Exploration on ALT threshold for initiating antiviral therapy in chronic HBV-infected patients based on results of 707 liver puncture cases / 中国热带医学

@#Abstract: Objective To explore the threshold of ALT for initiating antiviral therapy in HBV infected patients, and to provide a basis for initiating antiviral therapy in chronic HBV-infected patients. Methods This retrospective cohort study recruited 707 consecutive treatment-naïve chronic hepatitis B (CHB) patients undergoing diagnostic liver biopsy in the department of infectious diseases of the Affiliated Hospital of Yan′an University from October 2013 to August 2018. Liver biopsy specimens were obtained under ultrasound guidance using Menghini 16G disposable needles. The METAVIR scoring system, which is commonly used internationally, was used to divide the patients into the group with mild liver tissue injury and the group with significant liver tissue injury, and the alanine aminotransferase (ALT) levels were measured separately. Receiver operating characteristic (ROC) curve and Mann-Whitney U test were used to evaluate the diagnostic value of ALT for significant liver tissue injury under different demographic characteristics. Results Of 707 patients, 292 (41.30%) had significant liver tissue injury confirmed by liver biopsy (METAVIR ≥A2 and/or F2). When the ULN of ALT was set to NICE criteria (30 U/L for males, 19 U/L for females), AASLD criteria (35 U/L for males, 25 U/L for females) and EASL or APASL criteria (40 U/L for males and females), CHB patients with <ULN accounted for 32.38%, 35.03% and 36.07% of significant liver tissue injury, respectively. And significant liver tissue injury in CHB patients with 1-2×ULN accounted for 41.99%, 41.85% and 50.30%, respectively. The optimal ALT critical values were 33 U/L for overall patients, 25 U/L for females, 45 U/L for males, 45 U/L for ≤30 years olds, 33 U/L for>30 years olds, 22 U/L for HBeAg negative and 31 U/L for HBeAg positive patients. Conclusions The threshold of ALT for initiating antiviral therapy in chronic HBV patients should be individualized, especially should be down-regulated for the females, olders and HBeAg-negative patients.

Diagnostic value of heparin-binding protein in the cerebrospinal fluid for purulent meningitis in children

This study aimed to investigate the diagnostic value of heparin-binding protein (HBP) in the cerebrospinal fluid of children with purulent meningitis (PM). This study included 118 children with PM diagnosed at our hospital from January 2018 to January 2020, 110 children with viral meningitis (VM) and 80 children with suspected meningitis who were ruled out by cerebrospinal fluid (CSF) analysis during the same period. HBP and white blood cell (WBC) count in the CSF, and inflammatory factors, including C-reactive protein (CRP), tumor necrosis factor (TNF)-α, and procalcitonin (PCT), were measured. Receiver-operator characteristic curves were used to analyze the predictive value of HBP, CRP, PCT, and TNF-α levels in the diagnosis of PM by CSF analysis. HBP levels in the CSF of children with PM were higher, while the CRP and serum PCT and TNF-α levels were elevated in all groups (P<0.05). In addition, HBP levels in the CSF were more accurate for the diagnosis of PM than traditional diagnostic indexes. HBP levels in the CSF can be used as an important reference for early diagnosis of PM.

Effect of Fufang Zhenzhu Tiaozhi capsule on serum lipids and inflamma-tory factors in rabbit abdominal aortic restenosis model / 中国病理生理杂志

AIM:To investigate the effect of Fufang Zhenzhu Tiaozhi capsule(FTZ)on serum lipids and in-flammatory factors in rabbits with abdorminal aortic restenosis after balloon angioplasty.METHODS: New Zealand white rabbits(n=30)were divided into 5 groups.Except blank control group,the rabbits in other groups were used to establish abdominal aortic endothelium exfoliative vascular stenosis model.After 4 weeks of high-fat diet feeding,the animals in rest-enosis model group and drug treatment groups underwent percutaneous balloon dilatation in the stenosis.The angiographic stenosis was analyzed by a two-dimensional quantitative coronary angiography workstation with a digital subtraction X -ray machine.Blood samples were taken during angiography and the profiles of serum lipids and cytokines were measured.The expression of nuclear factor-κB(NF-κB)in the blood vessels was determined by immunohistochemistry.RESULTS:An-giography confirmed that the rates of area stenosis and diameter stenosis were significantly decreased in treatment groups compared with restenosis model group(P<0.01).Compared with restenosis model group,the serum lipid profiles and cy-tokine concentrations in drug treatment groups were significantly decreased(P<0.05).Immunohistochemistry showed the expression of NF-κB in restenosis model group was significantly higher than that in blank control group and drug treatment groups(P<0.05).CONCLUSION: FTZ significantly reduces the blood lipids and inflammatory factors in abdominal aortic restenosis model,and the anti-inflammatory effect may be related to the regulation of NF-κB pathway to inhibit the production of various inflammatory factors.