Factors associated with significant liver fibrosis in chronic hepatitis B patients with non-alcoholic fatty liver disease / 中华传染病杂志

Objective:To investigate the influencing factors of significant liver fibrosis in patients with chronic hepatitis B (CHB) concurrent with non-alcoholic fatty liver disease (NAFLD).Methods:Those who underwent liver pathological examination and confirmed diagnosis of CHB and NAFLD in Tianjin Second People′s Hospital from August 2014 to September 2017 were enrolled. Data regarding their demographic information, laboratory tests results, and liver pathology results were analyzed. The latter results were used to categorize the patients either in non-significant liver fibrosis group (Metavir stage<F2) or in significant liver fibrosis group (Metavir stage≥F2). The measurement data were compared using t test or Mann-Whitney U test, and the count data using chi-square test.The factors influencing the onset of significant liver fibrosis were subsequently explored with binary logistic regressions. Results:Out of 273 patients screened, 160 and 113 patients respectively belonged to the non-significant fibrosis group and the significant fibrosis group. Age, histologic activity, NAFLD type, liver stiffness measurement, hepatitis B e antigen (HBeAg) status (positive/negative), hepatitis B virus (HBV) DNA, aspartate aminotransferase, γ-glutamyl transpeptidase, total bilirubin, high blood glucose (with/without) and platelet count between the two groups were statistically significant( t=2.232, χ2=44.276, χ2=4.808, t=2.096, χ2=5.299, t=3.191, U=7 041.500, U=6 873.500, t=2.989, χ2=5.588, t=3.429, all P<0.05). Logistic regression showed that non-alcoholic steatohepatitis (NASH), histologicactivity, HBV DNA and platelet count were the independent influencing factors for significant liver fibrosis (odds ratio ( OR)=2.809, 6.730, 0.843, 0.995, respectively, all P<0.05). Patients were divided into two subgroups according to their HBeAg status, the results showed that for patients with negative HBeAg, NASH, histologic activity, HBV DNA and platelet count were the independent influencing factors for significant liver fibrosis ( OR=8.629, 3.626, 0.740, 0.992, respectively, all P<0.05). For patients with positive HBeAg, histologic activity and high blood glucose were the independent risk factors for significant liver fibrosis ( OR=12.738, 4.223, respectively, both P<0.01). Conclusion:Liver inflammation, NASH and high blood glucose are the serious risk factors during the onset and progression of significant liver fibrosis in patients with CHB and NAFLD, while HBV DNA and platelet count levels are negatively correlated with significant liver fibrosis.

Value of controlled attenuation parameter in diagnosis of fatty liver using FibroScan / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate the value of controlled attenuation parameter (CAP) in the diagnosis of fatty liver using FibroScan in patients with chronic liver disease (CLD).</p><p><b>METHODS</b>A prospective cohort study was performed for the patients with chronic hepatitis B (CHB), chronic hepatitis C (CHC), and non-alcoholic fatty liver disease (NAFLD) who underwent liver pathological examination followed by CAP measurement within 1 week in The Second People's Hospital of Tianjin from February 2013 to May 2014. According to related guidelines, hepatocyte steatosis was classified as S0: <5%, S1: 5%-33%, S2: 34%-66%, or S3: ≥67%. The receiver operating characteristic (ROC) curves were plotted with positive results as the diagnostic criteria, and the optimal cut-off values were determined at the maximum Youden index. Single linear regression and multiple stepwise regression were applied to analyze the influencing factors for CAP.</p><p><b>RESULTS</b>A total of 427 patients were enrolled, consisting of 19 patients (4.4%) with NAFLD, 383 (89.7%) with CHB, and 25 (5.9%) with CHC. The optimal cut-off values for CAP in the diagnosis of steatosis ≥5%, ≥34%, and ≥67% were 230 dB/m, 252 dB/m, and 283 dB/m, respectively, and the areas under the ROC curve were 0.803, 0.942, and 0.938, respectively (Z = 14.194, 28.385, and 16.486, respectively, all P < 0.01). CAP differentiated S0 from S1, S1 from S2, S0 from S2, S0 from S3, and S1 from S3 (Z = 10.109, 10.224, 47.81, 29.917, and 10.999, all P < 0.01), but was not able to differentiate S2 from S3 (Z = 0.656, P = 0.5116). The single linear regression and multiple stepwise regression analyses showed that only body mass index (BMI; B = 4.001, P < 0.01) and hepatic steatosis (B = 33.015, P = 0.000) were correlated with CAP. The coincidence rates between CAP and liver pathological diagnosis were 77.4%, 81.0%, and 96.2% for S0, S3, and ≥S2, respectively.</p><p><b>CONCLUSION</b>CAP has a good value in the diagnosis of fatty liver in CLD patients, and can well differentiate between all stages of fatty liver except S2 and S3. CAP is influenced by BMI, but is not found to be associated with liver fibrosis, inflammation, liver stiffness measurement, and etiology.</p>

Diagnostic value of alcoholic liver disease (ALD)/nonalcoholic fatty liver disease (NAFLD) index combined with γ-glutamyl transferase in differentiating ALD and NAFLD

BACKGROUND/AIMS: This study aimed to verify the reliability of the alcoholic liver disease (ALD)/nonalcoholic fatty liver disease (NAFLD) index (ANI) for distinguishing ALD in patients with hepatic steatosis from NAFLD, and to investigate whether ANI combined with γ-glutamyl transferase (GGT) would enhance the accuracy of diagnosis in China. METHODS: A hundred thirty-nine cases of fatty liver disease (FLD) were divided into two groups of ALD and NAFLD. The ANI was calculated with an online calculator. All indicators and ANI values were analyzed using statistical methods. RESULTS: ANI was significantly higher in patients with ALD than in those with NAFLD (7.11 ± 5.77 vs. -3.09 ± 3.89, p 0.05). CONCLUSIONS: ANI can help distinguish ALD from NAFLD with high accuracy; when ANI was combined with GGT, its effectiveness improved further.

The association between hepatic steatosis and HBsAg and HBcAg in chronic hepatitis B patients / 中华消化杂志

ObjectiveTo explore the association between hepatic steatosis and the liver tissue expression of HBsAg and HBcAg in chronic hepatitis B (CHB) patients.MethodsFrom January 2005 to June 2008,a total of 147 CHB patients with hepatic steatosis diagnosed by liver biopsy and other 149 CHB patients without hepatic steatosis but with similar HBV DNA titer were enrolled.The differences of HBsAg and HBcAg immunostaining and liver injury in these two groups were compared.The data were analysed using t test and chi square test.ResultsCompared with non-steatosis group,the average age and body weight index of hepatic steatosis group were higher (t values were -3.31and -6.57,both P＜0.01).The percentage of moderate to severe hepatic inflammation in liver,obvious hepatic fibrosis and the strong positive HBsAg staining was lower (30.6％ vs 15.4％ ； 26.5％vs 12.8％； 23.1 ％ vs 6.7 ％； x2=9.63,8.92,15.76； all P＜0.01),and the percentage of strong positive HBcAg staining was also in downtrend.Compared with degree F1 and F2 of liver steatosis,the percentage of HBsAg and HBcAg strong positive staining in liver tissues of degree F3 and F4 was in downtrend.ConclusionsHepatic steatosis affected the expression of HBsAg and HBcAg in liver tissue of CHB patients.As hepatic steatosis appeared and became more severe,both expression of HBsAg and HBcAg and the degree of liver injury were in downtrend.

Hand Hygiene and Preventive Strategies among Clinical Laboratory Workers / 中华医院感染学杂志

OBJECTIVE To measure the compliance of laboratory personnel with different components of hand hygiene and improve their concerns for prevention.METHODS By checking and evaluating the exposing risks factors,including HIV,HBV and HCV source of infections,we found and formulated effective ways for preventing occupational disease.RESULTS The level of compliance at the end of duty was 95.0%.Pathogenic microorganisms were exclusively found on hands of laboratory personnel who wore jewelry.CONCLUSIONS Accurate evaluation and practical preventive strategies are key factors to reduce the professional exposing risks.Hand hygiene should be directed not only at healthcare workers but also at laboratory personnel.