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Objective@#To investigate the value of 1H-magnetic resonance spectroscopy (1H-MRS) in determining the content of liver triglyceride in patients with fatty liver disease (FLD), as well as its influencing factors.@*Methods@#A total of 124 patients with nonalcoholic fatty liver disease (NAFLD), chronic hepatitis B (CHB), or hepatitis B complicated by FLD who underwent liver biopsy in the Affiliated Hospital of Hangzhou Normal University were enrolled, and the clinical data, serological markers, FibroScan results, and 1H-MRS results were collected. A correlation analysis was performed with the results of liver biopsy as the gold standard, and the influence of factors including hepatitic B virus (HBV) infection and obesity on accuracy was analyzed. A one-way analysis of variance was used for comparison of means between the three groups, and the LSD or SNK test (for homogeneity of variance) or the Tamhane’s or Dunnett’s test (heterogeneity of variance) was used for comparison between any two groups. The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data. The MRS-PDFF receiver operating characteristic (ROC) curve was plotted, the area under the ROC curve (AUC) was calculated, the optimal cut-off points for the diagnosis of NAFLD were estimated, and sensitivity and specificity were calculated.@*Results@#The NAFLD group (42 patients) and the CHB + NAFLD group (40 patients) had a significantly higher proton density fat fraction (PDFF, the content of triglyceride in the liver) than the CHB group (42 patients) (16.84±9.76/9.39 ± 5.50 vs 3.45 ± 1.63, P < 0.001). The results were significantly correlated with the degree of steatosis confirmed by liver biopsy (P < 0.001), but it was not significantly correlated with inflammation or fibrosis grade. The correlation analysis showed that the MRS-PDFF value measured by 1H-MRS was significantly correlated with body mass index (BMI), blood lipids, alkaline phosphatase, and blood glucose, while it was not significantly correlated with age, sex, or the presence or absence of hepatitis B. The ROC curve analysis showed that the AUCs of PDFF measured by 1H-MRS were 0.93, 0.974, and 0.976, respectively, for the diagnosis of steatosis S1(≥5%), S2(≥34%), and S3(≥66%), and the corresponding optimal thresholds were 5.14%, 11.16%, and 16.7%, respectively.@*Conclusion@#1H-MRS has a high diagnostic value in quantitative evaluation of the degree of liver steatosis in patients with FLD and is not affected by the factors such as HBV infection, age, and sex, while it is correlated with BMI and lipid metabolism.
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Objective@#Study the clinical significance of HBX gene detection, sequence analysis in peripheral blood mononuclear cell(PBMC) of chronic hepatitis B(CHB) patients with serum HBV DNA negative conversion after treatment by nucleoside analogues(NAs).@*Methods@#Detected and analyzed the HBX gene sequence by real time PCR in PBMC of 60 patients with CHB including some with cirrhosis or hepatocellular carcinoma(HCC), all the serum HBV DNA had turned negative after treatment by NAs, and explore the clinical significance of the HBX gene.@*Results@#HBX genes were detected in 37 cases(61.67%, 37/60). HBX positive rates of PBMC in HCC and cirrhosis patients were higher than that of CHB patients(P=0.000, P=0.010). HBX △120, HBX△129, HBX△131 truncations were detected in two HCC and one CHB cases. Two hotspot mutation including A389T/G391A, T380C had been found, and A389T/G391A double mutation in HCC patients was significantly higher than that in CHB patients(P=0.021). In cirrhosis and HCC patients, T380C mutation rate in HBeAg(-) cases was higher than that in HBeAg(+ ) cases(P=0.035).@*Conclusions@#In patients with serum HBV DNA negative conversion after treatment by NAs, PBMC HBX gene positive rates in cirrhosis or HCC cases are higher than that in CHB cases. A389T/G391A double mutation rate in HCC cases is significantly higher than that in CHB cases. In cirrhosis and HCC patients, T380C mutation rate in HBeAg(-) cases is higher than that in HBeAg(+ ) cases.
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Objective@#We aimed, in our prospective study, to assess the predictive value of serum non-invasive and biochemical markers for clinical diagnosis of significant fibrosis (including early stages).@*Methods@#We measured sH2a levels in serum, comparing with routine liver function markers. We compared blindly pretreatment serum samples from a cohort of hepatitis B patients without non-alcoholic fatty liver disease(NAFLD), which had histological grades of liver fibrosis, with NAFLD individuals and CHB with NAFLD patients. Statistical analysis was by Student′s t test, and receiver-operating characteristic (ROC) curves were drawn.@*Results@#ROC curves showed that serum sH2a had greater diagnostic performance than routine liver function markers compared with histological grades of liver fibrosis(S0, S1-2, S3-4). ROC curves showed that using a sH2a cut-off point of 0.79 was with highest sensitivity as 63% and highest specificity as 80%. And sensitivity as 96.7% and specificity as 75.5% when using a sH2a cut-off point of 0.77.@*Conclusions@#sH2a has the potential to be a uniquely sensitive and specific novel marker for liver fibrosis and function.
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<p><b>OBJECTIVE</b>To study the clinical significance of hepatitis B surface antigen (HBsAg) levels and HBsAg/hepatitis B virus (HBV) DNA ratio in relation to liver inflammation in HBeAg-positive chronic hepatitis B (CHB).</p><p><b>METHODS</b>One hundred and fifty-three Chinese patients with chronic HBV infection with HBeAg-positive status were enrolled in the study.Quantitative measurements were made for HBsAg levels by immunoassay (Architect HBsAg QT by Abbott Diagnostic) and HBV DNA by real-time fluorescence quantitative PCR.Levels of liver function markers were measured by standard methods.Liver biopsy specimens were obtained from all patients and used to score the histology (liver inflammation) activity index (HAI) and grade (G) the extent of necroinflammation.Statistical correlation analysis was performed to determine the association of HBsAg titre or HBsAg/HBV DNA ratio with the various parameters of liver injury.</p><p><b>RESULTS</b>HBsAg titre and HBsAg/HBV DNA ratio were significantly correlated (r =0.578, P less than 0.0001).A significant positive correlation (r =0.642, P less than 0.0001) was found between HBsAg titre and HBV DNA load, and a significant negative correlation was found between the HAI and HBsAg (r =-0.389, P less than 0.0001) and HBsAg/HBV DNA ratio (r =-0.307, P=0.000l).A significant positive correlation was found between alanine aminotransferase (ALT) level and the HAI (r =0.480, P less than 0.0001).Patients with G less than 2 necroinflammation had significantly higher HBsAg titre and HBsAg/HBV DNA ratio than patients with G more than or equal to 2 necroinflammation (both P less than 0.01) but similar levels ofHBV DNA.Generation of a receiver operating characteristic curve using G more than or equal to 2 as the positive index provided the following area under the curve (AUC) values:HBsAg titre, 0.700; HBsAg/HBV DNA ratio, 0.672; ALT level, 0.713.When the random chance AUC was 0.5, all levels of AUC were statistically significant (Pless than 0.001).HBsAg titre (sensitivity =76.92%) was more sensitive than ALT level (sensitivity =76.92%), and HBsAg/HBV DNA ratio (specificity =81.33%) was more specific than ALT level (specificity =81.33%).Youden's index for comprehensive evaluation using ALT was higher than those for HBsAg titre or HBsAg/HBV DNA ratio.When HBsAg and ALT were considered in parallel, the sensitivity increased to 94.08% and specificity rose to 85.60%.</p><p><b>CONCLUSION</b>HBsAg titre, HBsAg/HBV DNA ratio and ALT levels can be used as the index for judging the degree of liver inflammation in HBeAg-positive CHB patients.Higher sensitivity and specificity are attained when HBsAg and ALT are used in series or parallel.</p>
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Humanos , Alanina Transaminase , Área Sob a Curva , Biomarcadores , DNA Viral , Antígenos E da Hepatite B , Vírus da Hepatite B , Hepatite B Crônica , Inflamação , Curva ROC , Reação em Cadeia da Polimerase em Tempo Real , Testes SorológicosRESUMO
0bjective To analyze the factors related tO the changes of liver pathology in hepatitis B e antigen (HBeAg) negative chronic hepatitis B (CHB) patients.Methods Two hundred and eighty-eight HBeAg negative CHB patients were enrolled.Bivariate Pearson correlation was employed to analyze the correlation of different age,gender,alanine aminotransferase (ALT) level,the immunohistochemistry results of hepatitis B surface antigen (HBsAg) and hepatitis B core antigen (HBcAg) in liver tissue with hepatitis B virus (HBV) DNA level,changes of liver pathology.Results The inflammation grades and fibrosis stages of livertissuesinmale were 1.72±1.23 and 1.71±1.24,respectively;1.25±1.39 and 1.21±1.40 in female,respectively,which were significantly different (t=2.398,t-2.551;both P<O.05).The HBV DNA levels in male were higher than those in female,but not significantly.The HBV DNA levels,inflammation grades and fibrosis stages of liver tissues in patients>40 years old were all significantly higher than those<40 years old(t一2.060,t一2.536,t=2.808;all P<0.05).In patients with normal ALT levels,75 cases (52.03%) showed HBV DNA level≤1×103 copy/mL,56(38.89%) showed≥G2 of liver tissues; the ALT level and inflammation grade of liver tissues was significantly correlated(r:O.244,P-O.004).In patients with elevated ALT 1evels,42 cases (31.57%) showed HBV DNA level≤1×10s copy/mL,89 (66.92%) showed≥G2 of liver tissues; the ALT level and inflammation grade of liver tissues was not significantly correlated (r=0.007,P=0.939) .The inflammation/fibrosis of liver tissues,HBV DNA levels in patients with both HBsAg and HBcAg positive in liver tissues were significantly higher than those in other patients (P<O.05).There was significant relationship between serum HBV DNA level and inflammation grade of liver tissue (r=0.349, P<0.05).Conclusions Gender,age,serum HBV DNA level and expressions of HBsAg.HBcAg in liver tissues are indicators of inflammation grade Of liver tissue in HBeAg negative CHB patients.The factors of male,older age,high serum HBV DNA level,HBsAg and HEcAg double positive in liver tissues indicate that the inflammation grades of 1iver tissues are more severe.Even patients with normal ALT level and serum HBV DNA level≤1×100 copy/mL,30% showed significant liver inflammation in HBeAg negative CHB patients.Therefore.frequent follow-up and if possible.liver biopsy should be considered tO early identify patients who need treatment.
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Objective To study effects of low molecular weight heparin on liver fibrosis and the serum levels of TGF-?_1 in patients with chronic hepatitis B virus.Methods 45 patients with chronic hepatitis B virus were randomized into control group(the routine strategy)and trial group(the routine strategy + low molecular weight heparin).The period of treatment is 3 weeks.Serum hepatic fibrosis indices before and after heparin treatment were examined by RIA,the levels of serum TGF-?_1 before and after heparin treatment were examined by ELISA.Results Hepatic functions became significantly better in trial groups,serum PⅢP and type IV collage levels and the levels of serum TGF-?_1 in trial group decreased significantly after treatment.Conclusions The mechanism of anti-fibrosis action of LMWH may inhibited production of TGF-?_1 in patients with HBV.
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0.05). Genotype B+C(2.93?0.74 and 2.95?0.71) was associated with higher grade of necroinflammation and stage of fibrosis than genotype B(1.76?1.18 and 1.76?1.15 ) and C (1.93?1.32 and 1.84?1.29) HBV. Conclusions[KG1]genotype C or B+C HBV are associated with more severe liver damage in patients. Stratification for HBV genotypes should be considered in the antiviral treatment of chronic hepatitis B.