Elevated alanine aminotransferase activity is not associated with dyslipidemias,but related to insulin resistance and higher disease grades in non-diabetic non-alcoholic fatty liver disease

Objective:To explore demographic and metabolic factors associated with increased alanine aminotransferase(ALT)activity in non-diabetic non-alcoholic fatty liver disease(NAFLD)patients.Methods:Overall 372 patients who consecutively attended to Gastroenterology Clinic of Baqiyatallah University of Medical Sciences,Tehran,Iran awere diagnosed as NAFLD entered into analysis.Exclusion criteria were having diabetes mellitus and fasting blood glucose over126 mg/dL,active hepatitis B virus infection,having hepatitis C virus positive serology,and to be under corticosteroid therapy.ALT levels were considered pathologically high when it was over30 IU/L for men and over 19 IU/L for women.Results:Bivariate analyses using t test and chisquare test showed that patients with pathologically augmented ALT levels had significantly higher NAFLD grades in their ultrasonographic evaluations(P=0.003).Moreover,these patients represented significantly higher homeostatic model assessment levels(P=0.003),levels of serum insulin(P=0.002),fasting blood glucose(P<0.001),and uric acid(P=0.02).The prevalence of insulin resistance was also higher in patients with increased serum ALT concentrations.Multifactorial logistic regression models showed that ultrasonographic grading of NAFLD(P=0.027)and insulin resistance(P=0.013)were the only variables significantly associated with abnormal ALT levels.Conclusions:This study shows that the associations of increased ALT serum levels in NAFLD patients are different from what are supposed before.By excluding diabetic patients from our population,we find that increased ALT levels are not associated with dyslipidemias but are independently associated with insulin resistance and NAFLD grading on ultrasonographic evaluations.Further studies are needed to confirm our results.

Aptamer based detection and separation platforms for ochratoxin A:A systematic review

Ochratoxin A(OTA),one of the most dangerous mycotoxins for human health,has been subjected to numerous studies for separation and detection in minimal amounts.Aptamers as novel recognition elements have been employed to fabricate ultrasensitive biosensors for the detection of OTA and designing delicate analytical tools.This review attempted to comprehensively examine all reported aptamer-based detection and separation platforms for ochratoxin.The most relevant databases were considered to discover all specific aptamers for dealing with OTA.Aptamer-based detection and separation devices specified for OTA were searched for,analyzed,discussed,and classified based on their specifications.The optical aptasensors have gathered a higher interest than electrochemical aptasensors,which can achieve a lower limit of detections.Moreover,some extraction platforms based on these aptamers were also found.However,aptamer-based devices seem to have some challenges in their application.

Immunohistochemical analysis of p53,cyclinD1,RB1,c-fos and N-ras gene expression in hepatocellular carcinoma in Iran

AIM: To study the effect of some genes especially those involved in cell cycle regulation on hepatocellular carcinoma. METHODS: Paraffin-embedded tissue samples of 25 patients (18 males and 7 females) with hepatocellular carcinoma were collected from 22 pathology centers in Tehran during 2000-2001, and stained using immunohistochemistry method (avidin-biotin-peroxidase) for detection of p53, cyclinD1, RB1, c-fos and N-ras proteins. RESULTS: Six (24%), 5 (20%), 12 (48%) and 2 samples (8%) were positive for p53, cyclinD1, C-fos and N-ras expression, respectively. Twenty-two (88%) samples had alterations in the G1 cell-cycle checkpoint protein expression (RB1 or cyclinD1). P53 positive samples showed a higher (9 times) risk of being positive for RB1 protein than p53 negative samples. Loss of expression of RB1 in association with p53 over-expression was observed in 4 (66.7%) of 6 samples. Loss of expression of RB1 was seen in all cyclinD1 positive, 20 (90.9%) N-ras negative, and 11 (50%) C-fos positive samples, respectively. CyclinD1 positive samples showed a higher (2.85 and 4.75 times) risk of being positive for c-fos and N-ras expression than cyclinD1 negative samples. CONCLUSION: The expression of p53, RB1 and c-fos genes appears to have a key role in the pathogenesis of hepatocellular carcinoma in Iran. Simultaneous overexpression of these genes is significantly associated with their loss of expression during development of hepatocellular carcinoma.

Predictive value and main determinants of abnormal features of intraoperative cholangiography during cholecystectomy

BACKGROUND:The major issue with intraoperative cholangiography (IOC) is whether its diagnostic accuracy for common bile duct (CBD) stones matches that of other diagnostic procedures,and thus,whether it will become a routine diagnostic procedure.The current study aimed to address the main determinants of CBD stone diagnosis in IOC among an Iranian population.METHODS:In a retrospective review database-based study conducted in Taleghani Hospital in Tehran between 2006 and 2008,baseline data and perioperative information of 2060 patients (male to female ratio 542:1518,mean age 53.7 years) who were candidates for cholecystectomy and underwent concomitant IOC for confirming CBD stones were reviewed.The predictive power of this procedure for diagnosis of abnormal biliary ducts with the focus on biliary stones was determined.RESULTS:Overall mortality and morbidity following cholecystectomy in the study population were 0.6% and 2.6%,respectively.Both early mortality and morbidity due to cholecystectomy were higher in male than female.The prevalence of CBD stones in IOC was 3.4% (5.2% in male and 2.8% in female,P=0.008).Among those without gallstones,8.7% had CBD stones and only 3.1% had concomitant gallstones and CBD stones.The main predictors of stone appearance as an abnormal feature of IOC during cholecystectomy were:advanced age (OR=1.022,P=0.001),male gender (OR=1.498,P=0.050),history of abdominal surgery (OR=1.543,P=0.040) and preoperative endoscopic retrograde cholangiopancreatography (OR=5.400,P<0.001).CONCLUSIONS:IOC is a safe and accurate method for the assessment of bile duct anatomy and stones.Therefore,the routine use of IOC within cholecystectomy seems reasonable and is recommended.

Intra-familial prevalence of hepatitis B virologic markers in HBsAg positive family members in Nahavand, Iran

AIM: To determine the prevalence of hepatitis B in Nahavand and evaluate the HBsAg positive prevalence in families with a member who was confirmed to have HBV infection.METHODS: This study was performed in two phases. In the first phase, 1 824 subjects in Nahavand city were selected. The interviewers visited the houses of chosen families to fill the questionnaire and take the blood samples.All subjects signed an informed consent before interviews and blood sampling. The samples were evaluated for HBV virologic markers. In the second phase, 115 HBsAg-positive cases were enrolled and evaluated for HBV virologic markers.RESULTS: The prevalence of positive HBsAg in Nahavand was 2.3%. The most frequent relatives of index cases were sons and daughters (32.2% and 23.5% respectively).Twelve (11%) of all family members were HBsAg positive.Fifty (56.2%) were isolated HBsAb positive and only one person (2.5%) was isolated HBcAb positive. The higher rates of HBsAg marker were detected in the brothers (1-25%) and fathers (1-12.5%). The infection rate in husbands and wives of index cases was 10%. Only two (16.7%) of all HBsAg-positive participants reported previous HBV vaccination.CONCLUSION: The prevalence of intra-familial HBV infection is lower in Nahavand of Iran compared to other studies.More attention should be paid to HBV vaccination and risk-lowering activities.

Hepatitis B and C virus-induced hepatitis: Apoptosis, autophagy, and unfolded protein response

AIM: To investigate the co-incidence of apoptosis, autophagy, and unfolded protein response(UPR) in hepatitis B(HBV) and C(HCV) infected hepatocytes.METHODS: We performed immunofluorescence confocal microscopy on 10 liver biopsies from HBV and HCV patients and tissue microarrays of HBV positive liver samples. We used specific antibodies for LC3β, cleaved caspase-3, BIP(GRP78), and XBP1 to detect autophagy, apoptosis and UPR, respectively. AntiHCV NS3 and anti-HBs antibodies were also used to confirm infection. We performed triple blind counting of events to determine the co-incidence of autophagy(LC3β punctuate), apoptosis(cleaved caspase-3), and unfolded protein response(GRP78) with HBV and HCV infection in hepatocytes. All statistical analyses were performed using SPSS software for Windows(Version 16 SPSS Inc, Chicago, IL, United States). P-values < 0.05 were considered statistically significant. Statistical analyses were performed with Mann-Whitney test to compare incidence rates for autophagy, apoptosis, and UPR in HBV- and HCV-infected cells and adjacent noninfected cells.RESULTS: Our results showed that infection of hepatocytes with either HBV and HCV induces significant increase(P < 0.001) in apoptosis(cleavage of caspase-3), autophagy(LC3β punctate), and UPR(increase in GRP78 expression) in the HCV- and HBVinfected cells, as compared to non-infected cells of the same biopsy sections. Our tissue microarray immunohistochemical expression analysis of LC3β in HBV^(Neg) and HBV^(Pos) revealed that majority of HBVinfected hepatocytes display strong positive stainingfor LC3β. Interestingly, although XBP splicing in HBVinfected cells was significantly higher(P < 0.05), our analyses show a slight increase of XBP splicing was in HCV-infected cells(P > 0.05). Furthermore, our evaluation of patients with HBV and HCV infection based on stage and grade of the liver diseases revealed no correlation between these pathological findings and induction of apoptosis, autophagy, and UPR.CONCLUSION: The results of this study indicate that HCV and HBV infection activates apoptosis, autophagy and UPR, but slightly differently by each virus. Further studies are warranted to elucidate the interconnections between these pathways in relation to pathology of HCV and HBV in the liver tissue.

Helicobacter pylori infection and expression of DNA mismatch repair proteins

瞄准：为了决定 DNA (MMR ) 蛋白质的表示，包括 hMLH1 和 hMSH2，在在病人与或没有 Helicobacter 的胃的上皮细胞， pylori (H pylori ) 感染了胃炎。方法：五十个 H pylori 积极的病人和 50 H pylori 否定的病人在学习被注册。在有非溃疡消化不良的病人的内视镜检查法期间，二窦和二语料库活体检视为组织学的检查(Giemsa 污点) 并且为免疫被拿 hMLH1 和 hMSH2 的组织化学的染色。结果：为染色的 hMLH1 表明了确实的上皮的房间原子核的百分比是 84.14 +/-7.32% 在 H pylori 否定的病人，当它是 73.34 +/- 时 10.10% 在 H pylori 积极的病人(P 【 0.0001 ) 。没有有效差量关于为染色的 hMSH2 表明了确实的上皮的房间原子核的百分比在二个组之间被看见(81.16 +/-8.32% 在 pylori 否定的 H 对 78.24 +/-8.71% 在 H pylori 积极的病人；P = 0.09 ) 。结论：这研究显示 H pylori 可能通过它影响 DNA MMR 系统的能力部分地至少支持胃的癌的开发。

Prevalence of hepatitis C virus infection and its related risk factors in drug abuser prisoners in Hamedan-Iran

AIM: Recent studies in Iran has shown that prevalence of hepatitis C virus (HCV) infection among Iranian prisoners is high, in spite of low HCV seroprevalence in general population.METHODS: This study was carried out in the central prison of Hamedan - Iran, in year 2002. Inmates were interviewed using a standard questionnaire including demographic,imprisonment history and HCV-related risk behaviors items. Thereafter, the sera drawn from the participants were tested for anti-HIV and anti-HCV antibodies.RESULTS: A total number of 427 drug abuser inmates participated in our study. Three hundred and ninety-seven (93%) were men and 30 (7%) were women. Total number of Ⅳ drug abusers (IDA) and non-Ⅳ drug abusers (NIDA)was 149 (34.9%) and 278 (65.1%), respectively. The overall rate of antibody positivity among inmates was 0.9% for HIV and 30% for HCV. Of all IDAs, 31.5% and of NIDAs, 29.1% had serological evidence of HCV infection.CONCLUSION: The seroprevalence of HCV infection among drug abuser prisoners in comparison with the general population in Iran, is very high (30% vs in italics 0.2%).Our results indicate the importance of policies to prevent transmission of HCV infection during and following incarceration.

Cytotoxic T-lymphocyte antigen 4 gene polymorphisms and susceptibility to chronic hepatitis B

瞄准：在细胞毒素的T淋巴细胞抗原 4 以内估计三个多型性区域( CTLA-4 )基因，在倡导者区域 -318 的 C/T 基础交换( CTLA-4 -318C/T),在 1 个位置上的前的 A/G 替换 49 ( CTLA-4 49A/G )，在 1172 的 T/C 替换(在有长期的肝炎 B 的病人的 CTLA-4 -1172T/C)。方法：当他们介绍了给肝的诊所，有长期的肝炎 B 感染和 150 个健康题目的 51 个病人顺序被招募。长期的肝炎 B (HBV ) 的分类感染了病人作为无征状的带菌状态(26 个病人) 和长期的肝炎 B (25 个病人) 。Genomic DNA 用 Milleros 腌外面方法从凝结反的外部血 Buffy 被孤立。CTLA-4 基因多型性的存在用聚合酶链反应扩大被决定倔强的变化系统(手臂) 。结果：我们观察了在 -318 遗传型频率之间的一个重要协会(T+C- ， T+C+ ， T-C+) 并且危险性到长期的肝炎 B (P=0.012， OR=0.49， 95%CI：0.206-1.162 ) 。然而，我们没为 +49 遗传型频率观察一个重要协会(T+C+ ， T+C-T-C+) 并且 -1172 遗传型频率(C+T+ ， T+C-C+T-) 并且疾病的状态。结论：我们的结果建议 CTLA-4 基因多型性可以部分涉及危险性到长期的肝炎 B。

Clinical, virologic and phylogenetic features of hepatitis B infection in Iranian patients

AIM: To characterize the clinical, serologic and virologic features of hepatitis B virus (HBV) infection in Iranian patients with different stages of liver disease. METHODS: Sixty two patients comprising of 12 inactive carriers, 30 chronic hepatitis patients, 13 patients with liver cirrhosis and 7 patients with hepatocellular carcinoma (HCC) were enrolled in the study. The HBV S, C and basal core promoter (BCP) regions were amplified and sequenced, and the clinical, serologic, phylogenetic and virologic characteristics were investigated. RESULTS: The study group consisted of 16 HBeAg- positive and 46 HBeAg-negative patients. Anti-HBe- positive patients were older and had higher levels of ALT, ASL and bilirubin compared to HBeAg-positivepatients. Phylogenetic analysis revealed that all patients were infected with genotype D (mostly ayw2). The G1896A precore (PC) mutant was detected in 58.1% patients. HBeAg-negative patients showed a higher rate of PC mutant compared to HBeAg-positive patients (χ2 = 9.682, P = 0.003). The majority of patients with HCC were HBeAg-negative and were infected with PC mutant variants. There was no significant difference in the occurrence of BCP mutation between the two groups, while the rate of BCP plus PC mutants was higher in HBeAg-negative patients (χ2 = 4.308, P = 0.04). In the HBV S region, the genetic variability was low, and the marked substitution was P120T/S, with a rate of 9.7% (n = 6). CONCLUSION: In conclusion, HBV/D is the predominant genotype in Iran, and the nucleotide variability in the BCP and PC regions may play a role in HBV disease outcome in HBeAg-negative patients.

Efficacy and safety of Aloe vera syrup for the treatment of gastroesophageal reflux disease: a pilot randomized positive-controlled trial

OBJECTIVE: To investigate the use of Aloe vera(A.vera) for the treatment of gastroesophageal reflux disease(GERD) symptoms and compare its effects with those of omeprazole and ranitidine.METHODS: In this pilot, randomized controlled trial, 79 subjects were allocated to A. vera syrup(standardized to 5.0 mg polysaccharide per m L of syrup)at a dose of 10 m L/d, omeprazole capsule(20 g/d)or ranitidine tablet(150 mg in a fasted state in the morning and 150 mg 30 min before sleep at night)for a period of 4 weeks. The frequencies of eight main symptoms of GERD(heartburn, food regurgitation, flatulence, belching, dysphagia, nausea,vomiting and acid regurgitation) were assessed at weeks 2 and 4 of the trial.RESULTS: A. vera was safe and well tolerated and reduced the frequencies of all the assessed GERD symptoms, with no adverse events requiring withdrawal.CONCLUSION: A. vera may provide a safe and effective treatment for reducing the symptoms of GERD.

在亚洲的 colorectal 癌症幸存率和预后的概述

Colorectal cancer is a rapidly rising trend in Asia.The incidence in many Asian countries is on par with the West.Several studies have provided data regarding the survival of patients with colorectal cancer.In Asia,the overall cure rate of colorectal cancer has not improved dramatically in the last decade,5-year survival remaining at approximately 60%.Colorectal cancer survival time has increased in recent years,but mortality rate remains high.Although studies have determined a number of factors that can predict survival of patients after diagnosis,life expectancy has not been increased dramatically.It seems that among the prognostic factors explored so far,the most important are those that relate to early diagnosis of cancer.Primary detection is feasible since efficient screening modalities are available.Colonoscopic surveillance is needed,especially in subjects at higher risk.

在亚洲的 colorectal 癌症的增加的负担

The incidence and mortality of colorectal cancer(CRC) is rising rapidly in Asia.It seems that ethnicity has an important etiological role in CRC in Asia.However the incidence,anatomical distribution and mortality of CRC among Asian populations are not different from those in Western countries.There is little support by health authorities for CRC screening and very low public awareness of this emerging epidemic in Asia.The increasing rate of CRC in Asia means that we need to take action immediately to prevent CRC and to diagnose the disease at the early stages by introducing CRC screening in countries at high risk of an increasing burden of CRC.

A shield against a monster:Hepatitis C in hemodialysis patients

Hepatitis C virus(HCV)infection is highly prevalent among patients on hemodialysis(HD).The prevalence of HCV infection in HD patients varies markedly from country to country.Some factors are especially related to these high prevalence rates,such as blood transfusions and length of dialysis time. Nosocomial routes of transmission including the use of contaminated equipment and patient-to-patient exposure is considered more important.Several prophylactic measures have been suggested to avoid infection by HCV in the HD environment.

Clinical features of hepatopulmonary syndrome in cirrhotic patients

瞄准：评估频率，临床并且帕拉肝肺症候群(HPS ) 并且到的临床的特征在伊朗在病人在这症候群的诊断决定他们的预兆的价值。方法：54 个肝脏硬化症的病人经历了对比由二位心脏病专家检测肺内、心内的分流的提高的回响心动描记法。动脉的血氧， O (2 ) 坡度(A-a ) 和正统说法被气体(ABG ) 测试的动脉的血测量。为 HPS 的诊断标准积极的病人被定义为表明肺内的动脉的膨胀的临床的 HPS 盒子和那些，但是另外的标准(动脉的血血氧不足) 都没被定义为 lHPS 盒子。HPS 频率，敏感，积极、否定的预兆的价值临床并且帕拉临床的特征被学习。结果：十(18.5%) 并且七(13%) 盒子分别地有临床、无临床症状的 HPS。最普通的病原学是肝炎 B。呼吸困难(100%) 和青紫(90%) 是最流行的临床的特征。呼吸困难并且打分别地是最敏感、特定的临床的特征。没有重要关系被发现在之间 HPS 和脾大，腹水，浮肿，黄疸，尿少，和并行的静脉。HPS 在肝炎 B 是更流行的。PaO (2 )【 70 并且动脉牙槽的坡度在 HPS 病人有最高的敏感。正统说法特性是 100% 。结论：与 75% 的否定预兆的价值(NPV ) 与 75% 的积极预兆的价值(PPV ) 和呼吸困难打是在 HPS 的诊断的最好的临床的因素症候群。PaO (2 )【 70 并且 P (A-a ) O (2 )】 30 并且他们的和，是在 HPS 病人的最珍贵的否定、积极的预兆的价值。

Association of promoter polymorphism of the CD14 C (-159) T endotoxin receptor gene with chronic hepatitis B

AIM: To investigate whether single-nucleotide polymor- phisms in the promoter regions of endotoxin-responsive genes CD14 C (-159) T is associated with chronic hepatitis B. METHODS: We obtained genomic DNA from 80 patients with established diagnosis of chronic hepatitis B and 126 healthy subjects served as a control population. The CD 14 C (-159) T polymorphism was investigated using an allele specific PCR method. RESULTS: Twenty seven percent of chronic hepatitis B patients and 75% of controls were heterozygous for CT genotype. The difference between the chronic hepatitis B and control groups was statistically significant [P < 0.0001; Odds ratio (OR) = 2.887; 95% CI: 1.609-5.178]. Twenty four point six percent of chronic hepatitis B and patients 12.3% of the control group were heterozygous for TT genotype. The difference between groups was not statistically significant (P = 0.256; OR = 0.658; 95% CI: 0.319-1.358). Forty eight point four percent of chronic hepatitis B patients and 12.7% of control were homozy- gote for CC genotype (P < 0.004; OR = 0.416; 95% CI: 0.229-0.755). The frequency of allele C was 61.9% and allele T was 38.1% in hepatitis B patients group. The frequency of allele C was 55.2% and allele T was 44.8% for the control group (P = 0.179; OR = 1.319; 95% CI: 0.881-1.977). CONCLUSION: The TT heterozygous genotype was not a risk factor for chronic hepatitis B. CC homozygote genotype is protective for hepatitis B. Lack of heterozy- gosis of genotype CT is a risk factor for chronic hepatitis B. Alleles C or T were not risk factors for chronic hepatitis B. These findings show the role of a single-nucleotide polymorphism at CD14/-159 on the development ofchronic hepatitis B. Endotoxin susceptibility may play a role in the pathogenesis of chronic hepatitis B.

内视镜的电子记录: 为改进 colorectal 癌症的管理的一条新途径预防

Digestive endoscopy is currently the main diagnostic procedure for investigation of the digestive tract when a digestive disease is suspected.The use of computers and electronic medical records for the management of endoscopic data are an important key to improving endoscopy unit efficiency and productivity.This technology supports optimal program operation,monitoring and evaluation colorectal cancer screening.This article is a comprehensive survey of endoscopic electronic medical records and information systems.Computerized clinical records have the capability of identifying patients due for screening and to calculate baseline rates of colorectal cancer screening by patient characteristics and by primary care physician and practice group.This paper describes data flow in the endoscopy unit,the minimum data set of colorectal cancer and key features of endoscopic electronic medical record.In addition,the researchers state standards in different aspects,especially terminology standards and interoperability standards for image and text.

Hepatitis C resistance to NS5A inhibitors:Is it going to be a problem?

Treatment of hepatitis C virus(HCV) infection has evolved greatly through the recent decade. The availability of direct-acting antiviral agents(DAAs) targeting the functional proteins of HCV has resulted in the introduction of DAA-based combination therapies,providing an optimal rate of treatment success. Among the DAAs,NS5 A inhibitors are used in most of the introduced and approved HCV antiviral regimens. Resistance-associated substitutions(RASs) are amino acid substitutions in HCV protein sequences that result in decreased antiviral efficacy of the HCV DAAs. Among the HCV RASs,the NS5 A RASs were found to effectively modify and decrease treatment response to NS5 A inhibitor-containing regimens. As a baseline predictor of treatment response,NS5 A RAS draws attention for pretreatment testing in targeted patient groups. Given NS5 A RASs are either naturally-occurring or DAA-selected,the application of NS5 A RAS testing can be considered in two settings of NS5 A inhibitor-na?ve patients and NS5 A inhibitor-experienced patients. Less than 5% of NS5 A inhibitor-na?ve patients harbor naturally-occurring NS5 A RAS with high resistance level(> 100 X resistance foldchange). In NS5 A inhibitor-na?ve patients,NS5 A RAS testing accompanied by treatment optimization cannot increase treatment response more than 2%-3%,while in NS5 A inhibitor-experienced patients,> 75% are found to have NS5 A RASs > 100 X and NS5 A RAS testing in this group of patients seems to be reasonable. This editorial will address the debate on the application of NS5 A RAS testing and will discuss if the NS5 A RAS testing has any role in clinical management of hepatitis C.

Biochemical response to lamivudine treatment in HBeAg negative chronic hepatitis B patients in Iran

瞄准：与长期的肝炎 B 在病人学习一个年 lamivudine 政体的效果。方法：在在 3 月 2002-March 日 2004 之间的德黑兰出席了一个肝炎诊所的 HBeAg 否定肝炎 B 病人的医药记录被评估。病人收到了为至少 12 瞬间从前每日的 100 片 mg lamivudine 药片。肝酶和全部血细胞计数在治疗的中止以后在基线和治疗(第 12 瞬间) 和 6 瞬间的结束被检查。结果：所有病人， 24 被排除。离开的 71 个病人，(81.7%) 58 是人。病人的吝啬的年龄是 38 +/- 14 年。在浆液的中高音的吝啬的水平是在有在到一个平均数的治疗的目的重要减小的基线的 205 nkat/L 723 +/- 铺平的 1437 +/- 92 nkat/L (P = 0.002 ) 。在 38 个病人(53.5%) ， ALT 水平在一个年治疗以后是正常的。五病人(7.3%) relapsed (简历化学上) 在在中止 lamivudine 治疗(有治疗反应的好结束的病人) 以后的 6 瞬间以内。在浆液的著名计算机生产厂商的吝啬的水平是 1060 +/- 在显著地减少了到 652 +/- 的基线的 105 nkat/L 在治疗的目的 75 nkat/L (P = 0.002 ) 。结论：在长期的肝炎 B 的一半(53.5%) 上，有 HBeAg negative 的病人在 12 瞬间 lamivudine 治疗有正常的肝酶水平。