Search

Objective: To construct a prediction model about the autoimmune liver disease (AILD) related cirrhosis based on two-dimensional shear wave elasticity (2D-SWE), ultrasound and serological indexes, and to evaluate the predicting effciency. Objective To construct a prediction model about the autoimmune liver disease (AILD) related cirrhosis based on two-dimensional shear wave elasticity (2D-SWE), ultrasound and serological indexes, and to evaluate the predicting effciency. Methods: Patients with AILD confirmed by liver biopsy with liver ultrasound, 2D-SWE and serological examination were collected from 2019.01 to 2022.05. Patients were divided into cirrhotic and non-cirrhotic groups. Independent risk factors for the AILD related cirrhosis were selected by multivariate logistic regression analysis, and a nomogram model (AILDC) of the AILD related cirrhosis was constructed. The internal was validated on the model by Bootstrap method, and the Receiver Operating Charateristic curve, calibration curve and clinical decision curve were drew to evaluate the differentiation degree, calibration degree and the clinical net benefit of the model. Results: A total of 255 patients, 45 had liver cirrhosis. Multivariate logistic regression analysis showed that liver stiffness (OR:1.322,95%CI:1.186-1.474), spleen thickness> 4 cm (OR: 5.154,95%CI: 1.943-13.674), complement C4(OR:0.001,95%CI:0.000-0.674), and the Golgi apparatus protein-73 (OR: 1.014,95% CI: 1.0 0 2-1.027) were all independent predictors of AILD related cirrhosis. The optimal cut-off for AILDC was 80, sensitivity 84.4%, specificity 78.6%, the area under curve(AUC) was 0.866. The optimal cutoff value for AILD liver stiffness was 10 Kpa, with the sensitivity of 71.1%, and the specificity of 85.2%, and an AUC of 0.803. Compared with other non-invasive indicators, AILDC has a higher net reclassification index, comprehensive discriminant improvement index, and clinical decision curve. Conclusions: The AILDC has better predictive efficacy than other noninvasive indices, and worth further promotion in clinical practice. [ABSTRACT FROM AUTHOR]

Objective: To investigate the value of liver stiffness measurement (LSM) combined with S index in predicting the degree of liver fibrosis in hepatitis B patients. Methods: A total of 187 chronic hepatitis B patients who were admitted to the Department of Infection, the First Affiliated Hospital of Hainan Medical College from January 2019 to December 2021 were selected. General data were collected; blood routine, liver function, liver fibrosis and liver stiffness measurement were tested; S index, APRI and FIB-4 index were calculated; and liver biopsy was performed. Results: According to the pathological results of liver puncture, the patients were divided into no significant fibrosis group (n=86), significant fibrosis group (n=71) and cirrhosis group ( n=30).There were significant differences in age, PLT, GGT, ALB, S index, HA, LN and LSM levels among the three groups (P<0.05). There was a good correlation between S index and the degree of hepatic fibrosis (rs=0.738, P<0.001). The AUC of S index and LSM for the diagnosis of significant fibrosis in hepatitis B were 0.873 and 0.792, respectively. And the AUC of S index and LSM for the diagnosis of liver cirrhosis were 0.966 and 0.879, respectively. The AUC for the combined diagnosis of significant fibrosis and cirrhosis were 0.908 and 0.988, respectively. The AUROC of combined detection in the diagnosis of cirrhosis was higher than that of LSM, APRI and FIB-4 (P<0.05).Conclusion: LSM combined with S index has certain application value in the diagnosis of liver fibrosis/cirrhosis in hepatitis B patients. [ABSTRACT FROM AUTHOR]

To explore the threshold of ALT for initiating antiviral therapy in HBV infected patients, and to provide a basis for initiating antiviral therapy in chronic HBV-infected patients. Methods This retrospective cohort study recruited 707 consecutive treatment-naïve chronic hepatitis B (CHB) patients undergoing diagnostic liver biopsy in the department of infectious diseases of the Affiliated Hospital of Yan'an University from October 2013 to August 2018. Liver biopsy specimens were obtained under ultrasound guidance using Menghini 16G disposable needles. The METAVIR scoring system, which is commonly used internationally, was used to divide the patients into the group with mild liver tissue injury and the group with significant liver tissue injury, and the alanine aminotransferase (ALT) levels were measured separately. Receiver operating characteristic (ROC) curve and Mann-Whitney U test were used to evaluate the diagnostic value of ALT for significant liver tissue injury under different demographic characteristics. Results Of 707 patients, 292 (41.30%) had significant liver tissue injury confirmed by liver biopsy (METAVIR ≥A2 and/or F2). When the ULN of ALT was set to NICE criteria (30 U/L for males, 19 U/L for females), AASLD criteria (35 U/L for males, 25 U/L for females) and EASL or APASL criteria (40 U/L for males and females), CHB patients with 30 years olds, 22 U/L for HBeAg negative and 31 U/L for HBeAg positive patients. Conclusions The threshold of ALT for initiating antiviral therapy in chronic HBV patients should be individualized, especially should be down-regulated for the females, olders and HBeAg-negative patients. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Modern Laboratory Medicine is the property of Journal of Modern Laboratory Medicine Editorial Department and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Imaging Science & Photochemistry is the property of Imaging Science & Photochemistry Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

To explore the application value of color Doppler ultrasound combined with Fibroscan scoring system in the diagnosis of chronic hepatitis B fibrosis, a total of 300 patients with chronic hepatitis B undergoing ultrasound-guided liver biopsy were selected, among which 235 patients had liver fibrosis (observation group) and 65 patients didn't have liver fibrosis (control group). The color Doppler ultrasound parameters [including main portal vein diameter (mPVD), splenic vein diameter (SVD), main portal vein blood flow (mPBF), mean velocity of main portal vein (mPVm), portal vein congestion index (CD, mean velocity of splenic vein (sVm), splenic vein blood flow (sVBF)] and liver stiffness measurement (LSM) of two groups were statistically analyzed, as well as the parameters between different liver fibrosis stages. The results showed that the AUC of combined diagnosis of CHB liver fibrosis was the highest, which was 0.876 (P<0.05). SVD, mPVD, CI, LSM were positively correlated with liver fibrosis stage, mPVm was negatively correlated with liver fibrosis stage (P < 0.05). The AUC of liver fibrosis stage diagnosed by LSM was the largest (P < 0.05). It can be seen that using color Doppler ultrasound and FibroScan directional instantaneous elastography system, which detected SVD, mPVD, CI, mPVm, and LSM, can effectively diagnose CHB liver fibrosis. And each parameter is closely related to the degree of liver fibrosis. The combined detection is expected to be a non-invasive method for evaluating liver fibrosis and severity. [ABSTRACT FROM AUTHOR]

Liver biopsy is an important means of clinical diagnosis and treatment of liver diseases, but it is not easily accepted by patients because of its invasiveness. The most commonly employed liver biopsy approaches are percutaneous or transjugular. Endoscopic ultrasound-guided liver biopsy (EUS-LB), a newly emerging transjugular technique, has been widely studied and applied in recent years, but its application in China is less common. The EUS-LB has the advantages of high safety and comfort, simultaneous sampling of both liver lobes, and adequate sampling volume; however, it also has the disadvantages of high requirements for hardware, operators, and cost. This article reviews the clinical application of EUS-LB in accordance with pertinent research findings from recent years and discusses its advantages, disadvantages, and implementation feasibility.

Objective To analyse the clinical characteristics of HBeAg-negative chronic HBV infection with persistent normal ALT. Methods A retrospective study was conducted for 60 patients of ALT persistent normal HBeAg negative chronic HBV infection who were followed up in the outpatient department of Infection Department of the Affiliated Hospital of Yan'an University from September 2013 to January 2020. The indexes difference of baseline and end points of patients were compared . The cumulative rates of HBV DNA negative conversion, spontaneously HBsAg seroclearance, hepatitis activity, cirrhosis, and hepatocellular carcinoma at the end of follow-up were analyzed. The paired-samples t test or the Wilcoxon signed ranks test was used for comparison of continuous data between groups. Results All patients were followed up for 24.00-72.00 months, 31 patients underwent liver biopsy during follow-up, 18(58.1%) had mild liver injury and 13(41.9%) had moderate liver injury. There were significant differences in the levels of HBsAg, HBeAb, HBcAb, ALT and ALB between the baseline and follow-up endpoints(P<0.05), but the levels of HBV DNA, AST and LSM were no significant differences (P>0.05). At the end of follow-up, 6 patients HBV DNA was not detected, 4 patients spontaneously occurred HBsAg seroclearance, 2 patients appeared hepatitis activity, 2 patients developed liver cirrhosis and 1 patient became liver cancer. Conclusion About 30.0% patients of HBeAg-negative chronic HBV infection with persistent normal ALT have indications of antiviral therapy. If conditions permit, the patients should actively perform liver biopsies to evaluate the degree of liver injury, otherwise clinicians can directly give antiviral treatment according to the virological, imaging and demographic characteristics of the patients. [ABSTRACT FROM AUTHOR]

Objective To investigate the significance of CK7 and CK19 in the pathological diagnosis of liver diseases such as hepatitis B，unidentified hepatitis， PBC (primary biliary cholangitis)， and PBC-AIH (primary biliary cholangitis combined with autoimmune hepatitis). Methods 238 liver biopsy cases from January 2014 to December 2018 were took in. These cases were divided into hepatitis B， unidentified hepatitis group， PBC and PBC -AIH group according to the result of pathology diagnosis. CK7 and CK19 expressions of the four groups were compared. Results Among the 238 cases， there were 37 cases in the hepatitis B group， 93 cases in the unidentified hepatitis group， 89 cases in the PBC group， and 19 cases in the PBC-AIH group. The results showed that CK7 was mainly expressed in bile duct epithelial cells and cholestatic hepatocytes， and CK19 was mainly expressed in biliary epithelial cells. The positive rates of CK7 and CK19 were significantly different in each group except for the PBC-AIH (P< 0.001)；And the expression intensity of CK7 and CK19 were statistically significant in all groups (P< 0.05). Only the difference between hepatitis B with PBC， and unidentified hepatitis with PBC was statistically significant (P< 0.05)， when CK7 positive rate and expression intensity were compared among the groups．CK19 positive rate and expression intensity showed no significant difference between both unidentified hepatitis with PBC-AIH group and PBC with the PBC-AIH (P> 0.05)， while the differences between other groups were statistically significant (P< 0.05) ．Conclusion CK7 and CK19 immunohistochemical staining have auxiliary value in pathological diagnosis of liver lesions， especially PBC. We recommend CK7 and CK19 to be used as pathological indicators for the detection of liver biopsy in addition to conventional HE， reticular fiber staining and collagen fiber staining. [ABSTRACT FROM AUTHOR]

Copyright of China Tropical Medicine is the property of China Tropical Medicine Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective To investigate the association between serum prolactin (PRL) and non-alcoholic fatty liver disease (NAFLD) in overweight and obese (body mass index ≥ 24 kg/m²) patients. Methods A total of 494 patients from September 2015 to January 2017 in our hospital were retrospectively analyzed. Patients were classified to non NAFLD (n=353) and NAFLD group (n=141) according to abdominal ultrasound. Twenty female obese patients who received bariatric surgery were also underwent liver biopsy. All patients' fasting blood samples were collected for the PRL and other metabolic parameters measurements. Abdominal ultrasound was also performed. The Mann-whitney U or Kruskal-wallis H rank test were used to compare the data between two groups, and the relationship between serum PRL and NAFLD was analyzed by non-conditional Logistic regression. Results Serum PRL levels were significantly lower in patients with NAFLD in males (n=277) and females (n=217) [7.7 (5.9, 10.8) vs 8.7 (6.9, 11.8) µg/L, Z=-2.500, P=0.012 in men; 8.4 (6.2, 12.2) vs 10.7 (7.7, 13.4) µg/L, Z=-3.890, P<0.001 in women] than those without NAFLD. Moreover, there was a stepwise decrease in prevalence of NAFLD in both gender from the lowest to the highest PRL tertiles (both P<0.05). After normalized for confounding factors, PRL level became a protective factor against NAFLD (OR=0.923, P=0.008). In obese patients with pathology diagnosis, NAFLD patients (n=16) also exhibited lower PRL levels than those without NAFLD [n=4, 9.2 (5.0, 13.5) µg/L vs 16.8 (11.8, 20.9) µg/L]. Conclusion In overweight and obese patients, decreased PRL is a risk factor for NAFLD. [ABSTRACT FROM AUTHOR]

Nonalcoholic fatty liver disease (NAFLD ) has become the most common liver disease in the world in terms of incidence rate and is gradually becoming the first cause of liver transplantation in developed countries. The spectrum of this disease includes simple fatty liver, nonalcoholic steatohepatitis (NASH) , liver fibrosis, and liver cirrhosis. Compared with simple fatty liver, NASH is not a benign disease and can progress to advanced cirrhosis and liver cancer. At present, liver biopsy remains the gold standard for the diagnosis of NASH, but its application is limited by its invasive and potential complications. Noninvasive diagnostic methods have been developed for the diagnosis of NASH in clinical practice to replace liver biopsy; however, there still lack mature and reliable noninvasive methods, and continuous efforts should be made for further exploration and modification. This article reviews the recent research advances in noninvasive diagnostic methods for NASH in China and foreign countries. [ABSTRACT FROM AUTHOR]

Liver biopsy is currently the gold standard for the diagnosis of nonalcoholic fatty liver disease (NAFLD), especially nonalcoholic steatohepatitis (NASH). Although liver biopsy has the limitations such as invasiveness, sampling error, and evaluation error, in clinical trials of NAFLD/NASH and related new drugs, it is still used to evaluate the enrollment of patients into a cohort and primary and/or secondary endpoints and cannot be replaced by other methods. The histological evaluation systems of NAFLD/NASH mainly include Brunt system, NASH-CRN scoring system, European SAF/FLIP scoring algorithm, and pediatric NAFLD histological scoring system, and an appropriate histological scoring system should be selected in clinical practice and research. [ABSTRACT FROM AUTHOR]

Objective To investigate the correlation between liver tissue inflammation and fibrosis degrees and CD4+ T- lymphocytes level in the patients with HCV/HIV co- infection. Methods The relationship between liver biopsy histological inflammatory grade and fibrosis stage， liver function （ALT， AST， TBIL and ALB）， CD4+ T- lymphocytes level of 50 cases HCV/HIV co- infection patients was analyzed. Re s ults There were 47 cases （94%） with liver tissue inflammatory grade G2， and 45 cases （90%） for fibrosis stage S2. Whether liver function was normal or not， most of the patients presented with severe liver tissue inflammatory and fibrosis. There were no distinct differences in serum levels of ALT，AST， TBIL and ALB between inflammatory grade and fibrosis stage （P＞0.05） . There were distinct differences on inflammatory grade and fibrosis stage between CD4≤200 cell/mm3 and CD4 ≤200 cell/mm3 group （P＜0.05） . Conclusions Liver biopsy is indispensable for confirming liver inflammatory staging and fibrotic scoring grading. Most of the patients with HCV/HIV co- infection present needing anti- HCV therapy. The CD4+ T- lymphocytes level of patients could be a sensitive index for the estimation of the severity of liver damage. [ABSTRACT FROM AUTHOR]

Objective: Plateletcrit (PCT) is considered a new potential index to predict the degree of liver fibrosis in patients with chronic hepatitis B (CHB). This study aimed to explore the predictive value of PCT for the degree of liver fibrosis in patients with chronic hepatitis B virus (HBV) infection with alanine aminotransferase (ALT) < 2× upper limit of normal (ULN). Measurement data were compared using the t -test, ANOVA, or non-parametric test (Mann-Whitney U test). Categorical variables were compared using χ (2) test or Fisher's exact test. Methods: 140 cases with chronic HBV infection who underwent liver biopsy and ALT < 2×ULN were enrolled from January 2016 to March 2021. Univariate and multivariate logistic regression and the area under the receiver operating characteristic curve (AUC) were used to determine the predictive value of PCT for the degree of liver fibrosis. The likelihood ratio (LR) was used to optimize the selection of the diagnostic cut-off. Results: (1) Among the 140 cases, there were 34 (24.3%) cases in the S0 stage, 47 (33.6%) cases in the S1 stage, 16 (11.4%) cases in the S2 stage, 19 (13.6%) cases in the S3 stage, and 24 (17.1%) cases in the S4 stage. The overall mean PCT level was 0.19 ± 0.06%. (2) Univariate analysis revealed that PCT between patients with stages of liver fibrosis was S(0-1) and S(2-4) (0.20% ± 0.05% vs. 0.16% ± 0.06%, t = 3.955, P < 0.001), S(0 -2) and S(3-4) (0.20% ± 0.05% vs. 0.15% ± 0.06%, t = 5.631, P < 0.001) and S(0-3) and S4 (0.20% ± 0.05% vs. 0.12% ± 0.05%, t = 7.113, P < 0.001), respectively, and the differences were statistically significant. Multivariate logistic regression analysis showed that PCT was an independent risk factor for liver fibrosis stages S(2-4), S(3-4), and S4 ( OR = 0.925, 95% CI : 0.859 - 0.997, P = 0.042; OR = 0.867, 95% CI : 0.789 - 0.954, P = 0.003; OR = 0.708, 95% CI : 0.593 - 0.846; P < 0.001). (3) The AUCs of PCT were 0.702, 0.777, and 0.885 for diagnosing liver fibrosis stages S(2-4), S(3-4), and S4 in patients with chronic HBV infection with ALT < 2×ULN. PCT was superior for the cirrhosis (S4) diagnosis. 92 (65.7%) cases were diagnosed as cirrhosis or non-cirrhosis according to the LR optimized diagnostic and exclusion diagnostic cut-offs (≤0.09%, ≤0.17%), with an accuracy of 97.8%. Conclusion: PCT has a high diagnostic and exclusion value for cirrhotic patients with chronic HBV infection with ALT < 2×ULN. Furthermore, it can be used as a non-invasive diagnostic index for determining and assisting the diagnosis of cirrhosis in resource-constrained areas, reducing the need for pathological examination of liver biopsies, and it has the advantage of being simple and intuitive without complex calculations.

A normal liver can develop cirrhosis through long-term and repeated stimulation from various etiologies. Histological manifestations like the collapse of hepatic lobular structure (including microvascular structure) and the formation of pseudolobules can lead to portal hypertension and even decompensated cirrhosis. More and more evidence suggests that effective etiological treatment can not only delay but also reverse the progression of cirrhosis. The mechanism of cirrhosis reversal mainly includes the degradation of extracellular matrix, hepatocyte regeneration, and hepatic lobular remodeling. The "gold standard" for the evaluation of cirrhosis reversal at present is still a liver biopsy. Therefore, the histopathological evaluation of cirrhosis reversal is very important for determining the disease's prognosis, efficacy, and mechanism of exploration.

Objective To investigate the relationship of hepatic immune cells (CD4+, CD8+, CD20+, and CD57+ T lymphocytes) with liver pathology and clinical relevance in chronic hepatitis B (CHB) patients with different HBeAg status. Methods A total of 70 CHB patients admitted to our hospital from January 2008 to December 2013 underwent liver biopsy, among whom 38 were HBeAg positive and 32 were HBeAg negative. Immunohistochemistry was used to examine the expression of CD4+, CD8+, CD20+, and CD57+ T lymphocytes in hepatic tissues, and the correlation between their expression and clinical relevance was analyzed in patients with different HBeAg status. Ranked data were analyzed by Kruskal - Walls H test. Comparison between groups was made by Nemenyi test. Correlation analysis was made by linear regression method. Results When inflammation reached to the level of G3 - G4 in patients with either positive or negative HBeAg, the expression of hepatic CD8+ and CD20+ cells in them was significantly higher than that in patients with inflammation level of G1 (all P < 0.05). When the levels of inflammation reached G4 in patients with positive HBeAg and G3 in those with negative HBeAg, the expression of hepatic CD4+ cells was significantly higher than that in patients with G1 inflammation (all P < 0.05). In patients with negative HBeAg, the CD4+, CD8+, CD20+, and CD57+ lymphocytes all showed a positive correlation with alanine aminotransferase (ALT) level (r = 0.353, 0.628, 0.693, and 0.540, respectively; all P < 0.05). In addition, CD20+ lymphocytes also showed a positive correlation with hepatitis B virus (HBV) DNA (r = 0.378, P < 0.05). However, in patients with positive HBeAg, only CD8+ and CD20+ lymphocytes showed a positive correlation with ALT level, and no correlation was found between all lymphocyte populations and HBV DNA. Conclusion The expression of CD4+, CD8+, and CD20+ lymphocytes was significantly correlated with the grade of inflammation in hepatic tissues in patients with different HBeAg status, whereas the correlations between hepatic immune cells and levels of ALT and HBV DNA vary. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinicopathological features of hepatic amyloidosis. Methods A retrospective analysis was performed for 8 patients with hepatic amyloidosis confirmed by liver biopsy in 302 Hospital of PLA from January 2005 to December 2012. Clinical data, laboratory examination results, imaging findings, and pathological data were analyzed to summarize the clinicopathological features of hepatic amyloidosis. Results The clinical manifestations and signs of this disease included hepatomegaly (7/8), weakness (6/8), poor appetite (6/8), splenomegaly (4/8), ascites (2/8), portal hypertension (2/8), edema of lower extremities (2/8), pruritus (2/8), a history of heart disease (2/8), and varices (1/8). Laboratory examination showed increases in alkaline phosphatase (ALP) (8/8) and gamma-glutamyl transpeptidase (5/8), hypoproteinemia (2/8), abnormal alanine aminotransferase (2/8), a slight increase in aspartate aminotransferase (1/8), and abnormal total bilirubin (1/8). As for imaging examinations, ultrasound showed uneven echo of liver parenchyma (8/8); transient elastography showed a significant increase in liver stiffness (2/2); CT showed diffuse weakness (4/8) or focal weakness (2/8). As for histopathological and immunopathological features, HE staining showed the deposition of pink substances around the hepatic sinusoids (8/8) and the central vein (6/8), Congo red staining of the pink substances obtained a positive result (8/8), and the pink substances showed a color of apple green under a polarization microscope; therefore, the patients were diagnosed with amyloidosis. As for immunohistochemistry, of all patients, 6 had positive Kappa staining and 4 had positive Lamda staining. Conclusion Hepatomegaly and elevated ALP are relatively common in patients with primary hepatic amyloidosis. When a patient has hepatomegaly and elevated ALP and cannot be diagnosed with common liver diseases, clinical physicians should consider the possibility of hepatic amyloidosis, which is rare but fatal, and make a confirmed diagnosis based on related examinations, in order to provide guidance for clinical treatment. [ABSTRACT FROM AUTHOR]

To analyze the clinical characteristics of drug - induced liver injury ( DILI I. Methods A retrospective analysis was performed on the clinical data of 394 patients with DILI who were admitted to our hospital from 2009 to 2011. The studied factors included age, sex, names and categories of toxic drugs, time of onset, liver function, whether liver biopsy was performed, treatment, and prognosis. Results There is an upward trend in cases of DILI. Among the 394 patients with DILI, 170 (43. 15% ) were males, and 224 (56. 85% ) were females ; the male - to - female ratio was 1 1.3; the peak ages were 41 - 50 years ( 25. 63 % ) and 51 - 60 years ( 25. 13 % ) . A variety of drugs could cause DILI, with traditional Chinese medicines (TCMs) (45. 43% ) as the most common one, followed by a combination of drugs (11.42% ) and antitubercular drugs (7.61% ). The TCM category mainly included those for treating osteoarthrosis (11% ) and dermatosis ( 11% ), and the drug names and components were mostly unknown. Forty - three cases ( 10. 91% ) were confirmed by pathological examination, and the common pathological changes included infiltration of neutrophils and eosinophils (65. 01% ) and cholestasis of capiilary bile ducts (39. 93% ), which had no speciicity for clinical diagnosis, but provided some hint. Among the 394 patients, 102 (25. 89% ) were cured, 184 (46.70%) showed an improvement, and 7 (1.78%) progressed to liver failure and death. The overall prognosis was good ; the prognostic factors included age, clinical classification, and peak level of total bilirubin. Conclusion A variety of drugs can cause DILI, which has no specific clinical manifestations and gold diagnostic criteria, often leading to misdiagnosis; most cases have good prognosis, but liver failure may occur in some cases. [ABSTRACT FROM AUTHOR]

To investigate the diagnostic value of FibroTest combined with FibroScan for liver fibrosis in patients with chronic hepatitis B (CHB). Methods Serum samples were collected from 99 CHB patients who underwent liver biopsy in Tianjin Second People's Hospital from August 2011 to July 2013. Serum levels of a2 - macroglobulin, haptoglobin, apolipoprotein AI, total bilirubin, and gamma -glutamyl transpeptidase were measured, and FibroTest scores were calculated according to the measurement results, as well as the age and sex of patients. In addition, al patients underwent liver stiffness measurement by FibroScan. According to the Scheuer system, liver fibrosis was staged as significant fibrosis (S2 -S4) and severe fibrosis (S3 -S4). With liver biopsy as the gold standard, the areas under the re-ceiver operating characteristic curves ( AUCs) of FibroTest and FibroScan were determined. The diagnostic values of FibroTest and FibroScan for liver fibrosis in CHB patients were evaluated accordingly, and their combined diagnostic value was determined by logistic stepwise regres-sion analysis. Results The AUCs of FibroTest and FibroScan for the prediction of significant fibrosis ( S2 - S4) were 0. 805 (95% C/: 0.713 -0. 897, P<0.001) and 0.896 (95% C/: 0. 833 -0.959, P<0.001), respectively, and their AUCs for the prediction of severe fibrosis (S3 -S) were 0.834 (95% C/-. 0. 741 -0. 928, P <0.001) and 0.945 (95% C/: 0. 891 -0. 999, P <0.001), respectively. Their combined AUC for the prediction of significant fibrosis ( S2 - S4) was 0. 911 (95% C/: 0. 854 -0. 967, P <0. 001 ) . Conclusion The combination of FibroTest and FibroScan can evaluate the liver fibrosis in CHB patients more accurately, and it not only improves diag-nostic specificity, but also ensures high diagnostic accuracy, providing guidance for the prognostic evaluation and treatment of CHB. [ABSTRACT FROM AUTHOR]

To analyze the clinical features and laboratory test results of patients with autoimmune hepatitis ( AIH ) - primary biliary cirrhosis (PBC) overlap syndrome, as well as their correct diagnosis rate and time to diagnosis. Methods Fifty - three patients who were diagnosed by liver biopsy as having AIH - PBC overlap syndrome from January 2009 to June 2013 were selected as subjects; 53 AIH patients and 53 PBC patients were selected as control groups. Their clinical manifestations, laboratory test results, and diagnosis on admission were retrospectively analyzed. Comparison of normally distributed quantitative data between groups was made by one - way analysis of variance, and multiple comparisons were made by SNK - q test ; comparison of qualitative data between groups was made using RxC contingency table, and multiple comparisons were made by Scheffe's confidence interval test. Results The 53 patients with AIH - PBC overlap syndrome had a serum alanine aminotransferase level of 173. 65 ±52. 08 U/L, a serum total bilirubin level of 38. 07 ± 6. 82 μmo/L, a serum alkaline phosphatase ( ALP) level of 293. 81 ± 28. 89 U/L, and a serum gamma - glutamyl transpeptidase level of 57. 57 ±78. 84 U/L. ALP showed significant difference between the patients with AIH - PBC overlap syndrome and control groups. The serum level of immunoglobulin M in overlap syndrome patients was 3. 33 ±2. 12 g/L, which was significantly different from those of two control groups. Of the 53 overlap syndrome patients, 27 were positive for anti - mitochondrial antibody - M2, and the positive rate was significantly different from those of two control groups. Without liver biopsy, the correct diagnosis rate was the lowest (52. 83% ), and it took the longest time (8 ±7.7 d) to confirm the diagnosis on admission. Conclusion The clinical manifestations of patients with AIH - PBC overlap syndrome are more similar to those of PBC patients, but their biochemical test results are more similar to those of AIH patients. AIH - PBC overlap syndrome has the clinical features of both AIH and PBC. [ABSTRACT FROM AUTHOR]

Liver biopsy plays an important role in the diagnosis of autoimmune liver diseases, particularly in patients without specific clinical manifestations or negative for autoantibodies. The histological features of several autoimmune liver diseases are reviewed. The characteristic features of autoimmune hepatitis in histology include interface hepatitis with lymphoplasmacytic infiltration, hepatic rosette formation, and emperipolesis, while chronic nonsuppurative destructive cholangitis and epithelioid granuloma are frequently found in primary biliary cirrhosis. Primary sclerosing cholangitis is characterized by onion skin - like periductal fibrosis, while storiform fibrosis with IgG4 - positive plasma cell infiltration often indicates IgG4 - related sclerosing cholangitis. Enhanced communication between clinicians and pathologists can help improve the diagnosis and treatment of autoimmune liver diseoses. [ABSTRACT FROM AUTHOR]

Nonalcoholic steatohepatitis (NASH) is a key stage in the progression of nonalcoholic fatty liver disease. Now liver biopsy is the gold standard for diagnosing NASH, but it cannot be widely used due to its invasiveness and potential hazards. Therefore, searching for non-invasive diagnostic methods for NASH with relatively high sensitivity and specificity is a hotspot of current research. The examination methods closely related to noninvasive diagnosis of NASH, such as serological tests for CK - 18, TGF - ß1, APRI, etc. and imaging examinations in-cluding ultrasound, TE, and MRE, are summarized. It is found that each method has advantages and disadvantages. [ABSTRACT FROM AUTHOR]

Liver biopsy ( LB ) is considered the gold standard for assessing the pathological damage of the liver in nonalcoholic fatty liver disease ( NAFLD), but this technique is not widely applied in clinical diagnosis because it is invasive. Rapid progress has been made in the research on the methods for noninvasive diagnosis of nonalcoholic steatohepatitis (NASH) and advanced fibrosis in recent years. Some noninvasive methods with relatively high diagnostic values from the aspects of clinical and biochemical indices, biomarkers, and imaging techniques were reviewed. Currently, it is thought that the noninvasive diagnostic methods for NAFLD stiil cannot be used as a substitute for LB, but a combination of serum cytokeratin 18 fragments, NAFLD fibrosis score, and FibroScan can make for primary diagnosis of NASH with or without advanced fibrosis, so as to decide the use of LB. [ABSTRACT FROM AUTHOR]

Objective To evaluate the diagnostic efficacy of various newly developed non - invasive flbrotic predictive models based on meas-urements of common biochemical indices in a group of ethnic Chinese patients with long - standing chronic hepatitis C ( CHC ) infection ac-quired by transfusion. Methods Between July 2010 and June 2011, 120 of the monitored residents of Dingxi District of Gansu Province who had acquired hepatitis C infection via the regional practice of untested whole blood or plasma transfusion during the yeas of 1992 - 1995 were recruited for the current study. Each participant underwent liver biopsy for histological evaluation of liver fibrosis ( Sl - S progressive stages, from mild fibrosis to ealy cirrhosis ). Each participat also provided serum samples for biochemical measurement of flbrotic indicators, inclu-ding hyaluronic acid (HA), type III procollagen protein (PCM), laminin (LN), and type IV collagen (CIV). In addition, aspartate amin-otransferase ( AST ), platelet count ( PLT ), alanine aminotransferase ( ALT ), prothrombin time ( PT ), and international normalized ratio (INR) were measured to calculate the various non - invasive flbrotic predictive models: AST - to - PLT ratio index (APRI), the Sheth index ( AST/ALT), the FibroQ index ( 10 x [ ( ae x AST x PT INR)/( ALT x PLT] ), and the FIB - 4 index ( [ ae x AST)/( PLT x ALT1/2 ) ] ) . Using the pathologic results as the reference standads, the diagnostic efficacies of these four non - invasive flbrotic predictive models were eval-uated by Spearman ' s rak correlation coefficient. Accuracies of the four were compaed by constructing receiver operating chaacteristic (ROC) curves ad analyzing their sensitivities, specificities and area under the curves (AUCs). Results The APRI, FibroQ and FIB -4 in-dexes, ad the levels of PIII, CIV, and HA increased in conjunction with progressive stages of liver fibrosis. However, only the APRI showed significant correlation to liver fibrosis stage (r = 0. 446, P <0. 001). The APRI index also had a better ability for distinguishing the moderate fibrosis stage from the severe fibrosis stage, as indicated by an AUC of 0. 722, diagnostic sensitivity of 57. 1%, and specificity of 78. 2%. Conclusion APRI may be an effective ad less traumatic alternative approach to surgical biopsy for diagnosing fibrosis, especiaally at stages greater than S2, in ethnic Chinese with CHC. [ABSTRACT FROM AUTHOR]

Objective To determine whether subtle changes in hyperechoic findings from low - /high - frequency ultrasound analysis of liver biopsy specimens from patients with chronic hepatitis correlate with differences in liver parenchyma morphology associated with presence and ex-tent of fibrosis. Methods Spatially - matched liver parenchyma biopsy specimens from 216 patients with chronic hepatitis (hepatitis b virus infection) were subjected to both low - and high - frequency ultrasound, as well as conventional histological analysis, which was used to score the extent of fibrosis ( progressive staging : S1, no fibrosis, through S, cirrhosis ). The low - and high - frequency point - like echo and echo performance, respectively, were used to classify samples among one of five fractionating features ( fine, thick, coarse/crude, iregular/nonlin-ear, cale stripes) . Significance of intergroup differences was assessed by Chi - squared test. Spearman's correlation coefficient was used to as-sess the correlation between the ultrasound findings and histological fibrosis stage. Results The changes in echoic findings paralleled progres-sive deterioration in fibrosis stage: from fine to thicker, uneven, and cale stripe shapes along stages S0 to S4. Both the low - and high - fre-quency ultrasound findings could differentiate changes in liver parenchyma morphology associated with S1 ( low - frequency : ?² = 76. 52 vs. S2, X =71.91 vs. S3, ;?² =59.43 vs. S4; high-frequency:*2 =76.52 vs. S2, =71.91 vs. S3, =59.43 vs. S4; al P< 0.01) and S2 ( low - frequency : ;?² = 5. 17 vs. S3, = 21. 25 vs. S ; high frequency : ;?² = 23. 67 vs. S3, ;?² = 34. 80 vs. S ; al P < 0. 01 ) . There were no significant differences associated with either low - or high - frequency ultrasound findings for S3 or S4. The low - and high - frequency ultra-sound liver parenchyma fractionation were postively correlated to liver fibrosis staging (r =0.4858 ad r =0.5513, respectively). The high -frequency ultrasound had a significantly higher positive rate of detecting nodules than the low - frequency ultrasound (61. 67% vs. 27. 31% ; X = 49.96, P < 0.01 ), ad the positive rates were positively correlated with liver fibrosis stage ( low - frequency : r = 0. 5437 ; high - frequen-cy : r = 0. 3021 ). Conclusion While both low - and high - frequency ultrasound allow for detection of liver fibrosis and differentiation of some fibrotic stages, the high - frequency ultrasound findings are superior for detecting fibrotic nodules. [ABSTRACT FROM AUTHOR]

Objective: To investigate the practicability and safety of transjugular liver biopsy (TJLB). Methods: Data of 53 cases with transjugular liver biopsy from June 2015 to June 2020 were collected. LABS-100 was used in all patients who underwent transjugular liver biopsy. Among them, 45 cases and eight were biopsied via hepatic vein and intrahepatic segment of the inferior vena cava. The surgical indications, related complications, and postoperative pathological diagnosis were analyzed and summarized. Results: TJLB was successful in all patients, with an average of 2.8 punctures per case. Satisfactory liver tissue and histopathological diagnosis was obtained in all patients. Two cases developed a cervical hematoma that was improved spontaneously, and one patient developed an intrahepatic hematoma that was improved after conservative treatment. Conclusion: TJLB is a practical and safe method for patients with contraindications to percutaneous liver biopsy.

Obj'ective To investigate the relationship between HBV DNA and HBeAg in serum and HBcAg and inflammation grade in liver tissue among chronic hepatitis B (CHB) patients. Methods A retrospective analysis was performed on 250 CHB patients who underwent liver biopsy. These patients were divided into three groups according to serum levels of HBV DNA : group A ( < 3 log10IU/ml, n = 45 ), group B ( 3 - 6 log1 IU/ml, n = 138 ), and group C ( > 6 log10 IU/ml, n = 67 ), and they were also divided into HBeAg - positive group ( n = 142 ) and HBeAg - negative group ( n = 108 ) . The positive rate of HBcAg and inflammation grade in liver tissue were compared between groups, and correlations were analyzed. Comparisons of rates were made by chi - square test and Fisher's exact test; correlations were deter-mined by linear correlation analysis. Results There were significant differences in positive rate of HBcAg between groups A, B, and C (X² = 11. 1, P =0. 05), and serum HBV DNA level was positively correlated with the positive rate of HBcAg in liver tissue ( r = 0. 75, P = 0. 001 ). There were no significant differences in inflammation grade between groups A, B, and C (( =13. 3, P =0.075), and no correla-tion was found between serum HBV DNA level and inflammation grade in liver tissue (r=0. 04, P=0. 325). There was significant differ-ence in positive rate of HBcAg between the HBeAg - positive group and HBeAg - negative group (X² =6.64, P= 0.01), and the presence or absence of HBeAg in serum was positively correlated with the positive rate of HBcAg in liver tissue ( r = 0. 56, P = 0. 001 ) . There was no significant difference in inflammation grade between the HBeAg - positive group and HBeAg - negative group (X² = 8. 43, P =0.65), and no correlation was found between the presence or absence of HBeAg in serum and inflammation grade in liver tissue ( r = 0. 06, P = 0. 415). o correlation was found between the presence or absence of HBeAg in serum and inflammation grade in liver tissue ( r = 0. 06, P = 0. 415 ). Conclusion The expression of HBcAg in liver tissue can better reflect HBV replication in the liver among CHB patients. When HBV mark-ers cannot be detected in the serum of patients, liver biopsy can be used to detect HBcAg in liver tissue and assess HBV replication. [ABSTRACT FROM AUTHOR]

Objective To investigate the influence of liver inflammation on the ability of the FibroScan non - invasive elastrography scanner to diagnose hepatic fibrosis in patients with chronic hepatitis B (CHB). Methods A total of l24 CHB patients who received liver biopsy and concomitant liver stiffness measurement (LSM) by FibroScan between June 2011 and February 20l2 were enrolled in the study. The liv-er puncture biopsies were subjected to histological analysis to determine fibrosis stage ( Sl to S4, mild fibrosis to severe fibrosis or ciirhosis) and inflammation grade (Gl to G4, low to high extent of inflammation). Diffflrences between groups were assessed by Kruskal - Wallis H test or Mann - Whitney U test. The correlations between LSM and fibrosis stages and inflammation grades were evaluated by Spearman ' s rank correlation coefficient. Results The progressive fibrosis stages were accompanied by increased inflammatory grades, such that the signif-icant majority of Sl samples showed Gl inflammation (8l.8%, n=55; P < 0. 0l ), ofS2 showed G2 inflammation (54.2%, n = l3 ; P < 0. 0l ), of S3 showed G3 inflammation (47.4%, n=9; P<0.05), and of S showed G3 and G4 inflammation (40.0%, n=6 and 33.4%, n=5; bothP<0.0l) . LSM and inflammation grade were positively correlated within each fibrosis stage group (P<0.0l), sug-gesting that the degree of liver inflammation arffects the FibroScan measured value. Conclusion Liver inflammation influences LSM by Fi-broScan and may impact the ability of this technology to diagnose hepatic fibrosis, with more severe inflammatory activity affecting the LSM to a greater extent. [ABSTRACT FROM AUTHOR]

Objective: To analyze and summarize the characteristics of liver pathology and their relation to clinical markers and further explore noninvasive markers of liver fibrosis in children with chronic hepatitis B. Methods: Data of 80 hospitalized children with chronic hepatitis B who underwent liver biopsy without antiviral treatment from 2011 to 2020 were retrospectively analyzed. Inflammation and liver fibrosis characteristics were analyzed in children of different ages and genders. Variables with good correlation with liver fibrosis stage were selected to establish a non-invasive diagnostic score of liver fibrosis in children. Measurement data was used to compare the t -test or rank sum test. Mantel-Haenszel χ (2) test was used for bidirectional ordered grouping data. Spearman's rank correlation test was used for rank correlation analysis. Receiver operating characteristic curve (ROC) was used to evaluate the diagnostic value of the newly established diagnostic score in children with liver fibrosis. Results: The median age of the children was 6.4 years. HBV DNA level was high (P50 = 7.6 log(10) IU/ml), and serum alanine aminotransferase (ALT) in P50 was 171 U/L (< ULN: 5 cases, ULN-2ULN: 10 cases, > 2 ULN: 65 cases). Pathological analysis showed that the incidence of liver tissue inflammation was 97.5%, and the proportion of patients with G≥2 was 42.5%, while S≥2 was 36.3%. The incidence rate of liver fibrosis and liver cirrhosis was 81.3%, and 1.3%, respectively. The changes in liver tissue inflammation and fibrosis were gradually aggravated with the increase of age, and the proportion of high-grade inflammation and liver fibrosis in male children was higher than that in female children. Serum levels of glutamyl transpeptidase (GGT), γ-glutamyltransferase/platelet ratio (GPR) and HBeAg had a good correlation with fibrosis stage ( r (s) = 0.397, 0.389, and - 0.311) in children with chronic hepatitis B. The combination of GGT, GPR and HBeAg can establish a non-invasive diagnostic score for evaluating liver fibrosis in children. When the score is less than 1.5, it can be diagnosed as S0, and 1.5 ≤ score < 3.5, it can be diagnosed as S1; 3.5 ≤ score < 5.5, the diagnosis of fibrosis is S2; score≥ 5.5, the diagnosis of fibrosis is S≥3. The sensitivity and specificity were 80%, 83%, 86%, and 53%, 55%, 67%, respectively. Conclusion: The incidence of liver tissue inflammation in children with chronic hepatitis B with elevated and fluctuating transaminase levels is high, and the pathological changes of liver tissue aggravate with the age of the children. GGT, GPR and HBeAg have a good correlation with liver fibrosis in children with chronic hepatitis B. Therefore, combining the above-mentioned markers to establish a new noninvasive diagnostic score has certain diagnostic value for liver fibrosis stage S0-S3 in children with chronic hepatitis B.

FibroTouch (FT) has been used widely in clinic. Studies of the FT diagnostic efficiency and influencing factors of liver stiffness measurement (LSM) of liver fibrosis in autoimmune liver diseases (AILD) have shown that FT has a good diagnostic efficiency and accuracy, especially in AIH. However, for patients with primary biliary cholangitis and overlap syndrome of autoimmune hepatitis, FT results should be vigilant. In addition, the diagnostic efficiency of FT. Notably, when using FT to diagnose AILD, the value of elastic stiffness depends on five influencing factors, such as, age, total bile acid, international standardized ratio, FIB-4 index, and prothrombin time.

Objective: To evaluate the using value of FibroTouch and six serological models in detecting the degree of liver fibrosis in patients with chronic hepatitis B, in an attempt to provide reference for accurate diagnosis. Methods: Two hundred and fifty-eight cases with chronic hepatitis B admitted to Xixi Hospital of Hangzhou from September 1, 2015 to September 1, 2017 were selected. All patients underwent liver histopathological examination and FibroTouch measurement to determine liver stiffness (LSM). Serum biochemical parameters were detected and the scoring values of six serological models were calculated. SAS 9.4 statistical software was used for statistical analysis, and the correlation between FibroTouch and the six serological models was analyzed by Spearman correlation. The diagnostic value of FibroTouch and six serological models was analyzed by receiver operating characteristic curve (ROC) based on liver histopathological findings. Results: The median LSM of 258 cases with chronic hepatitis B was 9.4 (6.5-13.8) kPa. In the six serological models, the median value of aspartate transaminase to platelet ratio index (APRI), FIB-4 index, S-index, Forn's index, PRPindex, and FIB-5 were 0.42 (0.28-0.62), 1.27 (0.78-2.03), 0.11 (0.07-0.20), 6.95 (5.89-8.51), 0.000 8 (0.000 6-0.000 9),and 38.59 (36.28-40.97). FibroTouch had positive correlation with APRI, FIB-4, S-index, Forn's index, PRP, fibrosis stage ( r = 0.73, P < 0.001) and inflammation grade, and had negative correlation with FIB-5, and both had statistical significance. The area under curve (AUC) of FT-LSM at S≥2, S≥3, S = 4 were 0.89, 0.90 and 0.85, respectively, which was significantly higher than serological models ( P < 0.001). The AUC of S-index model at S≥2, S≥3, S = 4 were higher than other five serological models. Conclusion: The diagnostic performance of FibroTouch is significantly better than serological model. S-index model has the best diagnostic performance in the six serological models, and the combination of S-index and FT-LSM may better diagnose the grading of liver fibrosis, and thus can be applied and promoted in clinic.

Objective: To compare the clinical value of FibroScan, FIB-4, APRI and AAR diagnosing hepatic fibrosis in chronic hepatitis B virus (HBV) carriers. Methods: A total of 213 patients with chronic HBV carriers diagnosed by clinical and liver biopsy were selected. And according to HBeAg status, 149 patients were divided into HBeAg-positive group and 64 patients were divided into HBeAg-negative group. The liver stiffness measurements (LSM) was measured by FibroScan (FS), FIB-4, APRI and AAR values were calculated using FIB-4, APRI and AAR formula. And all patients underwent liver biopsy in the same period. According to the degree of hepatic fibrosis in Knodell, one decision point was set: significant hepatic fibrosis (S ≥ 2). The Spearman correlation analysis method was used to analyze the correlation of indicators and the area under receiver operator characteristic curves (AUROCs) of LSM, FIB-4, APRI and AAR were drawn according to liver biopsy pathology results as gold standard. The value of LSM, FIB-4, APRI and AAR diagnosing hepatic fibrosis in chronic HBV carriers was retrospectively analyzed. Retrospective analysis of FS, FIB-4, APRI and AAR were divided into 149 HBeAg-positive chronic HBV carriers (HBeAg-positive group) and 64 HBeAg-negative chronic HBV carriers (HBeAg) in 213 patients with chronic HBV carriers and HBeAg Negative group) in the diagnosis of liver fibrosis. Results: The LSM of 213 patients with chronic HBV carriers, 149 patients with HBeAg-positive chronic HBV carriers and 64 patients with HBeAg-negative chronic HBV carriers were significantly correlated with liver fibrosis grade≥ 2 ( P < 0.001). Regardless of HBeAg status, only LSM in the three groups had moderate evaluation efficacy for evaluating significant fibrosis(S≥2), and the positive predictive value was more than 94%, but the diagnostic accuracy was not high, the minimum was 46.31% (HBeAg-positive group), the maximum value of 67.19% (HBeAg-negative group), while the remaining three kinds of serum noninvasive liver fibrosis diagnostic model indicators and diagnostic efficacy are low. The LSM in the three groups showed a significant positive correlation with liver fibrosis grade (S)≥2. Conclusion: LSM is more accurate than FIB-4, APRI and AAR in diagnosing chronic HBV carriers. Dynamically monitoring changes of LSM can earlier understand the progress of liver fibrosis than the three kinds of serology noninvasive diagnostic model and is contributed to the choice of liver biopsy timing.