Clinical research advances in traditional Chinese medicine in treatment of icteric hepatitis / 临床肝胆病杂志

The pathogenesis of icteric hepatitis is that pathogenic dampness blocks the middle energizer or blood stasis blocks the bile duct,so that the bile is not excreted normally and moves to the skin surface,which makes the skin yellow.Traditior al Chinese medicine (TCM) has unique advantages in the prevention and treatment of icteric hepatitis.This article systematically introduces the etiology and pathogenesis of icteric hepatitis and the TCM syndrome differentiation therapy for icteric hepatitis,in order to provide a reference for the clinical treatment of icteric hepatitis and the improvement in its prognosis.

Clinical characteristics of chronic hepatitis B patients with metabolic syndrome / 中华传染病杂志

Objective To explore the clinical characteristics of chronic hepatitis B patients with metabolic syndrome (MS).Methods A total of 127 patients with untreated chronic hepatitis B infection were recruited.The patients were divided into two groups according to the diagnosis of MS,with 45 in MS group and 82 in non-MS group.Age,gender,body mass index (BMI),waist-to-hip ratio (WHR),fasting blood glucose (FBG),triglyceride (TG),total cholesterol (TC),aspartate aminotransferase (AST),alanine aminotransferase (ALT),hepatitis B e antigen (HBeAg),hepatitis B virus deoxyribonucleic acid (HBV DNA) were compared between groups.Liver biopsy was performed in 94 patients,including 31 in MS group and 63 in non-MS group,to compare the histological characteristics of liver between two groups.A chi-square test and t test were used for the data analysis.Results BMI,WHR,TG,TC,and FBG results of patients in MS group and nonMS group were (28.88±3.00) kg/m2,0.93±0.03,(2.77±0.17) mmol/L,(6.51±0.95) mmol/L,(6.67±0.45) mmol/L,and (24.64± 2.21) kg/m2,0.91±0.04,(1.50±0.65) mmol/L,(4.38±0.71) mmol/L,(4.91±0.92) mmol/L,respectively.Patients in MS group had higher BMI,WHR,FBG,TG and TC compared with those in non-MS group (t=9.109,3.245,2.642,3.762 and 2.586,respectively; all P＜0.05).No statistical significant differences were found in age,ALT or AST between two groups (t=2.224,0.703 and 0.141,respectively; all P＞0.05).Neither any statistical difference was found in gender,the positive rate of HBeAg and HBV DNA between two groups (x2 =1.662,0.037 and 0.944,respectively; all P＞0.05).In inflammation activity comparison,the result of liver biopsy showed that 48.39 ％ (15/31) were classified as G0-G1 and 51.61％(16/31) as G2-G4 in MS group,and those in non MS group were 49.21％(31/63) and 50.79％(32/63),respectively.No statistical significance was reached (x2 =0.006,P＞0.05).In fibrosis stage comparison,patients in MS group classifies as S0-S1 and S2-S4 were 32.26％ (10/31) and 67.74％(21/31),respectively,and those in non-MS group were 60.32％ (38/63)and 39.68％ (25/63),respectively.The liver fibrosis in MS group was significantly more severe than that in non-MS group (x2 =6.546,P＜0.05).Conclusions The CHB patients with MS have higher BMI,WHR,FBG,TG and TC.The presence of MS may promote the progress of liver fibrosis in CHB patients.

A multi-center clinical study of a novel controlled attenuation parameter for assessment of fatty liver / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To evaluate the controlled attenuation parameter (CAP) assessment of fatty liver and choose a cut-off value of hepatic steatosis more than 5%.</p><p><b>METHODS</b>Consecutive patients, 18 years or older, who had undergone percutaneous liver biopsy and CAP measurement were recruited from five liver healthcare centers in China. All enrollees were categorized as hepatic steatosis grade S0 (<5%) or S1 (5%). An M-probe equipped FibroScan 502 was used to capture CAP values. Receiver operating characteristic (ROC) curves were plotted, and the areas under (AU) the curves were calculated to determine the diagnostic efficacy. The CAP cut-off values at the optimal thresholds were defined by maximum Youden indices; sensitivity and specificity were also calculated.</p><p><b>RESULTS</b>A total of 332 patients were enrolled in the study, including 67 patients with non-alcoholic fatty liver disease (NAFLD) and 265 with chronic hepatitis B (CHB) viru: infection. The median age (inter quartile range, IQR) of the study cohort was 39.0 (32.0-50.5) years-old. There were 46 males (68.7%) in the NAFLD group, with a median age of 37.0 (28.0-45.0) years-old, and 182 males (68.7%) in the CHB group; the differences between the two groups in median age and male: female ratio did not reach statistical significance. Multivariate linear regression analysis identified steatosis grade and body mass index (BMI) as independently associated with CAP. The median (IQR) CAP values among patients with S0 and S1 grade steatosis were 215.0 (190.0-241.0) dB/m and 294.0 (255.0-325.5) dB/m (P<0.001), respectively. For all patients, when BMI was <25 kg/m2, the ability of the AUROC of the CAP to discriminate hepatic steatosis more than or equal to 5% was 0.853, and the optimal cut-off value was 244.5 dB/m; however, when BMI≥25 kg/m2, the AUROC was 0.835 and the optimal cut-off value 269.5 dB/m.</p><p><b>CONCLUSION</b>CAP can identify hepatic steatosis more than or equal to 5% and is applicable for the diagnosis of fatty liver if it is adjusted for BMI.</p>

The influencing factors of hepatic steatosis in patients with chronic hepatitis B / 中华传染病杂志

Objective To explore the influencing factors of hepatic steatosis in patients with chronic hepatitis B (CHB),and to provide a theoretical basis of hepatic steatosis prevention and control.Methods A total of 291 hospitalized CHB patients in affiliated Southeast Hospital of Xiamen University were enrolled and divided into two groups:132 CHB patients with hepatic steatosis as the case group and 159 CHB patients without hepatic steatosis as the control group.Conducted a case control study and compared the two groups in terms of body mass index (BMI),waist-to-hip ratio (WHR),fasting blood glucose (FBG),triglyceride (TG),total cholesterol (TC),aspartate aminotransferase (AST),gamma-glutamyl transpeptidase (γ-GT),hepatitis B e antigen (HBeAg),hepatitis B virus DNA (HBV DNA) by descriptive analysis and inferential statistics to analyze the association of these factors with hepatic steatosis in CHB patients.The histological characteristics of the liver were observed.The date analysis used rank sum test and t test.Results FBG,TG,TC,γ-GT,AST of the case group and the control group were (5.11±0.62) mmol/L,(1.81±0.89) mmol/L,(5.29±1.05) mmol/L,(65.04±53.89) U/L,(65.60±71.52) U/L and (4.94±1.89) mmol/L,(1.21±0.79) mmol/L,(4.25±1.58) mmol/L,(146.48±200.39) U/L,(165.35±180.57) U/L,respectively.The case group had significantly higher FBG,TG and TC than the control group (Z=3.607,4.039 and 4.197,respectively,all P＜0.01),while the control group had significantly higher γ-GT and AST (Z=2.672 and 3.020,respectively,both P＜0.01).BMI of the two groups were (26.89±2.78) kg/m2 and (21.17±2.96) kg/m2,respectively,higher in the case group (t=9.711,P＜0.01).WHR in male patients of two groups were 0.93±0.05 and 0.87 ± 0.06,respectively,higher in male patients of the case group (t=4.469,P＜0.01).Positive rate of HBeAg,HBV DNA between the case group and the control group hadn't significantly difference (x2 =0.334,2.960; both P＞0.05).The case group had more severe degree of hepatic steatosis than the control group (Z=-16.145,P＜0.01),while the inflammatory activity and fibrosis were more advanced in the control group (Z=-12.639,P＜0.01; Z=-11.242,P＜0.01,respectively).Conclusions BMI,WHR,FBG,TG and TC appear to be the influencing factors of CHB with hepatic steatosis.The hepatic steatosis in CHB patients is mainly caused by the changes of anthropometric indexes and metabolic factors rather than the effect of HBV.If effective measures are taken,hepatic steatosis in CHB patients can be effectively prevented.