The value of liver fibrosis serum markers in predicting esophagogastric variceal re-bleeding after laparoscopic splenectomy and azygoportal disconnection: a prospective study / 中华消化外科杂志

Objective:To investigate the value of liver fibrosis serum markers in predicting esophagogastric variceal re-bleeding (EGVR) after laparoscopic splenectomy and azygoportal discon-nection (LSD).Methods:The prospective study was conducted. The clinical data of 155 cirrhotic portal hypertension patients with EGVR after LSD in the Clinical Medical College of Yangzhou University from September 2014 to January 2017 were selected. Observation indicators: (1) grouping situations of the enrolled patients; (2) risk factors analysis for postoperative EGVR; (3) prediction of postoperative EGVR; (4) follow-up. Follow-up was conducted using telephone interview, outpatient examination and hospitalization. Patients were followed up once every 3 months after operation to detect occurrence of EGVR and survival of patient up to January 2018. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data wite skewed distribution were represented as M(range), and comparison between groups was conducted using the non-parameter test. Count data were described as absolute numbers, and comparison between groups were conducted using the chi-square test or Fisher exact probability. Logistic regression model was used for multivariate analysis. The area under curve (AUC) of receiver operating characteristic (ROC) curve was used to estimate the diagnostic efficiency. The Youden index was used to determine the optimal cut-off point. Results:(1) Grouping situations of the enrolled patients. A total of 155 patients were selected for eligibility. There were 106 males and 49 females, aged (53±11)years. Of the 155 patients, there were 21 cases with EGVR in the postoperative 1 year and 134 cases without EGVR in the postoperative 1 year. The protein expression of laminin and collagen Ⅳ were 100.3(range, 16.1?712.2)μg/L and 68.4(range, 35.0?198.8)μg/L in patients with EGVR, vs 35.5(range, 2.0?521.2)μg/L and 43.5(range, 4.3?150.4)μg/L in patients without EGVR, showing significant differences between them ( Z=?4.55, ?4.52, P<0.05). (2) Risk factors analysis for postoperative EGVR. According to the Youden index, the optimal cut-off point of protein expression of laminin and collagen Ⅳ were 64.0 μg/L and 65.0 μg/L, respec-tively. Results of multivariate analysis showed that the protein expression of laminin ≥64.0 μg/L and the protein expression of collagen Ⅳ ≥65.0 μg/L were independent risk factors for postoperative EGVR ( odds ratio=9.69, 8.16, 95 confidence intervals as 3.05?30.82, 2.65?25.15, P<0.05). (3) Prediction of postoperative EGVR. Results of ROC curve showed that the AUC of laminin and collagen Ⅳ in predicting postoperative EGVR was 0.79 (95% confidence interval as 0.66?0.92), with sensi-tivity as 0.62 and specificity as 0.96. (4) Follow-up. All the 155 patients were followed up for 12(range, 1?12)months. During the follow-up, there were 21 of the 155 patients (13.55%) with post-operative EGVR, including 3 cases died of EGVR. Of the 21 patients with postoperative EGVR, there were 6 cases with postoperative EGVR during the first month after operation including 2 cases died, 5 cases with postoperative EGVR at postoperative 1?3 month, 6 cases with postoperative EGVR more than 3 month and less than 6 month after operation and 4 cases with postoperative EGVR at postoperative 6?12 months including 1 case died at postoperative 12 month. Conclusions:Laminin and collagen Ⅳ show satisfactory ability to predict EGVR after LSD.

Ultrasound versus biological markers in the evaluation of periportal fibrosis in human Schistosoma mansoni

In this paper, the authors review the literature and share their experience of the principal biological markers of fibrosis for the evaluation of periportal fibrosis (PPF) caused by mansoni schistosomiasis. These biological markers are compared to diagnostic ultrasound (US) scans as means of grading PPF. We also review procollagen type I and III, collagen type IV, laminin, hyaluronic acid (HA), immunoglobulin G, platelets, aspartate aminotransferase to platelet ratio index (APRI) and gamma-glutamyl transpeptidase as markers of the disease. Although there are several good markers for evaluating PPF and portal hypertension, such as HA, platelets or APRI, none can yet replace US. These markers may, however, be used to identify patients at greater risk of developing advanced disease in endemic areas and determine who will need further care and US studies.

Serum hyaluronan and collagen IV as non-invasive markers of liver fibrosis in patients from an endemic area for schistosomiasis mansoni: a field-based study in Brazil

Non-invasive markers of fibrosis have been used to diagnose liver fibrosis in a variety of diseases. Hyaluronic acid (HA) and collagen IV (C-IV) levels were measured in the sera of patients from an endemic area for schistosomiasis in Brazil to diagnose and to rank the intensity of liver fibrosis. Seventy-nine adult patients with schistosomiasis, in the age range of 21-82 years (49 ± 13.4) were submitted to clinical and ultrasonographic examinations. Ultrasound was employed to diagnose and categorise liver fibrosis according to World Health Organization patterns. Serum HA and C-IV levels were measured using commercial ELISA kits. Ultrasound revealed six patients with intense liver fibrosis, 21 with moderate, 23 with light and 29 without. Serum HA was able to separate individuals with fibrosis from those without (p < 0.001) and light from intense fibrosis (p = 0.029), but C-IV was not (p = 0.692). The HA diagnostic accuracy for fibrosis was 0.89. The 115.4 ng/mL cut-off level diagnosed patients with fibrosis (sensitivity 0.98, specificity 0.64). HA correlated positively with portal hypertension. Periportal fibrosis (subjective evaluation), age and collateral circulation predicted HA increase. In conclusion, we propose that serum HA can be used to identify patients with liver fibrosis in an endemic area for schistosomiasis mansoni in Brazil.

Study on Distribution Characteristic of TCM Syndrome Types and Its Relationship with HBVDNA and Hepatic Fibrosis Markers in Patients with HBe Antigen-Negative Chronic Hepatitis B / 中国中医药信息杂志

insufficiency of both the spleen and the kidney (type E). The serum levels of ALT and AST in type B were significantly more higher than the other syndromes (P0.05). Conclusion The distribution of TCM types of syndrome of the patients with HBeAg-negative chronic hepatitis B has its characteristic. There are some relationships between TCM types of syndrome and the levels of transaminases, HBVDNA, the abnormal rates of four hepatic fibrosis markers.

Relationship of Liver Fibrosis with Portal Vein Hemodynamics of Chronic Hepatic B Patients / 医学研究杂志

Objective To investigate the relations between the portal parameters of homodynamic and stages of liver fibrosis of chronic hepatic B patients.Methods Fibrosis parameters of blood serum of one hundred and two patients with chronic viral hepatic B were measured with Doppler ultrasonic technique.The inner diameters,blood flow velocity,blood flow volume of their portal veins were investigated.And,the pathological changes of liver tissues were examined.Results The blood flow velocity of portal vein correlates very well with the stages of liver fibrosis,and reduces with the development of the degree of liver fibrosis.The blood flow velocity of severe fibrosis patients is obviously smaller than that of mild patients,and is 28.4% slower compared stage 4 with stage 1(P