hepatitis B (CHB) and cirrhosis treated during the same period served as controls.</p><p><b>RESULTS</b>A total of 223 ACLF survivors were included in this study. According to the presence of cirrhosis on admission, the enrolled patients were divided into chronic hepatitis B-related ACLF (CHB-ACLF) group (n=130) and liver cirrhosis ACLF (CIR-ACLF) group (n=93). The 12-, 24- and 50-month survival rates in CHB-ACLF group were 97%, 95.7% and 93.9%, respectively, significantly higher than the rates in CIR-ACLF group (91%, 86% and 74%, respectively; P=0.007). In patients with CHB-ACLF, the 12-, 24- and 36-month progression rates of cirrhosis were 37.9%, 58.4% and 68.7% respectively. Multivariate Cox regression identified the peak value of serum creatinine (HR=1.015, P=0.026) and INR (HR=2.032, P=0.006) within 28 days as independent risk factors and serum sodium at baseline (HR=0.84, P=0.035) as an independent protective factor of occurrence of cirrhosis. The score of mental health on SF-36 in ACLF group was significantly lower than the national norms, and the scores for general health and body pain of ACLF patients were significantly higher than those in patients with CHB or cirrhosis.</p><p><b>CONCLUSION</b>The long-term prognosis of ACLF survivors with and without cirrhosis can be different. Acute attacks are associated with an increased rate of cirrhosis progression in CHB patients who recovered from ACLF, possibly in relation with the severity of extra-hepatic organ injuries. The physical and social functions of long-term survivors of ACLF do not significantly decline, but their psychological status can be affected.</p>

Imaging diagnosis of small hepatocellular carcinoma using ultrasound, contrast-enhanced ultrasound and multislice spiral CT / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the value of gray-scale ultrasound, contrast-enhanced ultrasound and multislice spiral CT in early and differential imaging diagnosis of small hepatocellular carcinoma (SHCC).</p><p><b>METHODS</b>This study included 35 patients with space-occupying lesions in the liver identified by routine ultrasound examination. The hemodynamics of the patients was recorded during the arterial, portal and lag phases using contrast-enhanced ultrasound. The enhancement features of the 3 phases were observed using multislice spiral CT. All the cases were confirmed by pathological examinations.</p><p><b>RESULTS</b>For SHCC diagnosis, gray-scale ultrasound, contrast-enhanced ultrasound and multislice spiral CT showed a sensitivity of 77.8%, 94.4%, and 100%, specificity of 88.2%, 100%, and 94.1%, positive predictive value of 87.5%, 100%, and 94.7%, negative predictive values 78.9%, 94.4%, and 100%, concordance rate of 82.9%, 97.1%, and 97.1% and Younden index of 0.66, 0.94, and 0.94, respectively.</p><p><b>CONCLUSIONS</b>Contrast-enhanced ultrasound and multislice spiral CT have significantly greater diagnostic efficacy than gray-scale ultrasound in early and differential diagnosis of SHCC. But in some atypical cases, gray-scale ultrasound, contrast-enhanced ultrasound and multislice CT have to be combined to establish a diagnosis.</p>

Factors influencing the success rate and stability of transient elastography for liver fibrosis evaluation / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the factors influencing the success rate and stability of transient elastography(FibroScan)for assessment of liver fibrosis.</p><p><b>METHODS</b>Liver stiffness was assessed using transient elastography in totally 637 subjects including healthy subjects, asymptomatic hepatitis B virus (HBV) carriers, patients with chronic hepatitis B and patients with HBV-related cirrhosis. Of these subjects, 302 received 2 examinations and totalling 939 examinations were performed. In each case, one operator performed 2 consecutive series of 10 validated measurements, or 2 operators performed a series of 10 validated measurements. The factors including gender, age, body mass index (BMI) and the state of diseases were analyzed for their association with the success of the examination. Intraclass correlation coefficient (ICC) was used to evaluate the reproducibility of the operation.</p><p><b>RESULTS</b>Failure of the measurement occurred in 14 cases (2.2%), which was not associated with the age of the subjects and the state of diseases. The success rate of measurement decreased as the BMI increased (t=3.112, P=0.002), and was lower in female subjects (t=-2.193, P=0.029). The intra- and inter-operator stability of liver stiffness measurement was satisfactory, with ICC of 0.970 and 0.847, respectively. But for healthy subjects and asymptomatic HBV carriers, the stability was lower, with ICC of 0.736 and 0.639, respectively. Liver stiffness in patients with liver cirrhosis was positively correlated to complications and Child-Turcotte-Pugh (CTP) score.</p><p><b>CONCLUSION</b>Liver stiffness measurement has high stability with FibroScan, and high BMI could lower success rate of the measurement. Liver stiffness as measured by FibroScan allows prediction of the liver function and presence of complications in patients with liver cirrhosis.</p>

Ultrasonic scores combined with blood indexes for screening and predicting compensated liver cirrhosis in chronic hepatitis B patients / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the correlation between ultrasonic scores, routine blood tests and stages of hepatic fibrosis in patients with chronic hepatitis B (CHB), and identify non-invasive indexes to establish a diagnostic model for liver cirrhosis.</p><p><b>METHODS</b>A retrospective analysis of 428 patients with CHB undergoing liver biopsies was conducted. The patients' hematology, serum biochemical indexes, serum alpha fetal proteins (AFP), serum HBeAg status and ultrasonic scores were statistically analyzed. A diagnostic model was established by stepwise discriminant analysis, and aspartate aminotransferase (AST) to platelet ratio index (APRI) was used to estimate the diagnostic value.</p><p><b>RESULTS</b>Partial correlation analysis indicated that platelet, serum albumin, bilirubin, AST, ratio of AST to alanine aminotransferase, prothrombin time and ultrasonic scores were correlated to the stages of liver fibrosis, and significantly differed between patients with and without liver cirrhosis. Logistic regression analysis identified ultrasonic scores, platelet, serum bilirubin, albumin and AST as indexes affecting the diagnosis of compensated cirrhosis. The area under receiver operation curve of model was 0.907. The cirrhosis index (CI) of -0.94 for this model was suitable for screening, with specificity of 85.0%, sensitivity of 81.7%, and accuracy of 84.3%. About 56.2% of the patients' CI was lower than -2.0 with the negative predictive value of 97.0% and the rate of missed diagnosis of 3.0%. About 18.2% of the patients' cirrhosis probabilities were above 0.15, with positive predictive value of 77.3%, and only 2.7% of the patients had mild fibrosis (F2), suggesting that nearly 75% of the patients did not have to receive liver biopsies.</p><p><b>CONCLUSION</b>This diagnostic model integrates the ultrasonic scores, platelet, serum bilirubin, albumin and AST to enable effective screening and prediction of compensated cirrhosis, and can reduce the number of patients required to undergo liver biopsy by about 75%.</p>

Changes of serum HBsAg in HBeAg positive chronic hepatitis patients with sustained viral response to long-term lamivudine treatment / 中华肝脏病杂志

<p><b>OBJECTIVE</b>HBsAg loss is rare in chronic hepatitis B patients, even in the patients with long-term nucleos(t)ide analogue therapy; therefore information about serum HBsAg kinetics will be of value in understanding this unusual occurrence.</p><p><b>METHODS</b>Forty-five consecutive patients were studied, which were all HBeAg positive and never had antiviral therapy prior to lamivudine treatment; they then achieved rapid and good viral responses (defined as undetectable HBV DNA [Roche Lightcycler, less than 1000 copies/ml] at treatment week 24 and they remained so until week 156). Abbott Architect HBsAg assay was used to quantify serum HBsAg and HBV genotypes were determined by direct sequencing.</p><p><b>RESULTS</b>Twenty-six (57.8%) patients had HBeAg loss during the observation and one patient had HBsAg loss following his HBeAg seroconversion. Serum HBsAg levels decreased to 39.5% (median) of their baseline values at week 12, but no further significant reductions of serum HBsAg were found afterwards. Changes of serum HBsAg were comparable between patients with or without HBeAg loss. Serum HBsAg levels at their baselines were higher in HBV genotype B (HBV/B, n = 21) patients than in genotype C (HBV/C, n = 24) patients. HBV/B patients achieved many more HBsAg reductions than HBV/C ones (75.5 vs. 26.0%, median, P less than 0.05) in the first 12 treatment weeks, however HBsAg levels at week 156 were comparable between these two subgroups. HBsAg changes mainly showed two distinct patterns: a biphasic pattern (HBsAg levels were less than 60% of baseline ones at week 12 and 24, n = 25) and a maintaining pattern (HBsAg levels were greater than 80% of the baseline ones at week 12 and 24, n = 14). Logistic regression analysis showed that low serum HBsAg at baseline (odds ratio 0.020, 95% confidence interval 0.002-0.743, P less than 0.05) and HBV/C infection (odds ratio 8.206, 95% confidence interval 1.070-62.948, P less than 0.05) were the determinants of the occurrences of the maintaining pattern.</p><p><b>CONCLUSION</b>In patients we examined, their HBsAg changes were mainly presented as either a biphasic pattern or a maintaining pattern, which were associated with HBV genotypes (B/C) but not with HBeAg loss. This might explain that why HBsAg loss is a rare occurrence even with long-term lamivudine therapy.</p>

An ultrasonographic scoring system for screening compensated liver cirrhosis in patients with chronic hepatitis B and C virus infection / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the correlation between the stage of hepatic fibrosis and ultrasonographic findings of the liver, spleen and gallbladder and establish a sensitive ultrasonographic semi-quantitative scoring system for screening compensated liver cirrhosis.</p><p><b>METHODS</b>Totalling 248 patients with chronic hepatitis B and hepatitis C virus infection underwent liver biopsy and ultrasonic examination. The images of the liver surface, parenchymal echo, intrahepatic vessels, gallbladder, spleen and diameter of portal vein were analyzed.</p><p><b>RESULTS</b>The stages of hepatic fibrosis were not correlated to ultrasonographic findings of the liver surface or diameter of portal vein, but hepatic fibrosis of different stages showed significant differences in parenchymal echo, intrahepatic vessels, gallbladder and splenomegaly. In cases with normal liver parenchymal, intrahepatic vessels, gallbladder and spleen, the negative predictive value of the ultrasonographic semi-quantitative scoring system for diagnosing compensated liver cirrhosis amounted to 96.3%. The sensitivity of a score not lower than 5 was 90% for detecting compensated cirrhosis. With a score not lower than 7, the diagnostic accuracy and specificity was 85.9% and 95.2%, respectively, but the sensitivity was lowered to 37.5%.</p><p><b>CONCLUSION</b>The ultrasonic images of the liver parenchyma, intrahepatic vessels, gallbladder and spleen in patients with compensated liver cirrhosis vary significantly in patients with hepatic fibrosis of different stages, and this ultrasonographic scoring system allows for a sensitive diagnosis of compensated cirrhosis.</p>

Screening and evaluation of non-invasive diagnosis markers for compensated liver cirrhosis in patients with chronic hepatitis B / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To evaluate the diagnostic value of liver fibrosis markers and ultrasonic examination for determining compensated liver cirrhosis in patients with chronic hepatitis B, and screen applicable non-invasive diagnostic marker for compensated liver cirrhosis.</p><p><b>METHODS</b>Serum hyaluronic acid (HA), Type III procollagen (PCIII), laminin (LN) and Type IV collagen (CIV) were measured from 350 patients with chronic hepatitis B, who were also detected with liver biopsy and ultrasonography. To determine the cut-off value of every serum liver fibrosis marker for diagnosing compensated liver cirrhosis, data was analysed with clinical epidemiology methods. Then evaluated and compared all the markers.</p><p><b>RESULTS</b>85 out of 350 patients were diagnosed as compensated liver cirrhosis by liver biopsy, and 81 had liver cirrhosis images by ultrasonic examination. HA achieved the biggest area under the ROC curve. The cut-off values with best sensitivity and accuracy of HA, PCIII, LN and CIV were 154.35 microg/L, 198.44 microg/L, 137.58 microg/L and 100.80 microg/L respectively. The related diagnostic sensitivities of HA, PCIII, LN and CIV were 82.4%, 63.5%, 57.3% and 70.6%, specificities were 79.3%, 54.0%, 56.8%, 68.3%, and accuracies were 80.0%, 56.3%, 56.9%, 68.9%, respectively. Parallel tests could increase the diagnostic sensitivity, but decreased specificity and accuracy accordingly. Compared with other non-invasive diagnostic methods, HA was the best marker (mu > or =1.814, P<0.05). The level of HA at 119.17 microg/L was suitable for determining compensated cirrhosis, with a 87.1% sensitivity, 67.6% specificity, 72.3% accuracy, 46.25% positive predictive value and 94.7% negative predictive value.</p><p><b>CONCLUSION</b>Among the non-invasive serum diagnostic markers for liver fibrosis and ultrasonic examination for cirrhosis image, HA is the best marker for diagnosing compensated liver cirrhosis.</p>