BACKGROUND: The accurate assessment of the degree of hepatic fibrosis plays a critical role in guiding the diagnosis, treatment and prognostic assessment of chronic liver diseases. Liver biopsy is currently the most r...BACKGROUND: The accurate assessment of the degree of hepatic fibrosis plays a critical role in guiding the diagnosis, treatment and prognostic assessment of chronic liver diseases. Liver biopsy is currently the most reliable method to evaluate the severity of hepatic fibrosis. However, liver biopsy is an invasive procedure associated with morbidity and mortality, and has several limitations in patients with decompensated cirrhosis. There is no report on the collagen proportionate area (CPA) of liver tissue in the decompensated stage of cirrhosis. This study aimed to determine the CPA of resected liver tissue samples from patients with HBV-related decompensated cirrhosis using digital image analysis, and to analyze the relationship between the CPA and liver functional reserve. METHODS: Fifty-three resected liver tissue samples from liver transplant patients with chronic hepatitis B-induced decompensated cirrhosis were stained with Masson’s trichrome, and the CPA in these samples was quantitatively determined using digital image analysis. The values of relevant liver function just before liver transplantation, the CPA in liver tissue, and their correlation were analyzed. RESULTS: The mean CPA at the decompensated stage of cirrhosis was 35.93±14.42% (11.24%-63.41%). The correlation coefficients of the CPA with a model for end-stage liver disease score, serum total bilirubin and international standard ratio of prothrombin B were 0.553, 0.519 and 0.533, respectively (P<0.001). With increasing CPA values, the three indices reflecting liver functional reserve also changed significantly.CONCLUSIONS: The degree of fibrosis may be correlated with the functional reserve. With the advancement of fibrosis, the liver functional reserve is attenuated accordingly.展开更多
AIM To explore the relationship between collagen proportionate area(CPA) and portal hypertension-related clinical manifestations in alcoholic liver disease(ALD).METHODS Retrospective study with chart review of patient...AIM To explore the relationship between collagen proportionate area(CPA) and portal hypertension-related clinical manifestations in alcoholic liver disease(ALD).METHODS Retrospective study with chart review of patients with ALD adressed to our center between January 2012 and December 2013 for a transjugular liver biopsy(TJLB) and hepatic hemodynamic study. Patients were included if they met the following criteria:(1) Medical indication for a liver biopsy in the setting of ALD;(2) recent(< 15 d) clinical, radiological, endoscopic and biological data available; and(3) estimated follow-up of at least 6 mo. Liver tissue from cirrhotic subjects obtained from transjugular liver biopsies was stained with Picro Sirius red and computer-assisted digital image analysis to determine fibrosis density using CPA was performed. RESULTS We included 61 patients with alcoholic ALD, subdivided in 41 active alcohol drinkers and 20 durably abstinent patients. Nine healthy liver donors served as controls. Mean CPA in patients with ALD was 7.1%, with no difference between active drinkers and abstinent patients(P = 0.17). Using a fibrosis density cutoff of 5%, we observed a positive correlation between high fibrosis density and the hepatic venous pressure gradient(HVPG) only in active drinkers(P = 0.02). At 12-mo of follow-up, in the group of active alcohol drinkers, patients reaching a composite outcome showed a higher HVPG value as compared to those who did not(18.5 mm Hg vs 14.5 mm Hg P < 0.04) whereas CPA values were similar(6.9% vs 11%, P = 0.23).CONCLUSION In active alcoholic ALD, CPA correlates to portal pressure but only HVPG predicts clinical events, pointing to the role of alcohol as a modulator of portal hypertension.展开更多
目的观察复方黄芪养心合剂(CAMNH)对SD大鼠冠状动脉结扎术后心室及血管周围胶原重构(VR)的影响。方法 SD大鼠47只随机取假手术组(SO组)8只。其余39只行冠状动脉左前降支结扎术,观察10天,存活29只大鼠按随机数字表法分为三组,复方黄芪养...目的观察复方黄芪养心合剂(CAMNH)对SD大鼠冠状动脉结扎术后心室及血管周围胶原重构(VR)的影响。方法 SD大鼠47只随机取假手术组(SO组)8只。其余39只行冠状动脉左前降支结扎术,观察10天,存活29只大鼠按随机数字表法分为三组,复方黄芪养心合剂组(CAMNH组)、美托洛尔缓释片组(MSSRT组)每组10只,心脏重构组(VR组)9只,CAMNH组MSSRT组予相应药物灌胃,VR组和SO组予蒸馏水灌胃,共计8周。计算全心室质量与体质量比(Vt/Wt);使用改良Masson染色法观察大鼠心室重构,用Image Pro Plus 6.0图像分析系统,计算心肌组织胶原容积分数(CVF)和血管周围胶原面积(PVCA)。结果 Vt/Wt:MSSRT组小于VR组[(2.77±0.26)%比(3.06±0.21)%,P<0.05];CAMNH组明显小于VR组[(2.67±0.17)%比(3.06±0.21)%,P<0.01]。CVF与PVCA:MSSRT组及CAMNH组与VR组比较明显降低[(43.89±6.83)%、(42.60±17.55)%比(59.01±6.93)%;(101.8±49.7)%、(104.1±41.2)%比(148.1±69.3)%;P<0.01]。结论复方黄芪养心合剂能够减轻冠状动脉结扎术后SD大鼠Vt/Wt,降低VR大鼠CVF、PVCA,作用与美托洛尔缓释片相当。展开更多
基金upported by a grant from the Technology and Plan of Guangdong Province, China (2009B030801006)
文摘BACKGROUND: The accurate assessment of the degree of hepatic fibrosis plays a critical role in guiding the diagnosis, treatment and prognostic assessment of chronic liver diseases. Liver biopsy is currently the most reliable method to evaluate the severity of hepatic fibrosis. However, liver biopsy is an invasive procedure associated with morbidity and mortality, and has several limitations in patients with decompensated cirrhosis. There is no report on the collagen proportionate area (CPA) of liver tissue in the decompensated stage of cirrhosis. This study aimed to determine the CPA of resected liver tissue samples from patients with HBV-related decompensated cirrhosis using digital image analysis, and to analyze the relationship between the CPA and liver functional reserve. METHODS: Fifty-three resected liver tissue samples from liver transplant patients with chronic hepatitis B-induced decompensated cirrhosis were stained with Masson’s trichrome, and the CPA in these samples was quantitatively determined using digital image analysis. The values of relevant liver function just before liver transplantation, the CPA in liver tissue, and their correlation were analyzed. RESULTS: The mean CPA at the decompensated stage of cirrhosis was 35.93±14.42% (11.24%-63.41%). The correlation coefficients of the CPA with a model for end-stage liver disease score, serum total bilirubin and international standard ratio of prothrombin B were 0.553, 0.519 and 0.533, respectively (P<0.001). With increasing CPA values, the three indices reflecting liver functional reserve also changed significantly.CONCLUSIONS: The degree of fibrosis may be correlated with the functional reserve. With the advancement of fibrosis, the liver functional reserve is attenuated accordingly.
文摘AIM To explore the relationship between collagen proportionate area(CPA) and portal hypertension-related clinical manifestations in alcoholic liver disease(ALD).METHODS Retrospective study with chart review of patients with ALD adressed to our center between January 2012 and December 2013 for a transjugular liver biopsy(TJLB) and hepatic hemodynamic study. Patients were included if they met the following criteria:(1) Medical indication for a liver biopsy in the setting of ALD;(2) recent(< 15 d) clinical, radiological, endoscopic and biological data available; and(3) estimated follow-up of at least 6 mo. Liver tissue from cirrhotic subjects obtained from transjugular liver biopsies was stained with Picro Sirius red and computer-assisted digital image analysis to determine fibrosis density using CPA was performed. RESULTS We included 61 patients with alcoholic ALD, subdivided in 41 active alcohol drinkers and 20 durably abstinent patients. Nine healthy liver donors served as controls. Mean CPA in patients with ALD was 7.1%, with no difference between active drinkers and abstinent patients(P = 0.17). Using a fibrosis density cutoff of 5%, we observed a positive correlation between high fibrosis density and the hepatic venous pressure gradient(HVPG) only in active drinkers(P = 0.02). At 12-mo of follow-up, in the group of active alcohol drinkers, patients reaching a composite outcome showed a higher HVPG value as compared to those who did not(18.5 mm Hg vs 14.5 mm Hg P < 0.04) whereas CPA values were similar(6.9% vs 11%, P = 0.23).CONCLUSION In active alcoholic ALD, CPA correlates to portal pressure but only HVPG predicts clinical events, pointing to the role of alcohol as a modulator of portal hypertension.
文摘目的观察复方黄芪养心合剂(CAMNH)对SD大鼠冠状动脉结扎术后心室及血管周围胶原重构(VR)的影响。方法 SD大鼠47只随机取假手术组(SO组)8只。其余39只行冠状动脉左前降支结扎术,观察10天,存活29只大鼠按随机数字表法分为三组,复方黄芪养心合剂组(CAMNH组)、美托洛尔缓释片组(MSSRT组)每组10只,心脏重构组(VR组)9只,CAMNH组MSSRT组予相应药物灌胃,VR组和SO组予蒸馏水灌胃,共计8周。计算全心室质量与体质量比(Vt/Wt);使用改良Masson染色法观察大鼠心室重构,用Image Pro Plus 6.0图像分析系统,计算心肌组织胶原容积分数(CVF)和血管周围胶原面积(PVCA)。结果 Vt/Wt:MSSRT组小于VR组[(2.77±0.26)%比(3.06±0.21)%,P<0.05];CAMNH组明显小于VR组[(2.67±0.17)%比(3.06±0.21)%,P<0.01]。CVF与PVCA:MSSRT组及CAMNH组与VR组比较明显降低[(43.89±6.83)%、(42.60±17.55)%比(59.01±6.93)%;(101.8±49.7)%、(104.1±41.2)%比(148.1±69.3)%;P<0.01]。结论复方黄芪养心合剂能够减轻冠状动脉结扎术后SD大鼠Vt/Wt,降低VR大鼠CVF、PVCA,作用与美托洛尔缓释片相当。
