| Part One Dynamic liver stiffness measurement detection in monitoring portal hypertension and gastroesophageal varices in cirrhosis patients with combined therapy with endoscopic and pharmacy therapy.Background and aims: Transient elastography has been widely used in the qualitative and quantitative diagnosis for liver fibrosis.Liver stiffness measurement(LSM)is closely related to hepatic venous pressure gradient(HVPG).Non-selective beta receptor blockers(NSBB)combined with endoscopic therapy is the first-line treatment to esophageal and gastric varices hemorrhage,which is very common and severe in cirrhosis patients.The aim of current paper is to clarify the role of dynamic detection of LSM in evaluating and monitoring the clinical effect of secondary prevention in patients with cirrhosis,portal hypertension,esophagogastric varices and hemorrhage receiving drugs combined with endoscopic therapy.Methods: 85 hospitalized cirrhotic patients with gastroesophageal varices hemorrhage consistently enrolled during 2016 to 2018 from Renji Hospital to Shanghai Jiao Tong University.Patients were treated with endoscopic esophageal ligation(EVL)or sclerosing agent/ tissue glue combined with drugs including oral NSBB after acute hemorrhage control,and then followed up regularly with endoscopic therapy.Laboratory examination,endoscopic conditions,LSM and portal hypertension related events were recorded at the baseline,3 months after treatment and 6 months after treatment.Patients were divided into endoscopic improvement group and endoscopic unimproved group according to the improvement of endoscopic varicose veins before and after treatment,and LSM significantly decreased group and non-significantly decreased group according to the decrease of 20%.Results: LSM was significantly correlated with Child-Pugh scores(r = 0.438,P <0.01).For endoscopic improved group,the Child-Pugh score and LSM were both decreased significantly after receiving 3 months and 6 months combined therapy with endoscopic and pharmic treatment.After 3months treatment,the Child-Pugh,FIB-4 and APRI scores were all significantly decreased were(all P<0.01)in LSM significant decreased group(LSM decreased over 20%),and 36.7% of the patients required re-endoscopic treatment,and 26.7% had re-bleeding.But in LSM nonsignificant decreased group,the Child-Pugh,FIB-4 and APRI scores were not affect significantly,and 66.7% of the patients required re-endoscopic treatment,and 37.5% had re-bleeding.After 6 months treatment,the Child-Pugh score was significantly decreased(P<0.01)33.3% of the patients required re-endoscopic treatment,and 37.5% of the patients had re-bleeding in LSM significantly decreased group patients.But the proportion of re-endoscopic treatment and re-bleeding was 66.7% and 45.8% respectively in LSM significantly decreased group patients.Conclusions: LSM was closely related with Child-Pugh scores.The decrease in LSM after NSBB combined with endoscopic treatment was associated with an improvement in endoscopic varices and relevant event in portal hypertension.Dynamic LSM monitoring can better evaluate the efficacy of drug combined with endoscopic treatment for patients with cirrhotic portal hypertension and esophageal varices bleeding and can be used for long-term follow-up.Part Two: Performance of transient elastography in assessing liver fibrosis in patients with autoimmune hepatitis-primary biliary cholangtitis overlap syndromeBackground and aims: Timely and accurate assessment of liver fibrosis plays an important for disease control and long-term treatment evaluation in patients with chronic liver disease.In recent years,transient elastography Fibro Scan has been shown to have high accuracy in the assessment of liver fibrosis in chronic liver disease.At present,there are limited studies on transient elastography(TE)for evaluating liver fibrosis in patients with AIH-PBC overlap syndrome.This study is to explore the diagnostic value of TE in the evaluation of liver fibrosis in patients with AIH-PBC overlap syndrome.Methods: A total of 70 patients with biopsy-proven AIH-PBC overlap syndrome were included during 2016 to 2018 from Renji Hospital to Shanghai Jiao Tong University.Collect general data,clinical serum biochemical test results,LSM values,liver tissue pathological findings and other data of patients.Spearman correlation test was used to analyze the correlation of liver stiffness measurement(LSM)and fibrosis stage.Independent samples Student’s t-test or one-way analysis of variance was used to compare quantitative variables.Receiver operating characteristics(ROC)curve was used to calculate the optimal cut-off values of LSM for predicting individual fibrosis stages.A comparison on the diagnostic accuracy for severe fibrosis was made between LSM and other serological scores.Results: Patients with AIH-PBC overlap syndrome had higher median LSM than healthy controls(11.3 ± 6.4 k Pa vs 4.3 ± 1.4 k Pa,P < 0.01).LSM was significantly correlated with fibrosis stage(r = 0.756,P < 0.01).LSM values increased gradually with an increased fibrosis stage.The areas under the ROC curves of LSM for stages F ≥ 2,F ≥ 3,and F4 were 0.837(95%CI: 0.729-0.914),0.910(0.817-0.965),and 0.966(0.893-0.995),respectively.The optimal cut-off values of LSM for fibrosis stages F ≥ 2,F ≥ 3,and F4 were 6.55,10.50,and 14.45 k Pa,respectively.LSM was significantly superior to FIB-4,GPR,and APRI scores in detecting severe fibrosis(F ≥ 3)(0.910 vs 0.715,P < 0.01;0.910 vs 0.649,P < 0.01;0.910 vs 0.616,P < 0.01,respectively).Conclusions: TE can accurately detect hepatic fibrosis as a noninvasive method in patients with AIH-PBC overlap syndrome.Part Three: Evaluation of controlled attenuation parameter in assessing hepatic steatosis in patients with chronic liver diseasesBackground and aims: Studies have shown that the controlled attenuation parameter(CAP)measured by the transient elastography Fibro Scan has a high diagnostic value in non-invasive assessment of hepatic steatosis and has been used in patients with nonalcoholic fatty liver disease(NAFLD)and other chronic liver diseases.But the value of CAP in evaluating hepatic steatosis in autoimmune liver disease still unknown.The aim of current study is to investigate the performance of controlled attenuation parameter(CAP)for diagnosis of hepatic steatosis in patients with chronic liver diseases.Methods: Patients underwent liver biopsy and histology showed that varying degrees of steatosis in the live were consistently enrolled during 2016 to 2018 from Renji Hospital to Shanghai Jiao Tong University.Collect general conditions,clinical laboratory and imaging findings,liver stiffness values(LSM)and CAP values,and liver histopathological findings.Patients were diagnosed as autoimmune liver disease,NAFLD or other liver disease based on medical history,laboratory tests,and liver histology.Spearman correlation test was used to analyze the correlation of controlled attenuation parameter(CAP)and steatosis stage.Independent samples Student’s t-test or one-way analysis of variance was used to compare quantitative variables.Receiver operating characteristics(ROC)curve was used to calculate the optimal cut-off values of CAP for predicting individual steatosis stages.Factors affecting CAP values were obtained by univariate analysis and multivariate analysis.Results: A total of 190 patients were enrolled,the number of the AIH,PBC,AIH-PBC overlap syndrome,NAFLD/NASH,and others was 69,18,27,66 and 10,respectively.CAP was significantly correlated with steatosis stage(r = 0.549,P < 0.001).For all the 190 patients,the CAP was 270.19±54.42db/m,the LSM was 7.66±5.57 k Pa,and the BMI index was 23.97±2.69.Among the 190 patients,the CAP values of liver steatosis S0,S1,S2 and S3 were 204.39±52.51,261.13±46.48,295.73±40.17 and 306.44±45.86 db/m,respectively.The areas under the ROC curves of CAP for stages S1,S2 and S3 were 0.857,0.773,and 0.724,respectively.Among the 69 AIH patients,the CAP values of liver steatosis S0,S1,S2 and S3 were 205.63±43.36,258.41±42.83,293.00±37.18 and 313.60±27.89 db/m,respectively.There were no significant differences in CAP values among three autoimmune liver disease patients with AIH,PBC,and AIH/PBC overlap syndrome(P > 0.05).Compared with NAFLD patients with autoimmune phenomena,patients with AIH and NAFLD were older(P<0.01),serum Ig G levels were higher(P<0.05),and LSM values were significantly higher(P<0.05).NAFLD patients with immune phenomena had higher serum GGT levels(P < 0.05).However,there was no significant difference in the mean CAP between the two groups in the stratified S1,S2 and S3 subgroups(P>0.05).The OR values of CAP value and hepatic steatosis degree and BMI index were 28.336(24.168-31.552)(P<0.001)and 11.837(9.573-13.091),respectively(P<0.001).Conclusions: CAP value can be used as a non-invasive diagnostic method to effectively and accurately evaluate hepatic steatosis in patients with autoimmune liver disease.There are no significant correlation between hepatic steatosis and cause of liver damage.Serum Ig G,GGT levels and LSM values can identify AIH patients with NAFLD from NAFLD patients with autoimmune phenomena. |
PDF Full Text Request