超声E成像联合血清铁蛋白水平对非酒精性脂肪性肝病的早期诊断价值

【目的】探讨超声E成像联合血清铁蛋白(SF)水平对非酒精性脂肪性肝病(NAFLD)的早期诊断价值。【方法】回顾性分析2020年2月至2022年6月宝鸡高新医院收治的85例NAFLD患者(NAFLD组),依据NAFLD患者肝脂肪变性的严重程度分为轻度脂变组(n=26)、中度脂变组(n=38)和重度脂变组(n=21)。另选取同期在宝鸡高新医院体检的60例健康志愿者(健康组)。比较各组患者临床资料、杨氏模量值及SF水平,分析NAFLD发生的影响因素及杨氏模量值、SF对NAFLD的早期诊断效能。【结果】NAFLD组体重指数(BMI)、空腹血糖(FPG)、总胆固醇(TC)、甘油三酯(TG)、杨氏模量值、SF水平高于健康组(P<0.05)。重度脂变组杨氏模量值、SF水平高于轻度脂变组和中度脂变组(P<0.05);中度脂变组杨氏模量值、SF水平高于轻度脂变组(P<0.05)。多因素分析结果显示:BMI、杨氏模量值及SF均为NAFLD发生的影响因素(P<0.05)。受试者工作特征(ROC)曲线的分析结果显示:杨氏模量值、SF及两者联合对NAFLD早期诊断的灵敏度分别为76.47%、78.82%、75.29%,特异度分别为71.67%、68.33%、96.67%,AUC分别为0.734、0.714、0.901。【结论】NAFLD的发生与BMI、杨氏模量值及SF水平有关,且超声E成像联合SF水平对NAFLD的早期诊断价值较高。

CAP对儿童非酒精性脂肪性肝病的诊断价值研究

【目的】探讨CAP对儿童非酒精性脂肪性肝病(NAFLD)的临床诊断价值。【方法】选择2016年8月至2020年9月本院肝病中心收治的91例NAFLD患儿,均经肝脏组织活检,同时进行受控衰减参数(CAP)检查。另选取30例其他肝病患儿为对照组,经肝活检证实无肝脂肪变性,同时也进行CAP检测。运用儿童NAFLD组织学评分系统对肝脂肪变性进行分级,并进行相关性分析。【结果】观察组患儿BMI、门冬氨酸转移酶(AST)、丙氨酸转氨酶(ALT)、谷氨酰转移酶(GGT)、CAP、总胆固醇(TC)、三酰甘油(TG)均大于对照组,差异有统计学意义(P<0.05)。CAP区分有无肝脂肪变性的AUC为0.955,最佳截断值为222.5dB/m,95%CI为0.91~1.00,为94.5%、特异性为86.7%,按最佳截断值评估观察组肝脂肪变性准确率为94.51%(86/91)。BMI与CAP具有显著相关性(r=0.241,P=0.021<0.05)。【结论】CAP对儿童NAFLD的诊断有较高的临床价值,值得临床推广应用。

肝病患者血清T_3、T_4、TSH和CG、HA的含量分析

目的 探讨甲状腺激素和甘胆酸、透明质酸在肝病中的诊断、预后、评估价值。方法 采用放射免疫分析法 ,测定 155例肝病患者和 52例健康者甲状腺激素和甘胆酸、透明质酸含量水平 ,所获数据经方差分析和t检验处理。结果 各种肝病时血清甲状腺激素含量明显降低 ,与正常对照组比较 (P <0 .0 5) ,而甘胆酸和透明质酸则明显升高 ,与正常对照组比较 (P <0 .0 1)。结论 血清甲状腺激素和甘胆酸、透明质酸测定可作为各类肝病的诊断、预后评估的参考指标。

血清胆碱酯酶活性在肝脏疾病预后中的临床意义

目的探讨检测血清胆碱酯酶活性在肝脏疾病预后中的临床意义。方法检测122例各型肝病患者及80例正常对照组的血清胆碱酯酶活性。结果各型肝病患者血清胆碱酯酶活性均低于正常对照组(P<0.05),肝硬化、肝癌患者最低。结论检测胆碱酯酶活性对了解肝病患者病情发展及判定预后有一定的临床意义。

Pentoxifylline versus prednisolone for severe alcoholic hepatitis:A randomized controlled trial

AIM： To compare the efficacy of pentoxifylline and prednisolone in the treatment of severe alcoholic hepatitis, and to evaluate the role of different liver function scores in predicting prognosis.METHODS： Sixty-eight patients with severe alcoholic hepatitis （Maddrey score ≥ 32） received pentoxifylline （n = 34, group Ⅰ） or prednisolone （n = 34, group Ⅱ） for 28 d in a randomized double-blind controlled study, and subsequently in an open study （with a tapering dose of prednisolone） for a total of 3 mo, and were followed up over a period of 12 mo.RESULTS： Twelve patients in group Ⅱ died at the end of 3 mo in contrast to five patients in group Ⅰ. The probability of dying at the end of 3 mo was higher in group Ⅱ as compared to group Ⅰ （35.29% vs 14.71%, P = 0.04; log rank test）. Six patients in group I developed hepatorenal syndrome as compared to none in group Ⅰ. Pentoxifylline was associated with a significantly lower model for end-stage liver disease （MELD） score at the end of 28 d of therapy （15.53± 3.63 vs 17.78± 4.56, P=0.04）. Higher baseline Maddrey score was associated with increased mortality.CONCLUSION： Reduced mortality, improved risk-benefit profile and renoprotective effects of pentoxifylline compared with prednisolone suggest that pentoxifylline is superior to prednisolone for treatment of severe alcoholic hepatitis.

Assessment of drug-induced hepatotoxicity in clinical practice: A challenge for gastroenterologists

Currently, pharmaceutical preparations are serious contributors to liver disease; hepatotoxicity ranking as the most frequent cause for acute liver failure and post-commercialization regulatory decisions. The diagnosis of hepatotoxicity remains a difficult task because of the lack of reliable markers for use in general clinical practice. To incriminate any given drug in an episode of liver dysfunction is a step-by-step process that requires a high degree of suspicion, compatible chronology, awareness of the drug’s hepatotoxic potential, the exclusion of alternative causes of liver damage and the ability to detect the presence of subtle data that favors a toxic etiology. This process is time-consuming and the final result is frequently inaccurate. Diagnostic algorithms may add consistency to the diagnostic process by translating the suspicion into a quantitative score. Such scales are useful since they provide a framework that emphasizes the features that merit attention in cases of suspected hepatic adverse reaction as well. Current efforts in collecting bona fide cases of drug-induced hepatotoxicity will make refinements of existing scales feasible. It is now relatively easy to accommodate relevant data within the scoring system and to delete low-impact items. Efforts should also be directed toward the development of an abridged instrument for use in evaluating suspected drug-induced hepatotoxicity at the very beginning of the diagnosis and treatment process when clinical decisions need to be made. The instrument chosen would enable a confident diagnosis to be made on admission of the patient and treatment to be fine-tuned as further information is collected.

HBV cccDNA in patients' sera as an indicator for HBV reactivation and an early signal of liver damage

AIM:To evaluate the covalently closed circle DNA (cccDNA) level of hepatitis B virus (HBV) in patients' liver and sera. METHODS:HBV DNA was isolated from patients' liver biopsies and sera.A sensitive real-time PCR method,which is capable of differentiation of HBV viral genomic DNA and cccDNA,was used to quantify the total HBV cccDNA.The total HBV viral DNA was quantitated by real-time PCR using a HBV diagnostic kit (PG Biotech,LTD,Shenzhen,China) described previously. RESULTS:For the first time,we measured the level of HBV DNA and cccDNA isolated from ten HBV patients' liver biopsies and sera.In the liver biopsies,cccDNA was detected from all the biopsy samples.The copy number of cccDNA ranged from from 0.03 to 173.1 per cell,the copy number of total HBV DNA ranged from 0.08 to 3 717 per cell.The ratio of total HBV DNA to cccDNA ranged from 1 to 3 406.In the sera, cccDNA was only detected from six samples whereas HBV viral DNA was detected from all ten samples.The ratio of cccDNA to total HBV DNA ranged from 0 to 1.77%.To further investigate the reason why cccDNA could only be detected in some patients' sera,we performed longitudinal studies.The cccDNA was detected from the patients' sera with HBV reactivation but not from the patients' sera without HBV reactivation.The level of cccDNA in the sera was correlated with ALT and viral load in the HBV reactivation patients. CONCLUSION:HBV cccDNA is actively transcribed and replicated in some patients' hepatoo/tes,which is reflected by a high ratio of HBV total DNA vs cccDNA.Detection of cccDNA in the liver biopsy will provide an end-point for the anti-HBV therapy.The occurrence of cccDNA in the sera is an early signal of liver damage,which may be another important clinical parameter.

A case report of hepatic veno-occlusive disease after ingesting dainties

Hepatic veno-occlusive disease (HVOD) is rarely encountered and easily misjudged as Budd-Chiari syndrome. It is often related to stem cell transplantation in recent years. We report a case of HVOD that is related to ingestion of some palatable local dishes. The diagnosis was confirmed by liver biopsy pathology with specific observation of inflammatory changes and fibrosis of venules intima, dilated sinusoids and central veins. Chronic diarrhea is unique for this case as a result of ingesting harmful stuffs. This case demonstrated that supervision and instruction of food recipe and traditional medicine are crucial, and prompt diagnosis, supportive care and specific treatment are essential to decreasing the morbidity and mortality of HVOD.

Primary malignant melanoma of the liver: A case report

Primary malignant melanoma of the liver is an exceedingly rare tumor. Only 12 cases have been reported in the worldwide literature. We present a case of isolated malignant melanoma of the liver occurring in a 36-year-old Chinese male patient. Comprehensive dermatologic and ophthalmologic examinations revealed no evidence of a cutaneous or ocular primary lesion. Other lesions in brain, respiratory tract, lung, gastrointestinal tract and anus, were not demonstrated by serial position emission tomography (PET). Microscopic examination of the resected specimen revealed a malignant melanoma, which was confi rmed by immunohistochemical staining for HMB-45, S-100 protein, melanoma-pan and vimentin. Moreover, electron microscopy demonstrated melanosomes in tumor cell cytoplasm. Our case shows that primary malignant melanoma may occur in the liver and should be considered when the histopathological appearance is not typical for other hepatic neoplasm.

Characteristics of common solid liver lesions and recommendations for diagnostic workup

Due to the widespread clinical use of imaging modalities such as ultrasonography,computed tomography and magnetic resonance imaging (MRI),previously unsuspected liver masses are increasingly being found in asymptomatic patients.This review discusses the various characteristics of the most common solid liver lesions and recommends a practical approach for diagnostic workup.Likely diagnoses include hepatocellular carcinoma (the most likely;a solid liver lesion in a cirrhotic liver) and hemangioma (generally presenting as a mass in a non-cirrhotic liver).Focal nodular hyperplasia and hepatic adenoma should be ruled out in young women.In 70% of cases,MRI with gadolinium differentiates between these lesions.Fine needle core biopsy or aspiration,or both,might be required in doubtful cases.If uncertainty persists as to the nature of the lesion,surgical resection is recommended.If the patient is known to have a primary malignancy and the lesion was found at tumor staging or follow up,histology is required only when the nature of the liver lesion is doubtful.

Correlation between ultrasonographic and pathologic diagnosis of liver fibrosis due to chronic virus hepatitis

AIM： TO evaluate the validity of ultrasonographic and pathologic diagnosis of liver fibrosis in patients with chronic viral hepatitis. METHODS： The liver fibrosis status in 324 patients was evaluated by both needle biopsy and ultrasonography. Liver fibrosis was divided into SO -S4 stages. S4 stage was designated as definite cirrhosis. The ultrasonographic examination included qualitative variables, description of liver surface and parenchyma, and quantitative parameters, such as diameter of vessels, blood flow velocity and spleen size. RESULTS： Ultrasonographic qualitative description of liver surface and parenchyma was related with the severity of fibrosis. Among the quantitative ultrasonographic parameters, cut-off value of spleen length （12.1 cm） had a sensitivity of 0.600 and a specificity of 0.753 for diagnosis of liver cirrhosis. The diameters of spleen （8 mm） and portal vein （12 mm） had a diagnostic sensitivity of 0.600 and 0.767, and a diagnostic specificity of 0.781 and 0.446, respectively. The diagnostic accuracy for liver cirrhosis was moderately satisfactory, and the negative predictive values of these parameters reached near 0.95. CONCLUSION： Ultrasonography can predict the degree of liver fibrosis or cirrhosis. A single ultrasonographic parameter is limited in sensitivity and specificity for the diagnosis of early cirrhosis. The presence or absence of liver cirrhosis in patients with chronic virus hepatitis can be detected using 2 or 3 quantitative and qualitative pa- rameters, especially the length of spleen, the diameter of spleen vein and echo pattern of liver surface.

Overview and developments in noninvasive diagnosis of nonalcoholic fatty liver disease

High prevalence of non-alcoholic fatty liver disease (NAFLD) and very diverse outcomes that are related to disease form and severity at presentation have made the search for noninvasive diagnostic tools in NAFLD one of the areas with most intense development in hepatology today.Various methods have been investigated in the recent years,including imaging methods like ultrasound and magnetic resonance imaging,different forms of liver stiffness measurement,various biomarkers of necroinflammatory processes (acute phase reactants,cytokines,markers of apoptosis),hyaluronic acid and other biomarkers of liver fibrosis.Multicomponent tests,scoring systems and diagnostic panels were also developed with the purposes of differentiating non-alcoholic steatohepatitis from simple steatosis or discriminating between various fibrosis stages.In all of the cases,performance of noninvasive methods was compared with liver biopsy,which is still considered to be a gold standard in diagnosis,but is by itself far from a perfect comparative measure.We present here the overview of the published data on various noninvasive diagnostic tools,some of which appear to be very promising,and we address as well some of still unresolved issues in this interesting field.

Actigraphy: A new diagnostic tool for hepatic encephaiopathy

AIM： To assess the actigraphy, an ambulatory and continuous monitoring of wrist motor activity fitted to study sleep/wake patterns in hepatic encephalopathy （HE）. METHODS： Twenty-five cirrhotic patients （17 M, 8 F, mean age 56± 11 years, 24/25 alcoholic, Child-Pugh A, B, C： 2, 6, 17） were included. The patients were classified into 3 groups： stage 0 group （n = 12）, stage 1-2 group （n = 6）, and stage 3-4 group （n = 7） of encephalopathy. Over three consecutive days, patients had clinical evaluation 3 times a day with psychometric test, venous ammoniemia, flash visually evoked potentials （VEP）, electroencephalogram and continuous actigraphic monitoring for 3 d, providing 5 parameters： mesor, amplitude, acrophase, mean duration of activity （MDAI） and inactivity （MDII） intervals. RESULTS： Serum ammonia and VEP did not differ among the 3 groups. Electroencephalography mean dominant frequency （MDF） correlated significantly with clinical stages of HE （r=0.65, P=0.003）. The best correlation with HE stage was provided by actigraphy especially with MDAI （r= 0.7, P〈10^-4） and mesor （r= 0.65, P〈 10^-4）. MDAI correlated significantly with MDF （r= 0.62, 0.004） and was significantly shorter in case of HE compared to patients without HE （stage 0： 5.33± 1.6 min; stage 1-2：3.28±1.4 min; stage 3-4：2.52±1.1 min; P〈0.05）. Using a threshold of MDAI of less than 4.9 min, sensitivity, specificity, positive predictive value, negative predictive value for HE diagnosis were 85%, 67%, 73% and 80%, respectively. CONCLUSION： Actigraphy may be an objective method to identify HE, especially for early HE detection. Motor activity at the wrist correlates well with clinical stages of HE. MDAI and mesor are the most relevant parameters.

Gastroenterology service in a teaching hospital in rural New Zealand, 1991-2003

AIM: To retrospectively collect inpatient and outpatient data and to assess the use of endoscopic procedures during the years 1991, 1997 and 2003 to analyse for trends. METHODS: This retrospective survey was conducted in a University-associated Gastroenterology Unit offering secondary and tertiary health care services for a population of approximately 182 000 people in Southern New Zealand. Data collected included patient contacts (inand outpatients), gastroscopic and colonoscopic investigations. RESULTS: We observed a significant increase in the absolute numbers of patient contacts over the years (1991: 2308 vs 1997: 2022 vs 2003: 2783, P < 0.0001) with inflammatory bowel disease, other diseases of the colon, anus and rectum and iron studies related disorders decreasing significantly but liver disease and constipation increasing linearly over time. The use of endoscopy services remained relatively stable but colonoscopic investigations for a positive family history of colorectal cancer increased significantly while more gastroscopies were performed for unexplained anaemia. CONCLUSION: The whole spectrum of gastroenterology contacts was studied. A substantial proportion of colonoscopies and outpatient consultations were undertaken to screen for colorectal cancer. This proportion is likely to grow further. Our fi ndings have implications for the recruitment and training of the next generation of gastroenterologists.

Identification of individuals with non-alcoholic fatty liver disease by the diagnostic criteria for the metabolic syndrome

AIM:To clarify the efficiency of the criterion of metabolic syndrome to detecting non-alcoholic fatty liver disease(NAFLD).METHODS:Authors performed a cross-sectional study involving participants of a medical health checkup program including abdominal ultrasonography.This study involved 11 714 apparently healthy Japanese men and women,18 to 83 years of age.NAFLD was defined by abdominal ultrasonography without an alcohol intake of more than 20 g/d,known liver disease,or current use of medication.The revised criteria of the National Cholesterol Education Program Adult Treatment PanelⅢ were used to characterize the metabolic syndrome.RESULTS:NAFLD was detected in 32.2%(95%CI:31.0%-33.5%)of men(n=1874 of 5811)and in 8.7%(95%CI:8.0%-9.5%)of women(n=514 of 5903).Among obese people,the prevalence of NAFLD was as high as 67.3%(95%CI:64.8%-69.7%)in men and 45.8%(95%CI:41.7%-50.0%)in women.Although NAFLD was thought of as being the liver phenotype of metabolic syndrome,the prevalence of the metabolic syndrome among subjects with NAFLD was low both in men and women.66.8%of men and 70.4%of women with NAFLD were not diagnosed with the metabolic syndrome.48.2%of men with NAFLD and 49.8%of women with NAFLD weren't overweight[body mass index(BMI)≥25 kg/m2].In the same way,68.6%of men with NAFLD and 37.9%of women with NAFLD weren't satisfied with abdominal classification(≥90 cm for men and≥80 cm for women).Next,authors defined it as positive at screening for NAFLD when participants satisfied at least one criterion of metabolic syndrome.The sensitivity of the definition"at least 1 criterion"was as good as 84.8%in men and 86.6%in women.Separating subjects by BMI,the sensitivity was higher in obese men and women than in non-obese men and women(92.3%vs 76.8%in men,96.1%vs 77.0%in women,respectively).CONCLUSION:Authors could determine NAFLD effectively in epidemiological study by modifying the usage of the criteria for metabolic syndrome.

Role of diffusion-weighted magnetic resonance imaging in the differential diagnosis of focal hepatic lesions

AIM： To evaluate the utility of diffusion-weighted imaging （DWl） in screening and differential diagnosis of benign and malignant focal hepatic lesions. METHODS： Magnetic resonance imaging （MRI） examinations were performed using the Signa Excite Xl Twin Speed 1.5T system （GE Healthcare, Milwaukee, Wl, USA）. Seventy patients who had undergone MRI of the liver [29 hepatocellular carcinomas （HCC）, four cholangiocarcinomas, 34 metastatic liver cancers, 10 hemangiomas, and eight cysts] between April 2004 and August 2008 were retrospectively evaluated. Visualization of lesions, relative contrast ratio （RCR）, and apparent diffusion coefficient （ADC） were compared between benign and malignant lesions on DWl. Su- perparamagnetic iron oxide （SPIO） was administered to 59 patients, and RCR was compared pre- and postadministration.RESULTS： DWI showed higher contrast between malignant lesions （especially in multiple small metastatic cancers） and surrounding liver parenchyma than did contrast-enhanced computed tomography. ADCs （mean±SD × 10^-3 mm2/s） were significantly lower （P 〈 0.05） in malignant lesions （HCC： 1.31 ± 0.28 and liver metastasis： 1.11 ± 0.22） and were significantly higher in benign lesions （hemangioma： 1.84 ± 0.37 and cyst： 2.61 ± 0.45） than in the surrounding hepatic tissues. RCR between malignant lesions and surrounding he- patic tissues significantly improved after SPIO administration, but RCRs in benign lesions were not improved.CONCLUSION： DWI is a simple and sensitive method for screening focal hepatic lesions and is useful for differential diagnosis.

Comparison of real-time polymerase chain reaction with the COBAS Amplicor test for quantitation of hepatitis B virus DNA in serum samples

AIM:To compare the clinical performance of a real-time PCR assay with the COBAS Amplicor Hepatitis B Virus (HBV) Monitor test for quantitation of HBV DNA in serum samples. METHODS: The reference sera of the Chinese National Institute for the Control of Pharmaceutical and Biological Products and the National Center for Clinical Laboratories of China, and 158 clinical serum samples were used in this study. The linearity, accuracy, reproducibility, assay time, and costs of the real-time PCR were evaluated and compared with those of the Cobas Amplicor test. RESULTS: The intra-assay and inter-assay variations of the real-time PCR ranged from 0.3% to 3.8% and 1.4% to 8.1%, respectively. The HBV DNA levels measured by the real-time PCR correlated very well with those obtained with the COBAS Amplicor test (r = 0.948). The real-time PCR HBV DNA kit was much cheaper and had a wider dynamic range. CONCLUSION: The real-time PCR assay is an excellent tool for monitoring of HBV DNA levels in patients with chronic hepatitis B.

Hepatitis C virus: Virology, diagnosis and management ofantiviral therapy

Hepatitis C virus (HCV) infects approximately 170 million individuals worldwide. Prevention of HCV infection complications is based on antiviral therapy with the combination of pegylated interferon alfa and ribavirin. The use of serological and virological tests has become essential in the management of HCV infection in order to diagnose infection, guide treatment decisions and assess the virological response to antiviral therapy. Anti- HCV antibody testing and HCV RNA testing are used to diagnose acute and chronic hepatitis C. The HCV genotype should be systematically determined before treatment, as it determines the indication, the duration of treatment, the dose of ribavirin and the virological monitoring procedure. HCV RNA monitoring during therapy is used to tailor treatment duration in HCV genotype 1 infection, and molecular assays are used to assess the end-of-treatment and, most importantly the sustained virological response, i.e. the endpoint of therapy.

Budd-Chiari syndrome:Etiology,pathogenesis and diagnosis

Budd-Chiari syndrome is a congestive hepatopathy caused by blockage of hepatic veins. This syndrome occurs in 1/100 000 in the general population. Hypercoagulable state could be identified in 75% of the patients; more than one etiologic factor may play a role in 25% of the patients. Primary myeloproliferative diseases are the leading cause of the disease. Two of the hepatic veins must be blocked for clinically evident disease. Liver congestion and hypoxic damage of hepatocytes eventually result in predominantly centrilobular fibrosis. Doppler ultrasonography of the liver should be the initial diagnostic procedure. Hepatic venography is the reference procedure if required. Additionally liver biopsy may be helpful for differential diagnosis. The prognosis of the chronic form is acceptable compared to other chronic liver diseases.

Constant serum levels of secreted asialoglycoprotein receptor sH2a and decrease with cirrhosis

AIM: To investigate the existence and levels of sH2a, a soluble secreted form of the asialoglycoprotein receptor in human serum. METHODS: Production of recombinant sH2a and development of a monoclonal antibody and an enzyme-linked immunosorbent assay (ELISA). This assay was used to determine the presence and concentration of sH2a in human sera of individuals of both sexes and a wide range of ages. RESULTS: The recombinant protein was produced successfully and a specific ELISA assay was developed. The levels of sH2a in sera from 62 healthy individuals variedminimally (147 ± 19 ng/mL). In contrast, 5 hepatitis C patients with cirrhosis showed much decreased sH2a levels (50 ± 9 ng/mL). CONCLUSION: Constant sH2a levels suggest constitutive secretion from hepatocytes in healthy individuals. This constant level and the decrease with cirrhosis suggest a diagnostic potential.