[Long-term prognosis and quality of life of survivors with hepatitis B virus-related acute-on-chronic liver failure].

OBJECTIVE: To explore the long-term prognosis and health-related quality of life of patients surviving hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). METHODS: The clinical data were collected from patients with HBV-ACLF, who were hospitalized in our department between November, 2011 and October, 2016 and survived for more than 90 days. The patients were followed for occurrence of newly diagnosed cirrhosis, decompensation events, hepatocellular carcinoma and death. The quality of life of the patients was evaluated using SF-36 score, and the patients with chronic hepatitis B (CHB) and cirrhosis treated during the same period served as controls. RESULTS: A total of 223 ACLF survivors were included in this study. According to the presence of cirrhosis on admission, the enrolled patients were divided into chronic hepatitis B-related ACLF (CHB-ACLF) group (n=130) and liver cirrhosis ACLF (CIR-ACLF) group (n=93). The 12-, 24- and 50-month survival rates in CHB-ACLF group were 97%, 95.7% and 93.9%, respectively, significantly higher than the rates in CIR-ACLF group (91%, 86% and 74%, respectively; P=0.007). In patients with CHB-ACLF, the 12-, 24- and 36-month progression rates of cirrhosis were 37.9%, 58.4% and 68.7% respectively. Multivariate Cox regression identified the peak value of serum creatinine (HR=1.015, P=0.026) and INR (HR=2.032, P=0.006) within 28 days as independent risk factors and serum sodium at baseline (HR=0.84, P=0.035) as an independent protective factor of occurrence of cirrhosis. The score of mental health on SF-36 in ACLF group was significantly lower than the national norms, and the scores for general health and body pain of ACLF patients were significantly higher than those in patients with CHB or cirrhosis. CONCLUSION: The long-term prognosis of ACLF survivors with and without cirrhosis can be different. Acute attacks are associated with an increased rate of cirrhosis progression in CHB patients who recovered from ACLF, possibly in relation with the severity of extra-hepatic organ injuries. The physical and social functions of long-term survivors of ACLF do not significantly decline, but their psychological status can be affected.

Larger biopsies evaluation of transient elastography for detecting advanced fibrosis in patients with compensated chronic hepatitis B.

BACKGROUND AND AIM: Although larger biopsies sample had been recommended for the study of non-invasive liver fibrosis assessment, few studies with larger biopsies for transient elastography (TE) detecting liver fibrosis had been reported. The present study tries to re-evaluate the performance of TE for detecting advanced fibrosis (≥F3) with larger biopsies in patients with compensated chronic hepatitis B. METHODS: A total of 375 compensated patients were analyzed, who had undergone liver biopsy, reliable TE and routine blood tests. RESULTS: The area under the receiver operating characteristic curve (AUC) was influenced by liver biopsy sample: 0.873 (95% confidence interval 0.838-0.909) in total patients, 0.880 (0.844-0.917) in length ≥ 15 mm, 0.897 (0.863-0.932) in length ≥ 20 mm and 0.911 (0.874-0.949) in length ≥ 25 mm. In patients with sample length ≥ 20 mm, the cutoffs to exclude and confirm advanced fibrosis were 7.1 kPa and 12.7 kPa, respectively. Stratified by alanine aminotransferase of two times the upper limit of normal (ALT 2 × ULN), transient elastography detecting advanced fibrosis with the most efficiency by 72.5% of patients obviated from liver biopsy. In patients with normal bilirubin and ALT < 2 × ULN, the area was 0.921 (0.860-0.982), and cutoffs for excluding and confirming diagnosis were 7.4 kPa and 10.6 kPa, respectively; 80% of patients could be classified with or without advanced fibrosis (AF). In patients with normal bilirubin and ALT ≥ 2 × ULN, the corresponding numbers were 0.885 (0.824-0.947), 7.5 kPa, 12.7 kPa and 79.2%, respectively. CONCLUSIONS: Inadequate sample study would underestimate the efficiency of TE on detecting advanced fibrosis. With ALT 2 × ULN stratified cutoffs, TE determined nearly 80% of patients with normal bilirubin as AF or non-AF and obviated them from liver biopsies.

Improving transient elastography performance for detecting hepatitis B cirrhosis.

BACKGROUND: Transient elastography is a well-established method for detecting cirrhosis. AIM: To improve the performance of transient elastography in detecting hepatitis B cirrhosis by alanine aminotransferase (ALT)-stratified cutoffs, bilirubin normalization and transient elastography-based algorithms. METHODS: A total of 315 compensated patients were analysed following liver biopsies, transient elastography, ultrasonography and blood tests. RESULTS: The area under the receiver operating characteristics (ROC) curve of transient elastography for predicting cirrhosis was 0.88 (95% confidence interval 0.84-0.92). The cutoffs to exclude and confirm cirrhosis were 10.4 kPa and 17.3 kPa in patients with ALT <5 × upper limit of normal range, 13.7 kPa and 25.0 kPa in ALT ≥5 × upper limit of normal range, respectively. With ALT-stratified cutoffs, 68.6% of patients did not require liver biopsies. Areas under the ROC curve in patients with normal or abnormal bilirubin was 0.90(0.85-0.95) and 0.84(0.77-0.92), respectively. In patients with normal bilirubin, the cutoffs for excluding and confirming cirrhosis were 10.6 kPa and 16.9 kPa, respectively. By transient elastography screening, 78.3% of patients with normal bilirubin would not need a liver biopsy. Areas under the ROC curves between transient elastography and transient elastography-based algorithm including transient elastography-splenomegaly-platelet index [0.90(0.86-0.94)] and ultrasonic score-transient elastography index [0.91(0.86-0.96)] were not significantly different. CONCLUSIONS: Amongst ALT-stratified cutoffs, bilirubin normalization and transient elastography-based algorithm, bilirubin normalization was especially important for improving performance of transient elastography for compensated hepatitis B cirrhosis detection.

[Imaging diagnosis of small hepatocellular carcinoma using ultrasound, contrast-enhanced ultrasound and multislice spiral CT].

OBJECTIVE: To evaluate the value of gray-scale ultrasound, contrast-enhanced ultrasound and multislice spiral CT in early and differential imaging diagnosis of small hepatocellular carcinoma (SHCC). METHODS: This study included 35 patients with space-occupying lesions in the liver identified by routine ultrasound examination. The hemodynamics of the patients was recorded during the arterial, portal and lag phases using contrast-enhanced ultrasound. The enhancement features of the 3 phases were observed using multislice spiral CT. All the cases were confirmed by pathological examinations. RESULTS: For SHCC diagnosis, gray-scale ultrasound, contrast-enhanced ultrasound and multislice spiral CT showed a sensitivity of 77.8%, 94.4%, and 100%, specificity of 88.2%, 100%, and 94.1%, positive predictive value of 87.5%, 100%, and 94.7%, negative predictive values 78.9%, 94.4%, and 100%, concordance rate of 82.9%, 97.1%, and 97.1% and Younden index of 0.66, 0.94, and 0.94, respectively. CONCLUSIONS: Contrast-enhanced ultrasound and multislice spiral CT have significantly greater diagnostic efficacy than gray-scale ultrasound in early and differential diagnosis of SHCC. But in some atypical cases, gray-scale ultrasound, contrast-enhanced ultrasound and multislice CT have to be combined to establish a diagnosis.

[Effect of enucleation of hysteromyoma by laparoscopic surgery on protein oxidation and lipid hyperoxidation].

OBJECTIVE: To evaluate the effect of laparoscopic surgery on and lipid hyperoxidation in patients with hysteromyoma. METHODS: Forty patients with hysteromyoma were randomly divided into 2 equal groups: laparoscopy group and laparotomy group. The plasma advanced oxidation protein products (AOPP), malondialdehyde (MDA), antioxidant activity (AOA), and glutathione peroxidase (GPx) activity were measured before operation, just after operation (5 minutes after deflation) and 24 hours after operation. RESULTS: (1) In the laparoscopy group, the levels of AOPP and MDA were (50.20 +/- 9.23) micromol/L and (1.85 +/- 0.19) micromol/L before operation, increased significantly just after operation [(68.75 +/- 12.69) micromol/L and (2.52 +/- 0.55) micromol/L respectively, both P < 0.01], and recovered to the normal level 24 hour postoperatively [(49.70 +/- 9.92) micromol/L and (2.05 +/- 0.68) micromol/L respectively, both P > 0.05]. The levels of GPx and AOA decreased significantly just after operation [(0.29 +/- 0.09) U/ml vs. (0.62 +/- 0.27) U/mL and (0.90 +/- 0.24) mmol/L vs. (1.41 +/- 0.39) mmol/L respectively, both P < 0.01], and the GPx level recovered 24 hours after operation [(0.52 +/- 0.06) U/mL, P > 0.05], however, the AOA level was still lower [(1.00 +/- 0.31) mmol/L, P < 0.01]. In the laparotomy group, the levels of plasma AOPP and MDA level slightly increased just after operation in comparison with those before operation [(53.39 +/- 9.86) micromol/L vs. (52.30 +/- 7.10) micromol/L and (2.09 +/- 0.51) micromol/L vs. (1.83 +/- 0.64) micromol/L respectively, both P > 0.05] and continued to increase 24 hours after operation [(63.40 +/- 15.5) micromol/L, P < 0.05, and (2.42 +/- 0.44) micromol/L, P < 0.01]; the GPx and AOA levels decreased a little just after operation [(0.51 +/- 0.17) U/mL vs. (0.57 +/- 0.21) U/mL and (1.20 +/- 0.46) mmol/L vs. (1.33 +/- 0.37) mmol/L, both P > 0.05] and continued to decrease 24 hours after operation [(0.35 +/- 0.19) U/mL and (0.92 +/- 0.22) mmol/L respectively, both P < 0.01]. Compared with those of the laparotomy group, the plasma AOPP and MDA levels of the laparoscopy group were both significantly lower (P < 0.01 and P < 0.05), and the GPx level was significantly higher (P < 0.01) 24 hours after operation, however, the AOA level was not significantly different (P > 0.05). CONCLUSION: Laparoscopic surgery is better than laparotomy. Protein oxidation and lipid hyperoxidation occur during the laparoscopic surgery, however, disappeared after operation. Free radicals are generated by the end of laparoscopic procedure, possibly as a result of an ischemia-reperfusion phenomenon induced by the inflation and deflation of the pneumoperitoneum. AOPP and MDA are induced during laparoscopic procedure and then return to the normal levels finally.