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El ultrasonido endoscópico ha cambiado la evaluación de las enfermedades pancreáticas y ha logrado un diagnóstico histopatológico (cuando se asocia con la punción); sin embargo, este procedimiento requiere de entrenamiento, no está libre de complicaciones y alrededor de 25% de los pacientes puede tener falsos negativos. Por esto se ha implementado el uso de la elastografía cuantitativa con el strain ratio, el cual permite diferenciar las masas benignas de las malignas. Existe evidencia creciente, pero aún no conclusiva, dada la heterogeneidad de los resultados (sin consenso para su realización), por lo que es necesario desarrollar otros métodos, que permitan una mayor certeza diagnóstica, como el índice de fibrosis hepática (IFH) medido por ultrasonografía endoscópica, el cual tienen como base la inteligencia artificial, validado para el diagnóstico y el seguimiento de la fibrosis hepática. Nuestro grupo considera que se podría usar de la misma forma para valorar el parénquima pancreático. Objetivo: evaluar si el IFH puede diferenciar tres tipos diferentes de tejidos pancreáticos: páncreas normal, páncreas graso y cáncer de páncreas. Metodología: estudio prospectivo de corte transversal en un solo centro. Se incluyeron 66 pacientes mayores de 18 años, con indicación de ultrasonografía endoscópica. El grupo 1 fue de pacientes con indicación diferente a la enfermedad biliopancreática (55 pacientes). En este grupo se aplicó la escala de clasificación de páncreas graso por ultrasonografía endoscópica (USE), utilizando como referencia la ecogenicidad del bazo (previamente validada); este grupo se subdividió en uno con parénquima pancreático normal y en otro con páncreas graso. En el grupo 2 (11 pacientes) se incluyeron los pacientes llevados para el estudio de lesión sólida pancreática, con diagnóstico citológico positivo para carcinoma de páncreas. Como herramienta de recolección de datos se utilizó un formulario virtual de Google Drive, disponible con dirección acortada: shorturl.at/pIMWX, diligenciado antes y después del procedimiento por fellows de Gastroenterología, previamente entrenados para este fin. El IFH se tomó en el páncreas en tiempo real mediante un software suministrado por el fabricante (Hitachi-Noblus), en un período comprendido entre enero de 2019 y enero 2020. A todos los pacientes se les realizó una ecoendoscopia biliopancreática completa, con un ecoendoscopio Pentax lineal y procesador Hitachi-Noblus; luego se efectuó una elastografía cualitativa y una cuantitativa, la cual incluyó la medición del IFH. Resultados: en total se incluyeron 66 pacientes: 11 pacientes con diagnóstico confirmado por citología de cáncer de páncreas y 55 pacientes que se enviaron para ecoendoscopia por evaluación de otras patologías diferentes a la biliopancreática. El rango de edad fue de 23-89, media de 56,75 años. El antecedente más frecuente fue la esteatosis o esteatohepatitis (n = 14) (25,45%). La indicación para la realización del procedimiento más frecuente fue la lesión subepitelial (n = 29) (52,73 %). Los porcentajes de pacientes según los grados de ecogenicidad del páncreas fueron de grado I (n = 29) (52,73 %); grado II (n = 5) (9,09 %); grado III (n = 18) (32,73 %); grado IV (n = 3) (5,45 %). Se tomaron los grados I y II como páncreas normal, y los grado III y IV como páncreas graso. Estos se dividieron en n = 34 pacientes (61,82 %) para páncreas normal y n = 21 (38 %) para páncreas graso; es decir, que de acuerdo con la escala utilizada hay una prevalencia para páncreas graso de 38,18 %. Se realizó el IFH en los tres subgrupos diferentes: los considerados como ecoendoscópicamente normales, los clasificados como páncreas graso y los pacientes con diagnóstico de cáncer de páncreas confirmado por citología, tomado en el páncreas. El IFH para los tres diferentes grupos fueron, respectivamente, normal: IFH 2,60, rango 0,97-3,47 (IC 95 % 2,17-3,02); páncreas graso: IFH 3,87, rango 2-5,5 (IC 95 % 3,44-4,29); cáncer de páncreas: IFH 6,35, rango 5,8-7,8 (IC 95 % 5,92-6,77). Conclusiones: este es el primer estudio piloto que usa el IFH aplicado al parénquima pancreático, y se sugiere su utilidad para diferenciar, de manera no invasiva, el páncreas normal, el graso y el carcinoma de páncreas. Este hallazgo se debe confirmar en poblaciones más amplias y heterogéneas, con el fin de ser validado.
Abstract Endoscopic ultrasound has changed the evaluation of pancreatic diseases and has achieved a histopathological diagnosis (when associated with a puncture); however, this procedure requires training, is not free of complications, and around 25 % of patients may have false negatives. Therefore, quantitative elastography with the strain ratio has been implemented to differentiate benign masses from malignant ones. There is growing but not yet conclusive evidence, given the heterogeneity of the results (without consensus on its performance). It is necessary to develop other methods that allow for greater diagnostic certainty, such as the liver fibrosis index (LFI) measured by endoscopic ultrasonography. This method is based on artificial intelligence and validated for diagnosing and monitoring liver fibrosis. Our group considers that it could also be used to assess the pancreatic parenchyma. Aim: To evaluate whether the LFI can differentiate three types of pancreatic tissues: normal pancreas, fatty pancreas, and pancreatic cancer. Materials and methods: Prospective cross-sectional single-center study. We included sixty-six patients over 18 years of age with an indication for endoscopic ultrasonography. Group 1 consisted of patients with an indication other than the biliopancreatic disease (55 patients). The endoscopic ultrasonography (EUS) fatty pancreas classification scale was applied to this group, taking the echogenicity of the spleen (previously validated) as a reference; this group was subdivided into normal pancreatic parenchyma and fatty pancreas. Group 2 (11 patients) included those examined for solid pancreatic lesions with a positive cytological diagnosis of pancreatic carcinoma. We used a Google Form as a data collection tool, available with a shortened address (shorturl.at/pIMWX). It was filled out before and after the procedure by Gastroenterology fellows, previously trained for this purpose. The LFI was measured in the pancreas in real-time using software supplied by the manufacturer (Hitachi Noblus) between January 2019 and January 2020. All patients underwent a complete biliopancreatic echoendoscopy, with a linear Pentax echoendoscope and Hitachi Noblus processor. Then, qualitative and quantitative elastography was performed, including LFI measurement. Results: We included a total of 66 patients: 11 with a diagnosis of pancreatic cancer confirmed by cytology and 55 sent for ultrasound endoscopy due to pathologies other than the biliopancreatic disease. The age range was 23-89, with a mean of 56.75 years. The most frequent history was steatosis or steatohepatitis (n = 14) (25.45 %). The most frequent indication for performing the procedure was subepithelial lesion (n = 29) (52.73 %). The percentages of patients according to pancreatic echogenicity were Grade I (n = 29) (52.73 %); Grade II (n = 5) (9.09 %); Grade III (n = 18) (32.73 %); Grade IV (n = 3) (5.45 %). Grades I and II were taken as a normal pancreas and Grades III and IV as a fatty pancreas, divided into n = 34 patients (61.82 %) for a normal pancreas and n = 21 (38 %) for a fatty pancreas. According to the scale used, there is a fatty pancreas prevalence of 38.18 %. The LFI was measured in three subgroups: those considered endoscopically normal, those classified as fatty pancreas, and patients diagnosed with pancreatic cancer confirmed by cytology taken from the pancreas. The LFI for these groups were, respectively, normal pancreas: LFI 2.60, range 0.97-3.47 (95 % CI 2.17-3.02); fatty pancreas: LFI 3.87, range 2-5.5 (95 % CI 3.44-4.29); pancreatic cancer: LFI 6.35, range 5.8-7.8 (95 % CI 5.92-6.77). Conclusions: This is the first pilot study that applies the LFI to the pancreatic parenchyma. It is useful in differentiating a normal pancreas, a fatty pancreas, and pancreatic carcinoma non-invasively. This finding must be validated in larger and more heterogeneous populations.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Pancreas , Pancreatic Neoplasms , Ultrasonics , Liver Cirrhosis , Pancreatic Diseases , Data Collection , Parenchymal TissueABSTRACT
Objective: To evaluate the diagnostic value of transient elastography, aspartate aminotransferase-to-platelet ratio index (APRI), and fibrosis index based on 4 factors (FIB-4) for liver fibrosis in children with non-alcoholic fatty liver disease (NAFLD). Methods: A retrospective study was conducted on 100 cases of nonalcoholic fatty liver disease in Hunan Children's Hospital between August 2015 to October 2020 to collect liver tissue pathological and clinical data. The receiver operating characteristic curve (ROC curve) was used to analyze the diagnostic value of liver stiffness measurement (LSM), APRI and FIB-4 in the diagnosis of different stages of liver fibrosis caused by NAFLD in children. Results: The area under the ROC curve (AUC) value of LSM, APRI and FIB-4 for diagnosing liver fibrosis (S≥1) were 0.701 [95% confidence interval (CI): 0.579 ~ 0.822, P = 0.011], 0.606 (95%CI: 0.436 ~ 0.775, P = 0.182), and 0.568 (95%CI: 0.397 ~ 0.740, P = 0.387), respectively. The best cut-off values were 6.65 kPa, 21.20, and 0.18, respectively. The AUCs value of LSM, APRI, and FIB-4 for diagnosing significant liver fibrosis (S≥ 2) were 0.660 (95% CI: 0.552 ~ 0.768, P = 0.006), 0.578 (95% CI: 0.464 ~ 0.691, P = 0.182) and 0.541 (95% CI: 0.427 ~ 0.655, P = 0.482), respectively. The best cut-off values were 7.35kpa, 24.78 and 0.22, respectively. The AUCs value of LSM, APRI and FIB-4 for the diagnosis of advanced liver fibrosis (S≥ 3) were 0.639 (95% CI: 0.446 ~ 0.832, P = 0.134), 0.613 (95% CI: 0.447 ~ 0.779, P = 0.223) and 0.587 (95% CI: 0.411 ~ 0.764, P = 0.346), respectively. The best cut-off values were 8.55kpa, 26.66 and 0.27, respectively. Conclusion: The transient elastography technique has a better diagnostic value than APRI and FIB-4 for liver fibrosis in children with NAFLD.
Subject(s)
Child , Humans , Aspartate Aminotransferases , Biomarkers , Elasticity Imaging Techniques , Liver/pathology , Liver Cirrhosis/pathology , Liver Function Tests , Non-alcoholic Fatty Liver Disease/pathology , ROC Curve , Retrospective StudiesABSTRACT
ObjectiveTo explore the accuracy of clinical common serum fibrosis indexes hyaluronic acid （HA）， type Ⅳ collagen （CⅣ）， laminin （LN）， and type Ⅲ procollagen peptide （PⅢNP）， in combination with liver stiffness measurement （LSM， measured by transient elastography） and non-invasive markers of fibrosis aspartate aminotransferase to platelet ratio index （APRI） and fibrosis-4 （FIB-4） in the prediction of the hepatic fibrosis of Wilson's disease （WD） and to observe the clinical effect of Gandouling （GDL）. MethodThe data of 76 WD patients were collected and the LSM， serum fibrosis indexes （HA， PⅢNP， CⅣ， LN）， APRI， and FIB-4 before treatment were recorded. The correlation of LSM with serum fibrosis indexes， APRI， and FIB-4 was discussed via Pearson′s correlation analysis. According to the therapeutic schemes， patients were classified into the control group （36 cases） and treatment group （40 cases）. Patients in control group were treated with sodium dimercaptopropylsulfonate （DMPS）， while those in the treatment group received GDL in addition to the western medicine therapy. The treatment lasted 6 courses （8 days/course） and the influence of GDL on the indictors was evaluated. ResultHA， CⅣ， LN， PⅢNP， APRI， and FIB-4 were in positive correlation with LSM （r=0.517， 0.438， 0.281， 0.457， 0.778， 0.847， P<0.01）. HA， CⅣ， LN， and PⅢNP in the treatment group were lower after treatment than before treatment （P<0.05， P<0.01）. HA， CⅣ， and LN in the control group were lower after treatment than before treatment （P<0.05， P<0.01）， and PⅢNP showed no significant difference. LSM， FIB-4， and APRI in both groups decreased after treatment （P<0.05）. After treatment， LSM， FIB-4， APRI， HA， and PⅢNP in the treatment group were lower than those in the control group （P<0.05， P<0.01）， but CⅣ and LN demonstrated no significant difference from the control group. ConclusionLSM in combination with serum fibrosis indexes （HA， PⅢNP， CⅣ， LN）， FIB-4， and APRI can help accurately identify the level of the hepatic fibrosis in WD. Moreover， on the basis of decoppering by western medicine， GDL can significantly improve the liver function and hepatic fibrosis of WD patients.
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Objective:To evaluate the value of preoperative aspartate aminotransferaseto platelet ratio index (APRI) and fibrosis index 4 (Fib4) in predicting posthepatectomy liver failure (PHLF) of primary hepatocellular carcinoma.Methods:The data of 587 patients with hepatocellular carcinoma admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2014 to January 2020 were retrospectively collected and analyzed, including 412 males and 175 females, aged (56.8±11.2) years. Univariate and multivariate logistic regression were used to analyze the influencing factors of PHLF. The ability of Child-Pugh score, model for end-stage liver diseas (MELD) score, APRI and Fib4 to predict PHLF was evaluated through the receiver operating characteristic (ROC) curve of subjects.Results:Among 587 patients, 186 (31.7%) had liver failure after hepatectomy. In multivariate logistic regression analysis, APRI ( OR=2.660, 95% CI: 1.314-5.384, P=0.007) and Fib4 ( OR=1.322, 95% CI: 1.157-1.511, P<0.001) were risk factors for PHLF in patients with hepatocellular carcinoma. The higher the number, the greater the risk of PHLF. The predicted area under the ROC curve of PHLF in patients with hepatocellular carcinoma was Fib4(0.719)>APRI(0.686)>MELD score(0.618)>Child-Pugh score(0.565). Conclusion:APRI and Fib4 were risk factors of PHLF in patients with hepatocellular carcinoma. They predict the occurrence of PHLF better than Child-Pugh score and MELD score.
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OBJECTIVES: Antineutrophil cyto plasmic antibody-associated vasculitis (AAV) is a fatal disease. Currently, predictors of mortality due to AAV are based on the distribution of organ involvement. The novel fibrosis index (NFI) is an index composed of laboratory results that reflect the degree of liver fibrosis. This study aimed to evaluate whether NFI can predict poor outcomes in patients with AAV without substantial liver disease. METHODS: A total of 210 patients with immunosuppressive drug-naïve AAV were retrospectively reviewed. NFI was calculated as follows: NFI=(serum bilirubin × (alkaline phosphatase)2)/(platelet count×(serum albumin)2). NFI cut-off was set at 1.24 (the highest quartile). Poor outcomes were defined as all-cause mortality, relapse, and end-stage renal disease (ESRD). RESULTS: During the median 34.5 months of follow-up, 21 patients (10%) died, 72 patients (34.3%) relapsed, and 38 patients (18.1%) had ESRD due to AAV progression. The median calculated NFI was 0.61, and it was higher in AAV patients with all-cause mortality than in those without mortality, but the difference was not statistically significant (1.26 vs. 0.59). AAV patients with NFI at diagnosis ≥1.24 exhibited a significantly lower cumulative patient survival rate than those with NFI at diagnosis <1.24 (p=0.002). Multivariate Cox hazard model analysis showed that NFI at diagnosis ≥1.24 was an independent predictor of all-cause mortality in AAV (hazard ratios [HR] 2.850, 95% confidence interval [CI] 1.026, 7.910). CONCLUSIONS: NFI ≥1.24, which may be an independent predictive marker for all-cause mortality in AAV patients without substantial liver disease.
Subject(s)
Humans , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis , Liver Diseases , Fibrosis , Retrospective Studies , Antibodies, Antineutrophil CytoplasmicABSTRACT
Objective To detect the changes of aspartate aminotransferase-to-platelet ratio index ( APRI) and fibrosis index based on the four factors (FIB-4) in patients with chronic HBV infection,and to analyze and evaluate the status of liver function,and explore the clinical significance in order to find a simple non-invasive diagnostic method for liver fibrosis. Methods From January 2016 to June 2017, a clinical controlled study was conducted to select one hundred and twenty patients with chronic HBV infection in outpatient and inpatient clinics of the Second Affiliated Hospital of Medical College of Qingdao University. They were divided into three groups: HBV carriers,chronic hepatitis B patients and hepatitis B cirrhosis patients. Serum total bilirubin,albumin,alanine aminotransferase (ALT),aspartate aminotransferase (AST) and platelet levels were measured. According to the formula, the values of APRI and FIB-4 were calculated,and the numerical changes of APRI and FIB-4 in patients with different types of chronic HBV infection were studied. The correlation between total bilirubin and albumin was analyzed. At the same time,30 healthy persons were selected as healthy control group for clinical analysis. Results The APRI values of patients with chronic HBV infection and healthy control group were ( 1. 17 ± 0. 71) and ( 0. 50 ± 0. 23), respectively. The FIB-4 values of patients with chronic HBV infection and healthy control group were (1. 90± 0. 84) and (1. 08±0. 58),respectively. The differences were statistically significant (P＜0. 01). The APRI values of HBV carriers group,chronic hepatitis B group and hepatitis B cirrhosis group were(0. 53±0. 22), (1. 14± 0. 61) and ( 1. 84 ± 0. 49) . The values of FIB-4 were ( 1. 22 ± 0. 54),( 1. 85 ± 0. 48) and ( 2. 64 ±0. 77) respectively. The values of APRI and FIB-4 of chronic HBV infection patients in each group increased with the increase of liver fibrosis, and there was significant difference between the groups ( P＜0. 01). The results showed that hepatitis B cirrhosis grouP＞chronic hepatitis B grouP＞HBV carrier grouP＞healthy control group. There were significant differences between hepatitis B group and healthy control group,hepatitis B cirrhosis group and HBV carrier group,chronic hepatitis B group and HBV carrier group (P＜0. 01). There was no significant difference between HBV carriers and healthy controls (P＞0. 05). The results of correlation analysis showed that there was a positive correlation among APRI, FIB-4 and total bilirubin (P＜0. 01) and a negative correlation with albumin ( P＜0. 01) in patients with chronic HBV infection. Conclusion The changes of APRI and FIB-4 values in patients with chronic HBV infection have diagnostic value for liver fibrosis in different clinical infection states can reflect the liver function status of patients,and help judge the severity and prognosis of patients with chronic HBV infection.
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OBJECTIVE:To investigate the effects and safety of Sophoraflavescens preparation combined with Fuzheng huayu capsule on hepatic hemodynamics and fibrosis indexes in patients with hepatitis B liver cirrhosis.METHODS:One hundred and two patients diagnosed as hepatitis B liver cirrhosis in our hospital during Feb.2013-Jun.2014 were divided into combination group and control group according to random number table,with 51 cases in each group.Control group was treated with Adefovir dipivoxil capsules 10 mg,po,qd;combination group was additionally given Fuzheng huayu capsules 1.5 g,po,tid+Sophora flavescens preparation (Matrine glucose injection 250 mL,ivgtt,qd,in the first 3 months,oxymatrine capsules 200 mg,po,tid,after 3 months) on the basis of control group.Both groups were treated for 12 months.The levels of HBV-DNA,liver function indexes (AST,ALT,TBIL),portal hemodynamic indexes [main portal vein inner diameter (D),mean blood flow velocity (Ⅴ)] and liver fibrosis indexes [laminin protein (LN),hyaluronic acid (HA),type Ⅳ collagen (Ⅳ-C)] were observed in 2 groups before and after treatment.The negative conversion rate of HBV-DNA and incidence of ADR were recorded.RESULTS:Three cases lost to follow up,and a total of 48 effective cases were included in control group;5 cases lost to follow up,and a total of 46 effective cases were included in combination group.Before treatment,there was no statistical significance in HBV-DNA levels,liver function indexes (AST,ALT,TBIL),liver fibrosis indexes (LN,HA,Ⅳ-C) and portal vein hemodynamic indexes (D,V) between 2 groups (P＞0.05).After treatment,above indexes of 2 groups were decreased significantly,and the combination group was significantly lower than the control group,with statistical significance (P＜0.05).The negative conversion rate of HBV-DNA in combination group was 93.5％,which was significantly higher than 79.2％ of control group,with statistical significance (P＜0.05).There was no statistical significance in the incidence of ADR between 2 groups (P＞0.05).CONCLUSIONS:Sophora flavescens preparation combined with Fuzheng huayu capsules can promote the recovery of liver function,regulate liver hemodynamics and alleviate hepatic fibrosis in patients with hepatitis B liver cirrhosis with good safety.
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Objective To explore the clinical efficacy of entecavir combined with Fuzheng Huayu capsule in patients with chronic hepatitis B cirrhosis. Methods A total of 102 decompensated patients with chronic hepatitis B cirrhosis were enrolled in our hospital from May 2015 to May 2017. The patients were divided into study group and control group by random number method. The patients were treated with routine symptom and liver Treatment group, based on this line of entecavir treatment, the study group in the conventional therapy based on entecavir combined with Fuzheng Huayu capsule treatment, compared the two groups of patients with HBV DNA negative rate, inflammatory factors, fibrosis indicators and liver function indicators. Results However, the improvement of inflammatory factors, fibrosis indexes and liver function indexes in the study group was more significant than that in the control group, and the difference was significant, but there was no significant difference between the two groups There was statistical significance (P<0.05). Conclusion The efficacy of entecavir combined with Fuzheng Huayu capsule in patients with chronic hepatitis B liver cirrhosis is accurate and worthy of clinical application in clinical practice.
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Objective To explore the clinical efficacy of entecavir combined with Fuzheng Huayu capsule in patients with chronic hepatitis B cirrhosis. Methods A total of 102 decompensated patients with chronic hepatitis B cirrhosis were enrolled in our hospital from May 2015 to May 2017. The patients were divided into study group and control group by random number method. The patients were treated with routine symptom and liver Treatment group, based on this line of entecavir treatment, the study group in the conventional therapy based on entecavir combined with Fuzheng Huayu capsule treatment, compared the two groups of patients with HBV DNA negative rate, inflammatory factors, fibrosis indicators and liver function indicators. Results However, the improvement of inflammatory factors, fibrosis indexes and liver function indexes in the study group was more significant than that in the control group, and the difference was significant, but there was no significant difference between the two groups There was statistical significance (P<0.05). Conclusion The efficacy of entecavir combined with Fuzheng Huayu capsule in patients with chronic hepatitis B liver cirrhosis is accurate and worthy of clinical application in clinical practice.
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Objective To study the relation between Child Turcotte classification and pathology, diagonsis, prognosis and fibrosis index as well as its significance. Methods The levels of hyaluronic acid(HA), type Ⅲ procollagen(PCⅢ), Laminin(LN) and type Ⅳ collagen(Ⅳ C) were detected by enzyme linked immunoadsordent assay(ELISA) or radioimmunoassay(RIA). Pathomorphology was observed in 68 patients with cirrhosis. Results Level of HA in serum was positively correlated with cirrhotic severity, but other fibrosis indexes could not reflect cirrhotic severity. Child Turcotte classification was concordant with the pathological changes. The concordance rate of Child Turcotte classification B or C patients with pathologic diagnosis was up to 97.8%. The recovery rate of Child Turcotte classification A patients was up to 95.5%. Fatality rate of Child Turcotte classification C patients was up to 96.9%. Conclusion Child Turcotte classification is closely correlated with the severity of hepatic fibrosis, severity of pathological changes in liver and prognosis of patients. It is of clinical value in the reflection of severity of hepatic cirrhosis.
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OBJECTIVE:To study the influence of compound glycyrrhizin on hepatic fibrosis indices and cytokines in patients with chronic hepatitis B(CHB).METHODS:84 patients with CHB were randomly divided into the treatment group(conventional liver protection+compound glycyrrhizin tablet) and control group(conventional liver protection).The serum levels of transforming growth factor-?1(TGF-?1),tumor necrosis factor-?(TNF-?),hyaluronic acid(HA),collagen type Ⅳ(C-Ⅳ) and laminin(LN) in those patients were measured by specific-ELISA and RIA before and after treatment.The serum levels in 20 healthy subjects were used as normal controls.RESULTS:The serum levels of HA,Ⅳ-C,LN,TGF-?1,TNF-? in patients with CHB were significantly higher than those in healthy subjects(P