Combined acoustic radiation force impulse, aminotransferase to platelet ratio index and Forns index assessment for hepatic fibrosis grading in hepatitis B

AIM: To investigate the combined diagnostic accuracy of acoustic radiation force impulse(ARFI), aspartate aminotransferase to platelet ratio index(APRI) and Forns index for a non-invasive assessment of liver fibrosis in patients with chronic hepatitis B(CHB). METHODS: In this prospective study, 206 patients had CHB with liver fibrosis stages F0-F4 classified by METAVIR and 40 were healthy volunteers were measured by ARFI, APRI and Forns index separately or combined as indicated. RESULTS: ARFI, APRI or Forns index demonstrated a significant correlation with the histological stage(all P < 0.001). According to the AUROC of ARFI and APRI for evaluating fibrotic stages more than F2, ARFI showed an enhanced diagnostic accuracy than APRI(P < 0.05). The combined measurement of ARFI and APRI exhibited better accuracy than ARFI alone when evaluating ≥ F2 fibrotic stage(Z = 2.77, P = 0.006). Combination of ARFI, APRI and Forns index did not obviously improve the diagnostic accuracy compared to the combination of ARFI and APRI(Z = 0.958, P = 0.338). CONCLUSION: ARFI + APRI showed enhanced diagnostic accuracy than ARFI or APRI alone for significant liver fibrosis and ARFI + APRI + Forns index shows the same effect with ARFI + APRI.

Dynamic Changes of Multiple Immune Cells in Chronic Hepatitis B Patients Undergoing Antiviral Treatment

Objective Various immune cells in patients with CHB have been demonstrated to play critical roles in HBV infection.The goal of this study is to observe changes in Thl7,Treg,Thl and B lymphocytes from peripheral blood and to evaluate immune status of CHB patients undergoing antiviral treatment.Methods Total of 49 CHB patients,19 asymptomatic carriers and 29 healthy donors were included in our present study.The frequencies of peripheral Thl7 cells(CD3^+CD4^+IL-17^+Tcells),Treg cells(CD3^+CD4^+CD25^+CD127^- T cells),Th1 cells(CD3^+CD4^+IFN^-γ T cells) and B lymphocytes in chronic hepatitis B(CHB) were analyzed by flow cytometry.Results The frequency of Th17 cells increased after treatment for 6 months,but there was no statistically significant difference of IL-17 expression between baseline and 6 months after treatment.The frequencies of Treg cells,momory B cells and total CD19^+B cells decreased after antiviral treatment.The frequencies of Thl cells and plasma cells increased after antiviral treatment.Conclusions This study highlights that the reestablishment of immune function during antiviral treatment in CHB patients,which caused by the antiviral drugs or the patients themselves.CHB patients may exhibit varied responses to these antiviral drugs.It is essential to supplement immune therapy during the antiviral treatment,but Th17 may play a limited role in inflammation during antiviral treatment,targeting Th17 therapy may not be useful for CHB treatment.More time and more experiments are critical to explain it.