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Background/Aims@#Existing hepatocellular carcinoma (HCC) prediction models are derived mainly from pretreatment or early on-treatment parameters. We reassessed the dynamic changes in the performance of 17 HCC models in patients with chronic hepatitis B (CHB) during long-term antiviral therapy (AVT). @*Methods@#Among 987 CHB patients administered long-term entecavir therapy, 660 patients had 8 years of follow-up data. Model scores were calculated using on-treatment values at 2.5, 3, 3.5, 4, 4.5, and 5 years of AVT to predict threeyear HCC occurrence. Model performance was assessed with the area under the receiver operating curve (AUROC). The original model cutoffs to distinguish different levels of HCC risk were evaluated by the log-rank test. @*Results@#The AUROCs of the 17 HCC models varied from 0.51 to 0.78 when using on-treatment scores from years 2.5 to 5. Models with a cirrhosis variable showed numerically higher AUROCs (pooled at 0.65–0.73 for treated, untreated, or mixed treatment models) than models without (treated or mixed models: 0.61–0.68; untreated models: 0.51–0.59). Stratification into low, intermediate, and high-risk levels using the original cutoff values could no longer reflect the true HCC incidence using scores after 3.5 years of AVT for models without cirrhosis and after 4 years of AVT for models with cirrhosis. @*Conclusions@#The performance of existing HCC prediction models, especially models without the cirrhosis variable, decreased in CHB patients on long-term AVT. The optimization of existing models or the development of novel models for better HCC prediction during long-term AVT is warranted.
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Although etiological treatment has reduced the incidence and mortality rates of liver cirrhosis complications, some patients may still experience disease progression. It is of great importance for further reducing mortality rate to accurately predict the clinical endpoints of liver cirrhosis and strengthen intervention. Therefore, this article discusses the prediction of clinical endpoints of liver cirrhosis from the aspects of liver pathology, noninvasive markers, imaging, and methodology, in order to help with early screening of the high-risk population, establish accurate predictive models, and further reduce the incidence rate of clinical endpoints of liver cirrhosis.
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Achieving HBV DNA negative transformation and HBsAg clearance with effective antiviral therapy can reduce the incidence of HCC, but some patients are still at risk of developing HCC. Therefore, screening high-risk patients for close monitoring is essential to reduce the incidence of HCC. This paper reviews the occurrence of HCC, risk factors and risk prediction models of HBV DNA negative transformation and HBsAg clearance, and provides a basis for screening and follow-up management of high-risk group of HCC with chronic hepatitis B.
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ObjectiveTo investigate the effect of alanine aminotransferase (ALT) level on liver stiffness measurement (LSM) in patients with hepatitis B cirrhosis. MethodsThe patients who were diagnosed with hepatitis B cirrhosis by liver biopsy in Beijing Friendship Hospital from January 2012 to May 2015 and did not receive antiviral therapy were enrolled. Their demographic characteristics, routine blood test results, biochemical parameters, hepatitis B virus (HBV) DNA level, alpha-fetoprotein level, LSM, abdominal ultrasound findings, and liver biopsy data were collected. LSM was compared between hepatitis B cirrhosis patients with different ALT levels. The one-way analysis of variance or rank sum test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data. Pearson correlation analysis and partial correlation analysis were performed. ResultsA total of 104 patients were recruited and divided into three groups according to their ALT levels (≤2×upper limit of normal ［ULN］, 2-5×ULN, and ≥5×ULN). There were no significant differences between the three groups in sex ratio, body mass index, HBeAg status, HBV DNA level, albumin level, and platelet count (all P＞0.05). The median values of LSM for the three groups were 15.4 kPa, 18.8 kPa, and 29.9 kPa, respectively, suggesting that LSM increased as the ALT level increased, and there was a significant difference in LSM between the three groups (χ2=10.07, P＜0.05). After adjusting for age, which was significantly different between the three groups, LSM was still found to be positively correlated with ALT level (r=0.220, 95% confidence interval: 0.101-0.468, P＜0.05). ConclusionIn patients with hepatitis B cirrhosis, LSM increased with the increasing ALT level, and the positive correlation remains after adjusting for age.
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Objective@#To investigate the methods for qualitative pathological assessment of dynamic changes in liver fibrosis/cirrhosis after antiviral therapy in patients with chronic hepatitis B (CHB), since antiviral therapy can partially reverse liver fibrosis and cirrhosis caused by hepatitis B and semi-quantitative, rather than qualitative, pathological assessment is often used for the research on liver fibrosis regression.@*Methods@#Previously untreated CHB patients with liver fibrosis and cirrhosis were enrolled, and liver biopsy was performed before treatment and at 78 weeks after the antiviral therapy based on entecavir. The follow-up assessment was performed once every half a year. Based on the proportion of different types of fibrous septum, we put forward the new qualitative criteria called P-I-R classification (predominantly progressive, predominantly regressive, and indeterminate) for evaluating dynamic changes in liver fibrosis. This classification or Ishak fibrosis stage was used to evaluate the change in liver fibrosis after treatment and Ishak liver inflammation score was used to evaluate the change in liver inflammation after treatment.@*Results@#A total of 112 CHB patients who underwent liver biopsy before and after treatment were enrolled, and among these patients, 71 with an Ishak stage of ≥3 and qualified results of live biopsy were included in the final analysis. Based on the P-I-R classification, 58% (41/71) were classified as predominantly progressive, 29% (21/71) were classified as indeterminate, and 13% (9/71) were classified as predominantly regressive; there were no significant differences between the three groups in alanine aminotransferase, aspartate aminotransferase, albumin, HBeAg positive rate, HBV DNA, and liver stiffness (P < 0.05). After treatment, the proportion of predominantly progressive, indeterminate, or predominantly regressive patients changed to 11% (8/71), 11% (8/71), and 78% (55/71), respectively. Among the 35 patients who had no change in Ishak stage after treatment, 72% (25/35) were classified as predominantly regressive and had certain reductions in the Laennec score, percentage of collagen area, and liver stiffness.@*Conclusion@#This new P-I-R classification can be used to assess the dynamic changes in liver fibrosis after antiviral therapy in CHB patients.
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<p><b>OBJECTIVE</b>To perform a comparative assessment of the performance of FibroTouch and FibroScan in patients with hepatitis B.</p><p><b>METHODS</b>A total of 211 patients with hepatitis B, including cases of chronic hepatitis B (CHB) and of compensated cirrhosis, were enrolled for study between June and November of 2013. The patients underwent FibroScan testing (group 1) and FibroTouch testing (group 3), after which the operator examined a time motion ultrasound image from the FibroScan test and located a specific liver portion for focused FibroTouch testing (group 2). The consistency between the two tests' results was investigated by Pearson's correlation analysis, and the difference of liver stiffness between CHB patients and compensated cirrhosis patients was investigated by the two independent samples t-test or Mann-Whitney U test.</p><p><b>RESULTS</b>The values of liver stiffness were 5.30 (4.30,8.65) in group 1,6.10 (4.70,8.90) in group 2, and 5.70 (4.50, 8.00) in group 3 (all P < 0.05); the Pearson correlation coefficients were all more than 0.8 (P < 0.05) and there was no statistically significant difference found between the results from FibroScan and FibroTouch.The values of liver stiffness were significantly different between the CHB patients and the compensated cirrhosis patients (P < 0.05). The rates of successful detection were 100% for FibroTouch and 97% for FibroScan.</p><p><b>CONCLUSION</b>FibroTouch and FibroScan have good consistency in the evaluation of the degree of liver fibrosis. FibroTouch has a higher rate of successful detection than FibroScan.</p>
Subject(s)
Humans , Elasticity Imaging Techniques , Hepatitis B, Chronic , Pathology , Liver Cirrhosis , DiagnosisABSTRACT
The progression of liver fibrosis directly affects treatment options and prognosis.Early diagnosis and classification of liver fibrosis and dynamic monitoring are clinically needed.Noninvasive diagnostic techniques can avoid or reduce liver biopsy to enable early identifica-tion of liver fibrosis and to dynamically monitor the progression of fibrosis.But various limitations have restricted its application.Noninvasive diagnostic techniques,such as liver transient elastography using the different probe mode,controlled attenuation parameter,spleen stiffness measurement,ultrasound-based transient elastography for the early prediction of hepatic fibrosis,and risk assessment of hepatitis B virus-related hepatocellular carcinoma,have been applied in clinical studies.In order to better understand and apply these diagnostic models,the progress in clinical studies of noninvasive diagnosis of liver fibrosis,as well as the limitations,is reviewed.
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Objective To investigate the effect of alternative decompression body pad in the intraopera-tive pressure sore prevention.Methods Using random sampling methods,100 cases of patients were collect-ed and divided into the experimental group and the control group with 50 cases in each group,the experimental group adopted self-designed alternative decompression body pad and the control group used common body pad.The skin red,and hurt situation in the main parts of compression were observed,the average pressure of the main parts of compression,such as forehead,chest, anterior superior iliac spine was measured by means of stress-based software DZX29 figure measuring instrument, the above data underwent comparison.Results Statistical differences existed in skin red,skin damage and the average pressure between the two groups.Conclusions The alternative decompression body pad can effectively reduce the partial pressure of the vertical principal stress,and having an active role in the prevention of intraoperative pressure sores.But the prevention of pressure sores will still need to take comprehensive nursing measures.
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treating rheumatoid arthritis. METHODS: Eighty patients with rheumatoid arthritis were randomly divided into two groups with each group having 40 patients. Group one (M 8, F 32; age 46 a± s 11 a; disease history 63 mo±48 mo) was treated with anti-inflammation sub-group No.1 and No.3. Group two (M 6, F 34; 44 a±9 a; disease history 45 mo±45 mo) was treated with sub-group No.2 and No.4. One week before the initiate of the study, the originally used non-steroid anti-inflammation drugs were stopped for all two-groups patients and each patient took 2 tablets of oxaprozin po qn. At the beginning of the study the patients received 2 tablets of anti-inflammation drugs No.1 daily and 6 tables of No.3 weekly in 1st group, and 2 tablets of anti-inflammation drugs No.2 daily and 6 tablets of No.4 weekly in 2nd group respectively. RESULTS: In the leflunomide group, the total effect rate was 93 % and the remarkable improvement rate was 85 %. In the methotrexate group, the total effect rate was also 93 % and the remarkable effect rate was 83 %, P>0.05. Nine patients (23 %) in leflunomide group had adverse reaction as mainly skin itch, nettle-like rash, decrease of leukocytes, liver malfunction and others. Seventeen parients (43 %) in methotrexate group had adverse reaction as mainly responses of digestive tract, liver enzyme elevation, decrease of leukocytes, trichomadesis, manoxenia, and others. CONCLUSION: Leflunomide has similar therapeutic efficacy to methotrexate. However, it has relatively less toxicity.
