Non-invasive assessment of portal hypertension in patients with liver cirrhosis using FibroScan transient elastography / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate the clinical value of FibroScan transient elastography for assessing portal hypertension in liver cirrhosis patients by determining the relationship between the liver or spleen stiffness measurement with the imaging parameters of esophageal varices, portal vein width, spleen volume, and splenic vein width.</p><p><b>METHODS</b>A total of 259 patients with liver cirrhosis underwent FibroScan measurement, ultrasound, computed tomography and routine blood analyses. One-hundred-and-one of those patients also underwent endoscopy to diagnose esophageal varices. Receiver operating characteristic (ROC) curves were generated and the areas under the curves (AUCs) were calculated to assess the accuracy of the FibroScan liver and spleen stiffness measurements to predict esophageal varices. Pearson's correlation analysis was used to assess the relationship between clinical features.</p><p><b>RESULTS</b>The median liver and spleen stiffness of the cirrhotic patients were 24.27 kPa and 44.64 kPa, respectively. Liver and spleen stiffness increased in conjunction with increases in Child-Pugh score. Liver stiffness was positively correlated with spleen stiffness (P less than 0.05). Liver and spleen stiffness were positively correlated with esophageal varices, portal vein width, spleen thickness, spleen volume, and splenic vein width. The correlation of spleen stiffness was higher than that of liver stiffness. Spleen stiffness was also negatively correlated with white blood cell count and platelet count. Liver and spleen stiffness also increased in conjunction with increased severity of esophageal varices. The AUC of spleen stiffness was higher than that of liver stiffness for predicting esophageal varices (0.804 vs. 0.737). The optimal cut-off level of spleen stiffness was 44.5 kPa (sensitivity: 88%; specificity: 68%). The estimated prevalence of esophageal varices was 97.87% and the optimized cut-off level of liver stiffness was 18.0 kPa.</p><p><b>CONCLUSION</b>FibroScan appears to be a clinically valuable non-invasive method to assess portal hypertension in cirrhotic patients. Both liver and spleen stiffness measurements correlated with portal hypertension but the spleen stiffness measurement may be of higher clinical value.</p>

An experimental study of plasma-perfusion with a novel aminated chitosan on liver failure in a canine model / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To study the efficacy and safety of plasma-perfusion with a novel aminated chitosan on liver failure in a canine model.</p><p><b>METHODS</b>A canine model of liver failure was established. Plasma-perfusion with a novel aminated chitosan was performed on those dogs. Blood pressure and body temperature during plasma-perfusion were monitored. Total plasma bilirubin, direct bilirubin and indirect bilirubin at the entrance and exit of a column before and after plasma-perfusion and at the time of 15, 30, 60, and 120 min during plasma-perfusion were examined. Blood alanine aminotransferase, aspartate aminotransferase, ammonia, plasma prothrombin time, electrolytes and other blood parameters were examined before and after the plasma-perfusion.</p><p><b>RESULTS</b>After the plasma-perfusion, total bilirubin decreased from 177.4+/-18.1 to 46.1+/-3.7 (P less than 0.05), direct bilirubin decreased from 124.2+/-10.3 to 30.5+/-1.7 (P less than 0.05), indirect bilirubin decreased from 53.2+/-2.8 to 15.6+/-2.0 (P less than 0.05). Compared at the entrance of the column, there were significant decreases in the levels of total bilirubin, direct bilirubin and indirect bilirubin of plasma at the exit of the column at the times of 15 and 30 min during plasma-perfusion (P less than 0.05); there were no further significant decreases at 60 and 120 min (P more than 0.05). Compared with pre-plasma-perfusion, there were significant decreases in the levels of blood alanine aminotransferase, aspartate aminotransferase, and ammonia (P less than 0.05); the plasma prothrombin time was significantly increased (P less than 0.05), the electrolytes, hematocrit level, platelet count, and white cell count were not affected significantly by the perfusion (P more than 0.05); blood pressure and body temperature were not affected significantly during the plasma-perfusion.</p><p><b>CONCLUSION</b>Plasma-perfusion with a novel aminated chitosan resin is an effective and safe method for treating liver failure in this canine model.</p>