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Objective:To establish an early clinical prediction model for patients with chronic liver disease who are coinfected with hepatitis E virus (HEV), and quickly evaluate the probability of severe hepatitis in patients.Methods:A retrospective analysis was conducted on 87 patients with chronic liver diseases who were hospitalized at the Third Affiliated Hospital of Sun Yat-sen University from May 2018 to September 2023. Clinical features and laboratory indexes were analyszed and patients were classified to severe (TBIL >171 μmol/L with PTA <40%) and non-severe (TBIL <171 μmol/L with PTA >40%) groups. and Independent factors identified using LASSO regression were incorporated into a novel nomogram to identify patients at high risk of severe hepatitis in the early stages. The performance of the nomogram was evaluated using the area under the curve and the mean absolute error of the calibration curve.Results:Significant difference was observed in the serum total bile acid (TBA) level between the severe group [240.00 (183.30, 268.70) umol/L] and the non-severe group [93.40 (20.10, 271.70) μmol/L, U=269.00, P=0.002]. Additionally, the levels of apolipoprotein A1 (APOA1) [0.32 (0.18, 0.48) g/L] and uric acid (UA) [156.15 (117.00, 202.00) μmol/L] were significantly lower in the severe group compared to the non-severe group (APOA1: [0.77 (0.63, 1.06) g/L, U=71.00, P<0.001]; UA: [334.05 (243.70, 401.00) μmol/L, U=83.00, P<0.001]). The researchers developed a nomogram, which incorporated two independent factors (APOA1 and UA) and an additional variable (TBA), exhibiting a strong predictive ability, with an area under the curve (AUC) of 0.963 (95% confidence interval: 0.927-0.998) and a well-fitted calibration curve. Positive and negative predictive values of 94.0% and 88.2% were calculated, and a nomogram score of 129 or greater was considered indicative of a higher likelihood of developing severe illness. Conclusions:This nomogram offers a rapid and accurate means of evaluating the probability of severe illness in patients with chronic liver disease after overlapping infection with HEV, which can accurately and effectively predict the risk of severe illness in patients.
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ABSTRACT Objective: To analyze the spatial distribution and the temporal trend of the hepatitis mortality rate in Brazil from 2001 to 2020. Methods: Ecological, temporal, and spatial study on mortality from hepatitis in Brazil with data from the Mortality Information System (Sistema de Informações sobre Mortalidade - SIM/DATASUS). Information was stratified by year of diagnosis, region of the country, municipalities (of residence). Standardized mortality rates (SMR) were calculated. The temporal trend was estimated by Prais-Winsten regression and the spatial distribution by the Global Moran Index (GMI). Results: The highest SMR means in Brazil were for Chronic viral hepatitis with 0.88 deaths per 100,000 inhabitants (SD=0.16), followed by Other viral hepatitis with 0.22/100,000 (SD=0.11). In Brazil, the temporal trend of mortality from Hepatitis A was −8.11% per year (95%CI −9.38; −6.82), while for Hepatitis B it was −4.13% (95%CI −6.03; −2.20), of Other viral hepatitis of −7.84% (95%CI −14.11; −1.11) and of Unspecified Hepatitis −5.67% per year (95%CI −6.22; −5.10). Mortality due to chronic viral hepatitis increased by 5.74% (95%CI 3.47; 8.06) in the North and 4.95% in the Northeast (95%CI 0.27; 9.85). The Moran Index (I) for Hepatitis A was 0.470 (p<0.001), for Hepatitis B 0.846 (p<0.001), Chronic viral hepatitis=0.666 (p<0.001), other viral hepatitis=0.713 (p<0.001), and Unspecified Hepatitis=0.712 (p<0.001). Conclusion: The temporal trend of hepatitis A, B, other viral, and unspecified hepatitis was decreasing in Brazil, while mortality from chronic hepatitis was increasing in the North and Northeast.
RESUMO Objetivo: Analisar a distribuição espacial e a tendência temporal da taxa de mortalidade por hepatites no Brasil no período de 2001 a 2020. Métodos: Estudo ecológico, temporal e espacial sobre a mortalidade por hepatites no Brasil com dados do Sistema de Informações sobre Mortalidade (SIM/Datasus). As informações foram estratificadas por ano do diagnóstico, região do país, municípios (de residência). Foram calculadas as taxas padronizadas de mortalidade (TPM). A tendência temporal foi estimada pela regressão de Prais-Winsten e a distribuição espacial pelo Índice Global de Moran (IGM). Resultados: As maiores médias da TPM no Brasil foram para hepatite viral crônica, com 0,88 mortes para cada 100 mil habitantes (desvio padrão — DP=0,16), seguida de outras hepatites virais, com 0,22/100 mil (DP=0,11). No Brasil, a tendência temporal da mortalidade por hepatite A foi de −8,11% ao ano (intervalo de confiança de 95% — IC95% −9,38; −6,82), enquanto por hepatite B foi de −4,13% (IC95% −6,03; −2,20); de outras hepatites virais, foi de −7,84% (IC95% −14,11; −1,11) e de hepatite não especificada, de −5,67% ao ano (IC95% −6,22; −5,10). A mortalidade por hepatite viral crônica cresceu 5,74% (IC95%3,47; 8,06) no norte e 4,95% no nordeste (IC95% 0,27; 9,85). O Índice de Moran (I) para hepatite A foi de 0,470 (p<0,001), para hepatite B de 0,846 (p<0,001), hepatite viral crônica=0,666 (p<0,001), outras hepatites virais=0,713 (p<0,001) e hepatites não especificadas=0,712 (p<0,001). Conclusão: A tendência temporal das hepatites A, B, de outras hepatites virais e das não especificadas foi de diminuição no Brasil, enquanto a mortalidade por hepatites crônicas foi de crescimento nas Regiões Norte e Nordeste.
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Objective:To compare the clinical efficacy and safety of ledipasvir/sofosbuvir (LDV/SOF) and elbasvir/grazoprevir (EBR/GZR) in treatment of patients with chronic hepatitis C (CHC).Methods:The clinical data of 143 patients with genotype 1b CHC treated in Huzhou Central Hospital from January 2020 to December 2021 were retrospectively analyzed, including 74 cases treated with LDV/SOF and 69 cases treated with EBR/GZR. The virological response after 4 and 12 weeks of treatment and 12wk after drug withdrawal was determined; and the serological and liver inflammation indexes before and after treatment in two groups were compared. SPSS 25.0 software was used for statistical analysis of the data.Results:The virological response rates of the LDV/SOF group and EBR/GZR group were 97.30% and 98.55%, 98.65% and 100.00%, 97.30% and 98.55% after 4 and 12 weeks of treatment and 12 weeks after the end of treatment, respectively (all P > 0.05). At the end of treatment, the liver inflammation indexes ALT, AST and GGT in the two groups were significantly lower than the baseline levels ( Z=-7.470 and -6.974, -9.757 and -6.832, -3.578 and -4.054, P<0.01). Adverse reactions in both groups were mild, and no serious adverse events occurred. Conclusion:Both LDV/SOF and EBR/GZR have good clinical efficacy in the treatment of genotype 1b CHC patients. And the patients are well tolerated.
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T helper 17 (Th17) cells, differentiated from nave CD4+T cells, can secrete a series of cytokines including interleukin-17, interleukin-21, and interleukin-22 and are meanwhile regulated by a variety of cytokines and genes, playing an important role in various inflammatory diseases. Th17 cells are widely distributed in vivo and are associated with diseases in many systems. They are involved in the regulation of chronic inflammatory/autoimmune diseases by secreting pro-inflammatory factors and antagonizing the immunosuppressive effect of regulatory T cells. This article reviews the recent studies on the association between Th17 cells and the pathogenesis of various chronic inflammatory liver diseases, so as to provide a reference for scientific research and clinical treatment.
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Achieving HBV DNA negative transformation and HBsAg clearance with effective antiviral therapy can reduce the incidence of HCC, but some patients are still at risk of developing HCC. Therefore, screening high-risk patients for close monitoring is essential to reduce the incidence of HCC. This paper reviews the occurrence of HCC, risk factors and risk prediction models of HBV DNA negative transformation and HBsAg clearance, and provides a basis for screening and follow-up management of high-risk group of HCC with chronic hepatitis B.
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Chronic liver disease has a high incidence and prevalence in China, which had done great harm to people's health. Laboratory detection is an effective way to diagnose and evaluate therapeutic effect of chronic liver disease. However, the selection and interpretation of laboratory tests are difficult for the various causes of liver diseases. According to etiology of the chronic liver diseases, application of common laboratory tests for liver diseases based on the clinical guidelines were interpreted in this article .
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Liver fibrogenesis is a common pathway of pathological progression of chronic liver injuries. The diagnosis of liver fibrosis provides an important basis for treatment decision-making and prognostic evaluation of chronic liver diseases. With the rapid development of therapeutics, many new clinical issues have emerged, which requires new techniques for the diagnosis of liver fibrosis. At present, histological assessment remains the most reliable method for a definite diagnosis of liver fibrosis and cirrhosis. With reference to related clinical articles and data, this article analyzes the clinical value and research directions of histological assessment in chronic liver disease management and diagnosis of liver fibrosis/cirrhosis and its reversal.
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Liver biopsy plays an important role in the diagnosis and treatment of liver diseases and can give a comprehensive and detailed description of the morphology of lesions and objective grading and staging scores. There are several pathological grading and staging systems for chronic viral hepatitis and chronic hepatitis due to other causes. This article describes the application and advantages/disadvantages of each scoring system and summarizes related precautions.
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Liver pathology is the gold standard for the diagnosis of chronic hepatitis.Although there are many effective noninvasive diagnostic methods,liver pathology is still the most direct and reliable method for evaluating inflammation and fibrosis in patients with chronic hepatitis.The classification system for liver pathology has been also constantly changing,so as to provide more accurate information of grading and staging and to guide clinical and scientific research.This article reviews the development of classification systems for liver pathology,the basic criteria and disadvantages of each major classification system,and the prospects of pathological classification systems for chronic hepatitis.
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Objective@#To observe the changes of peripheral blood picture of CHB with Peg-IFN, and explored the relationship between the changes and decline of HBV DNA, clearance of HBsAg.@*Methods@#Patients with CHB treated with Peg-IFN α-2 a in the Second Division of Liver Disease in Beijing Ditan Hospital were monitored for blood routine examination and Liver function, kidney function, thyroid function of baseline and weeks 2, 4, 8, 12, 24, 36, 48, and weeks 12, 24, and 48 after the end of treatment for chronic hepatitis B, and HBV DNA, HBsAg.@*Results@#The decrease of peripheral blood cells began to occur at week 2 of treatment. For CHB with HBeAg negative patients, white blood cells, lymphocyte, neutrophils, hemoglobin and platelets significantly decreased at 2 weeks, while a minimum value occurred at 48 weeks. The recovery was obvious at the end of treatment (48 weeks), and reached pre-treatment levels at 48 weeks after the end of treatment. For CHB with HBeAg positive patients, white blood cells, neutrophils, hemoglobin and platelets significantly decreased at 2 weeks, while a minimum value was found at 36-48 weeks. The recovery was obvious at the end of treatment (48 weeks), and reached pre-treatment levels at 48weeks after the end of treatment. For patients with CHB, hemoglobin declined by more than13.64% at 36th week, which means that the patient would have a predictive significance for decrease of HBV DNA, and drops of more than 0.33% at 2nd week means that the patient would have a predictive significance for clearance of HBsAg.@*Conclusions@#During the treatment with interferon, the variation regularity of blood picture for predicting result have a certain effect, which may help predict and monitor the change of blood picture in clinical work.
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ObjectiveTo investigate the association of single nucleotide polymorphisms (SNPs) of programmed cell death-1 (PD-1) gene with chronic hepatitis C virus (HCV) infection and the effect of antiviral therapy with interferon combined with ribavirin. MethodsA total of 228 patients with chronic hepatitis C (CHC) who were hospitalized in seven hospitals in Hebei Province, China from October 2010 to October 2012 were enrolled and treated with interferon combined with ribavirin as the individualized antiviral therapy. Eighty-one persons who underwent physical examination were enrolled as control group. The TaqMan probe method was used to detect PD-1 gene polymorphisms. The distribution of alleles and genotypes at PD-1.1 and PD-1.3 were compared between the two groups, and the association between the SNPs of PD-1.1 and PD-1.3 and anti-HCV effect was analyzed. The chi-square test was used for the comparison of categorical data between groups. ResultsThe CHC group showed significantly higher frequencies of T allele and TT genotype at PD-1.1 than the control group (52.41% vs 43.21%, χ2=4.059, P=0.044; 28.51% vs 14.81%, χ2=6.469, P=0.039). The SNPs of PD-1.1 gene were not significantly associated with complete early virologic response or sustained virologic response (both P＞0.05). Both groups had CC genotype at PD-1.3. ConclusionPD-1.1 T allele might be associated with chronic HCV infection, and patients carrying TT genotype have a high risk of chronic HCV infection. PD-1.1 polymorphism is not associated with virologic response to anti-HCV therapy.
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Objective To explore clinical haracteristics, diagnosis, treatment, prognosis and prevention of mental disorder induced by interferon.Methods Thirty cases of interferon treatment for chronic hepatitis were select-ed as research subjects.The psychotic symptoms of these patients induced by interferon were analysized by clinical statistics.Results The Self-Rating Depression Scale( SDS) and the Self-Rating Anxiety Scale( SAS) scores after treatment were (47.10 ±9.47) points and (43.00 ±10.34) points,these were higher than before treatment and the difference was statistically significant (t=8.39,7.66,all P<0.01).The incidence rates of the psychotic symptoms in this group of interferon-induced were 66.7%(20/30).The occurrence rates of headaches,insomnias,depres-sions,anxieties and personality changes were respectively 36.7%,30.0%,16.7%,10.0%,10.0%.Before and after treatment,the difference was statistically significant (χ2 =15.43,P<0.01).Conclusion The symptoms of mental disorder induced by interferon have high incidence rate and serious consequences,so early detection and early treat-mentcan contribute a better prognosis.
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Objective To investigate the effect of recombinant interferon in the treatment of chronic hepatitis and the influence of neutralizing antibody (NA) on its clinical efficacy.Methods 80 cases with chronic hepatitis were randomly divided into the treatment group(n=40) and control group(n=40).The content of HBV DNA was determined by fluorescence quantitative polymerase chain reaction ( PCR) assay.The neutralizing antibodies against interferon were measured by antiviral-neutralizing assay(AVA).Results After the treatment,the content of HBV DNA in the observation group was significantly lower than before treatment (F=12.55,P0.05).The contents of HBV DNA in NA positive group had no significant difference before and after treatment (F=0.88,P>0.05);The contents of HBV DNA in NA negative group had significant difference before and after the treatment ( F=11.55,P<0.05).In 80 cases,degree of cell lesions in 0 grade(10 cases),1 grade(25 cases),2 grade (25 cases),3 grade (12 cases) and 4 grade(8 cases).Conclusion The recombinant interferon in the treatment of chronic hepatitis has certain effect,but NA can affect its treatment effect .
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Objective To analyze the clinical characteristics of drug-induced liver injury (DILI) from Chinese literatures published in Chinese Periodical Full-text Database (CNKI) from 2007 to 2011.Methods Using drug-induced liver injury as key words,the literatures in CNKI were searched,and the data of age,gender,medication,clinical manifestation and prognosis were analyzed.Results In search of CNKI,281 literatures were collected; finally 111 relevant papers were obtained.Total 10 693 cases of DILI were included with a male/female ratio of 1.14:1 and a mean age of 45.6 y ranging from 7 months to 93 y.Among 1093 cases with the age grouped,the highest incidence of DILI was in age 41-60 y(38.52％)and 20.68％ patients were over 60 y.Among 6592 cases with clinical manifestation recorded,43.51％ patients were asymptomatic and abnormal liver function was detected in health check-up; and others presented nonspecific gastrointestinal symptoms,including fatigue,nausea,vomiting and jaundice.In 9340 cases with medication recorded,the 6 most common drugs inducing DILI were antituberculotics (32.74％),Chinese herbs(22.12％),antibiotics(9.18％),antineoplastics(6.34％),NSAIDs (4.80％)and antithyroid drugs (4.37％).The most common type of toxicity was hepatocellular injury (63.66％,4438/6971).In general the prognosis was good with a fatality rate of 1.67％.Conclusions Antituberculotics and Chinese herbs are the main causes of DILI.Some DILI patients have occult onset and others have nonspecific gastrointestinal symptoms.Most patients have good prognosis if they are treated timely.
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Objective To evaluate the effect of anti-histamine treatment on intestinal endotoxemia and liver inflammation in experimental chronic hepatitis rats.Methods Thirty Wistar rats (15 males and 15 females) were randomly divided into control group (n =8),chronic hepatitis group (n =12) and hepatitis + anti-histamine group (n =10).Chronic hepatitis was induced by subcutaneous injection with 40％ of CCl4,and feeding with low protein,low choline,high cholesterol and high alcohol diet.Antihistamine treatment was given 1 week after the modeling by intragastric administration of ketotifen (1.25 mg/kg).All rats were sacrificed 4 weeks later.Plasma endotoxin,alanine aminotransferase (ALT),total bilirubin (TBil),tryptase,histamine,interferon-γ (IFNγ),iuterleukin (IL)-12,IL-10 and IL-4levels were detected,and the changes in liver histology,the morphology and ultrastructure of mast cells were observed.SPSS 13.0 software package was used for statistical analysis.ANOVA was used for the comparison of measurement data,and SNK method was used for pairwise comparison.Results Plasma endotoxin,ALT,TBil,tryptase,plasma and liver tissue histamine concentrations were (81 ± 19) pg/mL,(186 ± 140) U/L,(10.2±6.2) μmol/L,(0.75 ±0.21) mg/mL,(145 ±52) ng/mL,and (107 ±43) ng/100 mg in chronic hepatitis group,while the above parameters were significantly lower in anti-histamine group except TBil (P ＜ 0.05).Under light microscope,fatty degeneration and fibrosis were formed in liver of chronic hepatitis rats,the hepatic injury was attenuated in anti-histamine group.Toluidine blue stain showed that there was many degranulating and degranulated mast cells filled with purple granula around liver blood vessels and in fiber-interval in chronic hepatitis group,and there were few purple granula in anti-histamine group.The number of mast cells in anti-histamine group was (6.5 ± 1.5)/HP,which was significantly lower than chronic hepatitis group [(10.9 ± 1.6)/HP,P =0.000],but was still higher than that in the control group [(2.2 ± 0.9)/HP,P =0.000].Under electron microscope,the phenomenon of degranulation was severe in chronic hepatitis group and moderate in the anti-histamine group.Compared with the chronic hepatitis group,IL-4 and IL-10 in anti-histamine group were significantly decreased (P ＜0.05),IL-12 was increased (P ＜0.05),but the level of IFN-γ had no significant change (P ＞ 0.05).Conclusion Anti-histamine therapy can significantly improve liver inflammation and alleviate intestinal endotoxemia.
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Objective To explore the clinical effect of combination therapy of Iamivudine and Yigan decoction in treatment of chronic hepatitis B.Methods 52 patients with chronic hepatitis B were selected and divided into control group and combination group randomly according to the digital table.Based on regular treatments,control group received treatment of lamivudine,and based on treatment of control group,combination group received treatment of Yigan decoction.Treatment efficacy,viral serological response rate,viral nucleic acid response rate and cellular immunity status were observed and compared.Results Compared with control group,treatment efficacy increased significantly from 73.08％ to 84.62％ (P ＜ 0.05) ; viral serological response rate and viral nucleic acid response rate increased significantly at the same time,from 23.08％ to 65.38％ and from 38.46％ to 88.46％ respectively (P ＜0.05) ;Composition of CD4+ T cells increased significantly in all patients after treatment,but more significantly in combination group (P ＜ 0.05) ; Composition of CD8+ T cells decreased significantly in combination group after treatment (P ＜0.05) ; ratio of CD4+/CD8+ increased significantly after treatment in all patients but more significantly in combination group (P ＜ 0.05).Conclusion Combination therapy of lamivudine and Yigan decoction is an ideal treatment of chronic hepatitis B,which can improv viral serological response,viral nucleic acid response and cellular immunity status,better than application of lamivudine alone.
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Objective To investigate the causes and risk factors of postpartum hemorrhage (PPH) in hepatitis B virus (HBV) infected parturient.Methods Retrospective analysis was performed on the 1021 HBV infected parturient from Shanghai Public Health Clinical Center from July 2005 to June 2011.The comparisons were done by chi-square test.Results Among 1021 cases of HBV infected parturient,868 (85.01％) were asymptomatic and the PPH rate was 2.76％ (24/868) ;the remaining 153 cases (14.99％) were chronic active hepatitis B and the PPH rate was 16.99％(26/153).The difference between two groups was statistically significant (x2 =56.541,P＜0.01).The total incidence rate of PPH was 4.89％ (50/1021) and 17 cases (34.00％) were postpartum hemorrhage＞1000mL.The causes of PPH included uterine inertia (30/50,60.00％),abnormal placenta (11/50,22.00％),dysfunction of coagulation (5/50,10.00％) and lesion of birth canal (4/50,8.00％).The risk factors of PPH included delivery mode (x2 =6.528,P=0.038),abortion times (x2 =16.269,P=0.000),delivery times (x2 =6.990,P=0.008),ALT levels (x2=56.541,P=0.000) and HBV DNA (x2 =64.706,P=0.000).Conclusions The main causes of PPH in HBV infected parturient include uterine inertia,abnormal placenta,lesion of birth canal and dysfunction of blood coagulation.PPH is correlated with abortion times,delivery times,delivery mode,liver function and HBV DNA.The incidence of PPH in parturient with chronic active hepatitis B is higher than asymptomatic parturient.
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BACKGROUND/AIMS: To investigate the degree of cyclooxygenase-2 (COX-2) protein expression in chronic hepatitis and cirrhosis. METHODS: COX-2 protein expression was evaluated in 43 cases of chronic hepatitis and 24 cases of cirrhosis using immunohistochemical techniques. The COX-2 immunohistochemical staining score was assessed using the scoring systems of Pazirandeh et al and Qiu et al. and each scoring system was based on a sum of the parameters of staining intensity and distribution. RESULTS: The mean COX-2 expression scores in chronic hepatitis and cirrhosis were 2.5 +/- 1.3 vs. 3.3 +/- 1.1 (p = 0.008), and 3.2 +/- 2.0 vs. 4.5 +/- 1.7 (p = 0.006), respectively, based on the Pazirandeh et al. and Qiu et al. scoring systems. The percentage samples of high COX-2 expression score (4 to 5) in chronic hepatitis and cirrhosis were 16.3% vs. 45.8% (p = 0.022), and 23.3% vs. 50% (p = 0.021), respectively, based on the two scoring systems. The mean COX-2 expression scores based on the severity of hepatic fibrosis scored using Ishak's modified staging system (fibrosis score 0 to 3 vs. 4 to 6) were 2.4 +/- 1.3 vs. 3.2 +/- 1.1 (p = 0.009), and 3.1 +/- 2.0 vs. 4.3 +/- 1.8 (p = 0.009), respectively, based on the two scoring systems. CONCLUSIONS: COX-2 expression was significantly higher in liver cirrhosis group than in chronic hepatitis. COX-2 expression scores according to Ishak's staging was significantly higher in the advanced fibrosis group. COX-2 may play a role in the progression of hepatic fibrosis.
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Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ciclooxigenasa 2/análisis , Inhibidores de la Ciclooxigenasa 2/uso terapéutico , Progresión de la Enfermedad , Hepatitis Crónica/enzimología , Inmunohistoquímica , Cirrosis Hepática/tratamiento farmacológicoRESUMEN
Objective To evaluate clinical application value of DWI and reservation of liver function in patients with chronic liver disease. Methods Thirty cases of healthy control group, and 60 case group with chronic liver disease,including both 30 chronic hepatitis B and 30 cirrhosis. liver function in case group was analysed by venous blood samples. Case groups were divided into three groups according to MELD score: ＜30 group in 27 cases, 30 to 36 group in 17 cases, ＞36 group in 16 cases. All cases underwent liver magnetic resonance DWI. Among the case group, 15 cases were followed-up twice of pre- and aftertreatment. DWI images were read, ADC values of liver parenchyma were measured and standardized with the cephalospinal fluid (CSF) at the same slice. Used SPSS 13.0 for windows to treat the data, group comparison of ADC values were treated by one-factor analysis of variance, interclass comparison each other by SNK method, comparison between pretherapy and post-treatment by paired-samples t test. Results Healthy liver parenchyma of the control group is homogeneous signal on DWI. ADC pseudo-color pictures showed green on the homogeneous areas. Slightly restricted area of chronic hepatitis B showed irregular scattered patchy in DWI images, 25 cases in right and left lobes, 5 cases only in right lobe of the liver. ADC pseudo-color pictures reaveled blue region in proliferation-constrained areas. Restricted areas of the liver parenchymal become more evident, also showed an irregular liver edge in 30 cases of cirrhosis. The standarized ADC average values were: the healthy group (0. 47 ±0. 02) × 10-3 mm2/s, chronic hepatitis B group (0. 37 ±0. 03) × 10-3 mm2/s, cirrhosis group (0. 36 ±0. 04) × 10-3 mm2/s( F =97.05,P ＜0. 05).The difference between healthy group and patients group was statistically significant (P ＜ 0. 05 ). No statistically significant difference between groups of chronic hepatitis B and liver cirrhosis ( P ＞ 0. 05 ).Average ADC values of MELD score among groups of ＜ 30, 30 to 36, ＞ 36 were ( 0. 38 ± 0. 02 ) ×10-3 mm2/s,(0.35 ±0.02) × 10-3 mm2/s, (0.32 ± 0.03) × 10-3 mm2/s respectively. There is a significant difference among the three groups (P ＜0. 05). After treatment, DWI of 15 patients with chronic liver disease showed reduction in restricted areas, and the average ADC value from pre-treatment (0. 33 ±0. 03) × 10-3 mm2/s increased to(0. 38 ±0. 03) × 10-3 mm2/s, MELD score from pre-treatment 36. 01 ±6. 00 reduced to 27. 83 ± 4. 86. Conclusion DWI of chronic liver disease showed patchy diffuse restricted areas; more severe of the liver cell damage was, more worse the liver function was and lower ADC values was. ADC values increased after effective treatment, liver function recoved and diffuse restricted areas of liver parenchyma reduced.
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RACIONAL: O processo patológico mais discutido na gênese da cirrose hepática é a fibrose progressiva, porém alterações na vasculatura do órgão têm sido apontadas como elementos fundamentais na fisiopatologia da doença e de suas complicações, como hipertensão portal, insuficiência hepática e carcinoma hepatocelular. OBJETIVO: Avaliar a densidade microvascular em 35 casos de necropsias de pacientes com cirrose hepática mediante pesquisa imunoistoquímica do marcador endotelial CD34 a fim de comparar os informes obtidos mediante semi-quantificação com aqueles registrados por método quantitativo morfométrico, além de relacionar as alterações vasculares encontradas com os principais agentes causais, padrões de lesão e complicações clínicas da doença. MÉTODOS: Foram estudados 35 casos de cirrose obtidos retrospectivamente de necropsias realizadas no SVOC/USP no período de março de 2002 a junho de 2003. Os casos foram reagrupados segundo padrão anatomopatológico em esteatohepatite e hepatite crônica. A microvasculatura foi avaliada através da reação imunoistoquímica com anticorpo anti-endotelio clone CD34, QBend. RESULTADOS: Observou-se associação significativa entre a abordagem semi-quantitativa e a quantificação morfométrica da densidade de vasos no parênquima, o mesmo não ocorrendo no septo. Não foram detectadas associações específicas entre a neovascularização e os tipos de complicação da hepatopatia aqui estudados. O principal achado foi que a neoformação vascular no parênquima é significantemente maior nas cirroses associadas a hepatites crônicas do que nas esteatohepatites. CONCLUSÃO: Todos esses achados requerem necessários estudos clínicos para avaliar a hipótese de que o estudo do rearranjo da microcirculação hepática, através de marcadores como o CD34, pode ser fator prognóstico em pacientes cirróticos.
BAKGROUND: Fibrosis has been the most cited variable in cirrhosis, but major alterations in hepatic vascularization have been pointed as basic elements in the physiopathology of the illness and its complications as portal hypertension, hepatic failure and hepatocellular carcinoma. METHODS: The present study aims at assessing microvascular density in 35 cases of necropsies of cirrhotic patients by immunohistochemical detection of endothelial marker CD34, comparing semi-quantification with morphometric quantitative method, also searching for a possible relation of vascular alterations with the main causal agents, injury patterns and major clinical complications. RESULTS: A significant association was detected between semi-quantitative and quantitative approach of microvessel density in parenchyma, but not in septa. No significant association was detected between neovascularization and any specific clinical complication of cirrhosis. Under our standpoint, the main achievement of the present study was the demonstration that the vascular neoformation in hepatic parenchyma is significantly higher in cirrhosis associated with chronic hepatitis than in cirrhosis resulting from steatohepatitis. CONCLUSION: These findings require further clinical studies to assess the hypothesis that the rearrangement of liver microcirculation through the detection of CD34 might be relevant in prognostic assessment of cirrhotic patients.