丙氨酸转氨酶对FibroScan诊断肝硬度准确性的影响

目的:探讨不同血清丙氨酸转氨酶(ALT)浓度对于Fibroscan诊断肝纤维化期和肝硬化期的肝硬度准确性的影响。方法:根据血清ALT浓度分为三组:A组ALT相似文献   

HBV感染者肝纤维化四项指标检测值与Fibroscan检测值的相关性分析

目的分析HBV感染者四项肝纤维化血清学指标检测值与Fibroscan检测值之间的相关性。方法选择大连市第六人民医院211例HBV感染者,按肝影像学Fibroscan检测值将患者分为肝硬化组和非肝硬化组,非肝硬化组患者再根据Fibroscan分期分为无肝纤维化组、轻度肝纤维化组、中度肝纤维化组和重度肝纤维化组。所有患者均采集其相近时间内Fibroscan及Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(C-Ⅳ)、血清透明质酸(HA)、层黏连蛋白(LN)检测数据。结果运用SPSS 17.0软件进行统计学分析。结果 PCⅢ、C-Ⅳ、HA、LN检测值与Fibroscan检测值之间均具有良好的相关性(r=0.404、0.445、0.557、0.470,P0.01),其中以HA检测值与Fibroscan检测值之间的相关性最高(r=0.557,P0.01)。结论肝纤维化四项血清学指标检测值与Fibroscan检测值之间相关性显著。肝纤维化四项血清学指标检测在肝纤维化程度较重时的准确性更高。     

声辐射力脉冲成像技术与尿beta2-微球蛋白检测联合诊断高尿酸肾病的临床研究

目的：探讨声辐射力脉冲成像(ARFI)技术与尿beta2- 微球蛋白(beta2-MG)检测联合诊断高尿酸肾病(HUAN)的临床价值。方法：回 顾性分析和比较192 例原发性高尿酸血症患者(PHUA 组)、162 例HUAN患者(HUAN 组)和360例健康体检者(对照组)的血尿酸 (UA)、血尿素氮(BUN)、血肌酐(Cr)及尿beta2-MG 水平、二维超声检测结果及ARFI 技术检测的肾皮质、髓质和肾窦SWV 值,分析 HUAN患者的SWV 值与临床分期的相关性,其肾实质、肾窦SWV 值与尿beta2-MG 水平的相关性。结果：162 例HUAN 患者中,肾 实质回声增强76 例(46.91%),肾窦增宽89 例(54.94%),肾皮质髓质结石49 例(30.25%);192 例PHUA患者和360 例健康体检者 肾皮质和髓质回声均无明显异常,肾窦结石分别为3 例(0.83%)和5 例(2.60%)。HUAN 组肾皮质、髓质和肾窦SWV 值分别为 3.32± 0.45 m/s、3.02± 0.51 m/s和1.58± 0.45 m/s;PHUA组分别为2.92± 0.64 m/s、2.51± 0.51 m/s 和1.41± 0.35 m/s;对照组分别 为2.73± 0.58 m/s、2.26± 0.43 m/s和1.21± 0.21 m/s;三组SWV 值均为肾皮质> 肾髓质>肾窦(P<0.05)。HUAN组尿beta2-MG 水平 明显高于PHUA 组和对照组(P<0.05)。HUAN组尿beta2-MG 水平与肾实质SWV 值呈线性正相关(r=0.442,P<0.001),而与肾窦呈零 相关性(r=0)。Ⅰ、Ⅱ、Ⅲ期HUAN患者肾皮质SWV 值比较无明显差异(P>0.05),Ⅱ-Ⅴ期肾髓质、肾窦SWV 值均高于Ⅰ期(P<0. 05);Ⅳ、Ⅴ期肾皮质SWV值高于Ⅲ期(P<0.001)。结论：HUAN 患者在BUN和Cr升高之前,ARFI技术的SWV 值和尿beta2-MG 水 平均显著升高。ARFI技术联合尿beta2-MG 检测可作为评估肾实质组织弹性硬度及诊断早期HUAN 的重要方法.     

声辐射力脉冲成像技术与尿β2-微球蛋白检测联合诊断高尿酸肾病的临床研究

目的:探讨声辐射力脉冲成像(ARFI)技术与尿β2-微球蛋白(β2-MG)检测联合诊断高尿酸肾病(HUAN)的临床价值。方法:回顾性分析和比较192例原发性高尿酸血症患者(PHUA组)、162例HUAN患者(HUAN组)和360例健康体检者(对照组)的血尿酸(UA)、血尿素氮(BUN)、血肌酐(Cr)及尿β2-MG水平、二维超声检测结果及ARFI技术检测的肾皮质、髓质和肾窦SWV值,分析HUAN患者的SWV值与临床分期的相关性,其肾实质、肾窦SWV值与尿β2-MG水平的相关性。结果:162例HUAN患者中,肾实质回声增强76例(46.91%),肾窦增宽89例(54.94%),肾皮质髓质结石49例(30.25%);192例PHUA患者和360例健康体检者肾皮质和髓质回声均无明显异常,肾窦结石分别为3例(0.83%)和5例(2.60%)。HUAN组肾皮质、髓质和肾窦SWV值分别为3.32±0.45 m/s、3.02±0.51 m/s和1.58±0.45 m/s;PHUA组分别为2.92±0.64 m/s、2.51±0.51 m/s和1.41±0.35 m/s;对照组分别为2.73±0.58 m/s、2.26±0.43 m/s和1.21±0.21 m/s;三组SWV值均为肾皮质肾髓质肾窦(P0.05)。HUAN组尿β2-MG水平明显高于PHUA组和对照组(P0.05)。HUAN组尿β2-MG水平与肾实质SWV值呈线性正相关(r=0.442,P0.001),而与肾窦呈零相关性(r=0)。Ⅰ、Ⅱ、Ⅲ期HUAN患者肾皮质SWV值比较无明显差异(P0.05),Ⅱ-Ⅴ期肾髓质、肾窦SWV值均高于Ⅰ期(P0.05);Ⅳ、Ⅴ期肾皮质SWV值高于Ⅲ期(P0.001)。结论:HUAN患者在BUN和Cr升高之前,ARFI技术的SWV值和尿β2-MG水平均显著升高。ARFI技术联合尿β2-MG检测可作为评估肾实质组织弹性硬度及诊断早期HUAN的重要方法。     

MR扩散加权成像和CT及MR灌注成像对不同程度肝硬化患者的诊断价值

目的:研究MR扩散加权成像(DWI)和CT及MR灌注成像对不同程度肝硬化患者的诊断价值。方法:选择从2015年8月到2017年2月在我院治疗的肝硬化患者60例作为研究对象,根据Child-Pugh分级进行分组,其中A级32例为轻度肝硬化(记为A组),B级16例、C级12例为中重度肝硬化(记为B组),另选同期在我院进行体检的健康志愿者30例记为C组,对三组受试者分别进行DWI检查、CT及MR灌注成像,对比各组ADC值、肝脏动门脉灌注比率[SSr(ct)及SSr(mr)],采用Spearman相关性分析各指标之间的相关性。结果:三组ADC值整体比较无统计学差异(P0.05),A、B两组的ADC值较C组降低,但差异无统计学意义(P0.05)。A、B两组的ADC值比较无统计学差异(P0.05)。三组SSr(ct)、SSr(mr)整体比较,差异有统计学意义(P0.05),B组的SSr(ct)及SSr(mr)较A、C两组明显升高,差异均有统计学意义(均P0.05)。A、C两组的SSr(ct)及SSr(mr)比较无统计学差异(P0.05)。Spearman相关性分析显示,不同程度肝硬化患者的SSr(ct)与SSr(mr)呈正相关(r=0.687,P=0.000)。结论:CT以及MR灌注成像均可较好地反映出肝硬化的病变程度,且二者较DWI成像的诊断效果更佳,值得临床推广。     

瞬时弹性成像对慢性乙肝肝纤维化诊断的研究

目的:探讨瞬时弹性成像(FibroScan)诊断慢性乙型肝炎肝纤维化的准确性。方法:选取慢性乙型肝炎患者289例,其中未做病理组198例,病理组91例,正常对照50例,病理组患者行病理肝纤维化检测,未做病理组患者检查B超,全部患者及正常对照应用FibroScan进行肝脏硬度检测(liver stiffness measurement,LSM)值测量。分析未做病理组慢乙肝组与正常对照组间及未做病理组慢乙肝组B超肝纤维化各级间LSM值的差异;病理慢乙肝组采用受试者工作特征(Receiver Operating haracteristic,ROC)曲线分析FibroScan诊断肝纤维化的准确性,并得出各期诊断界值;根据该诊断界值对未做病理慢乙肝组进行FibroScan肝纤维化分期,分析其与B超肝纤维化分级的一致性。结果:LSM值在未做病理慢乙肝组和正常对照组间及B超肝纤维化各级间差别显著(P0.05);其中病理组统计结果显示F1、F2、F3、F4期肝纤维化的ROC曲线下面积(Area under Receiver Operating Characteristic,AUROC)分别为0.726、0.847、0.806、0.864,诊断界值分别为6.5、7.4、10.1、17.0 kPa,敏感性分别为69.62%、68.33%、66.67%、72.22%,特异性分别为66.67%、87.10%、85.71%、91.78%;肝纤维化的FibroScan分期和B超分级具有一致性(Kappa值=0.366,P0.05)。结论:FibroScan对慢性乙型肝炎肝纤维化尤其是严重肝纤维化及肝硬化诊断准确性高,具有良好的临床应用价值。     

16层螺旋CT灌注成像对肝硬化血流状态的评估及与肝硬化程度的相关性研究

目的:探讨16层螺旋CT灌注成像对肝硬化血流状态的评估价值及其与肝硬化程度的相关性。方法:选取2014年1月至2016年1月于我院接受诊治的肝硬化患者126例作为肝硬化组,根据Child-Pugh分级分为A组(Child A级,n=35例)、B组(Child B级,n=50例)、C组(Child C级,n=41例)。另选取同期于我院接受体检的健康人员100例作为对照组。应用16层螺旋CT对受试者肝脏、脾脏、主动脉以及门静脉的层面进行CT动态增强扫描,对比CT灌注参数,采用Pearson相关性分析分析CT灌注参数与肝硬化病情严重程度的关系。结果:肝硬化组肝动脉灌注量(HAP)、肝动脉灌注指数(HPI)、肝脏血流量(TBV)以及平均通过时间(MTT)均明显高于对照组,而门静脉灌注量(PVP)、总肝灌注量(TLP)均明显低于对照组(P0.05)。A组患者HAP、HPI均明显高于C组,而PVP与TLP均明显低于C组,差异有统计学意义(P0.05);两组TBV、MTT比较无统计学差异(P0.05);而A组与B组相比以及B组与C组相比,各项CT灌注参数均无统计学差异(P0.05)。肝硬化患者病情严重程度与HAP、HPI均呈正相关关系(P0.05),而与PVP、TLP均呈负相关关系(P0.05)。结论:16层螺旋CT灌注成像对肝硬化血流状态具有一定的评估价值,且CT灌注参数的水平变化与肝硬化患者病情严重程度存在密切相关。     

新型近红外荧光探针MHI85在胆道系统成像的实验研究

目的:观察一种新型近红外荧光探针MHI85在器官中的成像特点,寻找特异性的器官成像荧光探针,为手术提供帮助。方法:用海洋光学测量系统检测近红外荧光探针MHI85的吸光度和荧光强度,分析其光学特点。随后将近红外荧光探针MHI85注射到CD-1小鼠体内,4小时后观察小鼠体内腹腔、胆囊和胆管、离体小鼠腹部脏器的近红外荧光成像情况。并测量离体脏器的信号背景比(SBR)。结果:近红外荧光探针MHI85最大吸收峰值和荧光峰值分别在690 nm和713 nm,说明其发光谱在700 nm左右,且成像稳定。利用小动物活体成像系统发现,近红外荧光探针MHI85在小鼠胆囊、胆囊管、左右肝管、肝总管可见明显荧光信号。心、肺、肝、胰、脾、肾、十二指肠、小肠均无荧光信号,而胆囊中可见明显的荧光信号。离体脏器SBR结果显示,胆囊的SBR明显高于其他脏器。结论:近红外荧光分子探针MHI85对胆囊及胆道系统具有良好的靶向性,且成像清晰、定位准确。     

1H-MRS评估慢性肝病脑部代谢异常与肝硬化的相关性

目的:利用~1H-MRS研究慢性肝病脑部代谢改变,并探讨~1H-MRS评估慢性肝病脑部代谢异常与肝硬化Child-Pugh分级的相关性。方法:选取经临床确诊为慢性肝炎肝硬化患者42例(child A 19例,child B14例,child C 9例)及健康志愿者15例(对照组),行磁共振平扫及磁共振单体素~1H-MRS检查,计算相关代谢物N-乙酰天门冬氨酸(NAA)、谷氨酰胺复合物(Glx)、胆碱(Cho)、肌醇(mI)和肌酸(Cr)的峰下面积及前四项指标与Cr的比值(NAA/Cr、Glx/Cr、Cho/Cr、mI/Cr),并进行统计学分析,同时对相关代谢物的变化与肝硬化Child-Pugh分级及肝硬化Child-Pugh分级与肝性脑病的关系进行相关性分析。结果:~1HMRS分析显示与正常对照组相比,慢性肝炎肝硬化组Glx/Cr值升高,Cho/Cr与mI/Cr值降低,且差异均有统计学意义(P0.05);不同程度肝硬化病例组对比显示,Glx/Cr值均随着肝硬化程度加重而增大,且Glx/Cr值的差异在child A、child B、child C组中均有统计学意义(P0.05);肝性脑病(HE)组与非肝性脑病组脑代谢物峰下面积比值Glx/Cr、Cho/Cr、mI/Cr比较,差异有统计学意义(P0.05);Child-Pugh分级与Glx/Cr呈正相关,与Cho/Cr、mI/Cr呈负相关;随着肝硬化程度加重,肝性脑病出现概率越高,差异有统计学意义(P0.05)。结论:~1H-MRS作为一种无创性的评价手段,能够反映慢性肝硬化及肝性脑病患者存在脑代谢物浓度异常改变,可作为早期诊断肝硬化、肝性脑病及评价肝硬化、肝性脑病严重程度的一项指标,在一定程度上评估肝性脑病与肝硬化分级具有相关性。     

超声造影联合声辐射力脉冲成像鉴别诊断盆腔肿物的价值

目的:评价超声造影及声辐射力脉冲成像技术在诊断及鉴别诊断盆腔良恶性肿块性质中的优越性。方法:分析术前超声造影及声辐射力脉冲成像技术在48例盆腔肿块中的检查结果,探讨两种技术对于肿块性质判定的应用价值。结果:48例中,良性肿块28例,恶性肿块20例。超声造影、声辐射力脉冲成像技术与常规超声相比,诊断的敏感性、特异性、漏诊率、误诊率、诊断准确性等指标均有统计学差异(P0.05),两者联合应用组与常规超声组相比上述指标的统计学差异更加明显(P0.01),超声造影技术和声辐射力脉冲成像技术在判断肿块良恶性方面诊断的敏感性、特异性、漏诊率、误诊率、诊断的准确性没有统计学差异(P0.05);超声造影与声辐射力脉冲成像对盆腔良恶性肿块定性诊断与病理诊断具有一致性,两者联合具有更好的一致性(Kappa=0.8362,0.7126,0.9241)。良恶性盆腔肿块中,实性为主者ARFI值均高于囊实混合性者;实性为主和囊实混合性的恶性盆腔肿块ARFI值均高于良性盆腔肿块,差异有统计学意义(均P0.05)。结论:实时超声造影联合声辐射力脉冲成像技术较常规超声更具优势,可提高盆腔肿物诊断及鉴别诊断的准确性。     

Non-Invasive Evaluation of Cystic Fibrosis Related Liver Disease in Adults with ARFI, Transient Elastography and Different Fibrosis Scores

Background

Cystic fibrosis-related liver disease (CFLD) is present in up to 30% of cystic fibrosis patients and can result in progressive liver failure. Diagnosis of CFLD is challenging. Non-invasive methods for staging of liver fibrosis display an interesting diagnostic approach for CFLD detection.

Aim

We evaluated transient elastography (TE), acoustic radiation force impulse imaging (ARFI), and fibrosis indices for CFLD detection.

Methods

TE and ARFI were performed in 55 adult CF patients. In addition, AST/Platelets-Ratio-Index (APRI), and Forns'' score were calculated. Healthy probands and patients with alcoholic liver cirrhosis served as controls.

Results

Fourteen CF patients met CFLD criteria, six had liver cirrhosis. Elastography acquisition was successful in >89% of cases. Non-cirrhotic CFLD individuals showed elastography values similar to CF patients without liver involvement. Cases with liver cirrhosis differed significantly from other CFLD patients (ARFI: 1.49 vs. 1.13 m/s; p = 0.031; TE: 7.95 vs. 4.16 kPa; p = 0.020) and had significantly lower results than individuals with alcoholic liver cirrhosis (ARFI: 1.49 vs. 2.99 m/s; p = 0.002). APRI showed the best diagnostic performance for CFLD detection (AUROC 0.815; sensitivity 85.7%, specificity 70.7%).

Conclusions

ARFI, TE, and laboratory based fibrosis indices correlate with each other and reliably detect CFLD related liver cirrhosis in adult CF patients. CF specific cut-off values for cirrhosis in adults are lower than in alcoholic cirrhosis.     

Evaluation of Transient Elastography,Acoustic Radiation Force Impulse Imaging (ARFI), and Enhanced Liver Function (ELF) Score for Detection of Fibrosis in Morbidly Obese Patients

Background

Liver fibrosis induced by non-alcoholic fatty liver disease causes peri-interventional complications in morbidly obese patients. We determined the performance of transient elastography (TE), acoustic radiation force impulse (ARFI) imaging, and enhanced liver fibrosis (ELF) score for fibrosis detection in bariatric patients.

Patients and Methods

41 patients (median BMI 47 kg/m²) underwent 14-day low-energy diets to improve conditions prior to bariatric surgery (day 0). TE (M and XL probe), ARFI, and ELF score were performed on days -15 and -1 and compared with intraoperative liver biopsies (NAS staging).

Results

Valid TE and ARFI results at day -15 and -1 were obtained in 49%/88% and 51%/90% of cases, respectively. High skin-to-liver-capsule distances correlated with invalid TE measurements. Fibrosis of liver biopsies was staged as F1 and F3 in n = 40 and n = 1 individuals. However, variations (median/range at d-15/-1) of TE (4.6/2.6–75 and 6.7/2.9–21.3 kPa) and ARFI (2.1/0.7–3.7 and 2.0/0.7–3.8 m/s) were high and associated with overestimation of fibrosis. The ELF score correctly classified 87.5% of patients.

Conclusion

In bariatric patients, performance of TE and ARFI was poor and did not improve after weight loss. The ELF score correctly classified the majority of cases and should be further evaluated.     

外周血CD14~(high)CD16~+单核细胞在HIV/HCV重叠感染者肝损伤中的作用

目的:探讨HIV/HCV重叠感染患者外周血单核细胞亚群与肝损伤的关系。方法:观察对象为HIV/HCV重叠感染患者,分为对照组(n=11)、肝纤维化组(n=12)和肝硬化组(n=7)。运用流式细胞仪检测单核细胞及其亚群变化,瞬时弹性成像(Fibroscan)检测肝纤维化情况。比较单核细胞各亚群在不同程度肝损伤中的差异,并对HIV/HCV重叠感染患者外周血的单核细胞数与肝纤维化情况进行相关性分析。结果:HIV/HCV重叠感染患者肝硬化组与对照组比较,单核细胞CD14low CD16+和CD14high CD16+亚群显著增多(P=0.047,P=0.018)。HIV/HCV重叠感染患者肝纤维化组与对照组比较,单核细胞各亚群差异无统计学意义(P=0.84,P=0.812)。HIV/HCV重叠感染患者CD14high CD16+单核细胞与肝纤维化情况存在正性线性相关,方程成立,并且系数有统计学意义(P=0.018),方程似然比(r 2)0.45。结论:HIV/HCV重叠感染患者CD14high CD16+单核细胞增高有可能是肝损伤加重的原因之一。     

血清CD5L对肝脏疾病患者的临床意义研究

摘要 目的：检测CD5L水平在肝脏疾病患者血清中的变化,并分析其临床意义。方法：采用ELISA法检测41例慢性肝炎患者、192例肝硬化患者、69例肝癌患者和136例健康对照血清CD5L水平。全自动生化分析仪测定肝功能指标,Spearman相关性分析用于评估CD5L与肝功能指标的关系。受试者工作曲线（receiver operator characteristic, ROC）分析血清CD5L的潜在诊断价值。结果：与健康对照相比,CD5L水平在肝炎、肝硬化、肝癌患者中显著降低（P<0.01）。肝硬化患者血清CD5L水平较肝炎及肝癌患者显著降低（P<0.01）。肝硬化代偿期和失代偿期患者血清CD5L水平无显著差异。血清CD5L水平与FIB-4指数(肝纤维化评分)呈显著负相关（r=-0.2688,P=0.0001）。Spearman相关性分析结果显示：在肝炎患者中,血清CD5L与总胆红素（T-BIL）、直接胆红素（D-BIL）、间接胆红素（I-BIL）显著正相关;在肝硬化患者中,CD5L与其他肝功指标无显著相关性;在肝癌患者中,CD5L与碱性磷酸酶（ALP）显著正相关。以健康人为对照组,肝硬化患者为病例组,ROC分析显示血清CD5L的诊断特异性为85.3%,敏感性为77.1%。结论：CD5L水平在肝炎、肝硬化及肝癌患者血清中显著降低,且在肝硬化患者中最低。CD5L水平与肝纤维化评分FIB-4指数负相关,可作为监测肝纤维化进展的潜在生物标志物。     

Head-to-Head Comparison between Collagen Proportionate Area and Acoustic Radiation Force Impulse Elastography in Liver Fibrosis Quantification in Chronic Hepatitis C

BackgroundThe aim of this study was to compare the diagnostic performances of the collagen proportionate area (CPA) and liver stiffness measurement (LSM) for liver fibrosis quantification in chronic hepatitis C (CHC).MethodsA total of 137 eligible consecutive Taiwanese patients (74 women and 63 men; age 21–80 years; median age 54 years), with CHC underwent LSM by using acoustic radiation force impulse (ARFI) elastography and an immediate percutaneous liver biopsy for METAVIR scoring. Liver tissue sections were stained using picrosirius red. Areas of the stained collagen and the tissue parenchyma were calculated in pixels. The ratio between the two areas was expressed as a CPA percentage. The result of LSM was presented as shear wave velocity (SWV).ResultsMETAVIR fibrosis (F) stages were dichotomized using the CPA (%) and SWV (m/s), and the optimal cut-off values were 7.47 and 1.59 for F1 versus F2–4; 12.56 and 1.73 for F1, 2 versus F3, 4; 15.32 and 1.96 for F1–3 versus F4. To dichotomize F1 versus F2–4, the areas under receiver operating characteristic curves for the CPA was 0.9349 (95% confidence interval: 0.8943–0.9755) and for SWV was 0.8434 (0.7762–0.9105) (CPA versus SWV, P = 0.0063). For F1, 2 versus F3, 4, the CPA was 0.9436 (0.9091–0.9781); SWV was 0.8997 (0.8444–0.9551) (P = 0.1587). For F1–3 versus F4, the CPA was 0.8647 (0.7944–0.9349); SWV was 0.9036 (0.8499–0.9573) (P = 0.2585). The CPA could be predicted in a linear regression formula by using SWV and platelet count (R² = 0.524).ConclusionsThe CPA and ARFI elastography are promising tools for liver fibrosis evaluation. The CPA was superior to ARFI elastography in the diagnosis of significant fibrosis (≥ F2). The CPA may be independent of severe necroinflammation, which may augment liver stiffness.     

Correlation of endothelin-1 concentration and angiotensin-converting enzyme activity with the staging of liver fibrosis

Increased serum angiotensin-converting enzyme (SACE) activity and serum concentration of endothelin-1 (ET-1) were found in liver cirrhosis. We investigated a correlation between the different stages of liver fibrosis and SACE activity and serum ET-1 concentration. Seventy patients with pathohistologically established chronic liver disease were divided in three groups according to Ishak criteria for liver fibrosis: minimal fibrosis (Ishak score 0-1, n =20), medium fibrosis (Ishak score 2-5, n=20) and cirrhosis (Ishak score 6, n=30). SACE activity and ET-1 concentration were determined using commercial ELISA kits. SACE activity and ET-1 concentrations were proportional to the severity of disease, the highest being in patients with liver cirrhosis. Maximal increase in SACE activity was found between minimal and medium fibrosis while maximal increase in ET-1 concentration was revealed between medium fibrosis and cirrhosis. The analysis of the Receiver Operating Characteristic (ROC) curve for SACE activity suggested a cut-off value to separate minimal from medium fibrosis at 59.00 U/L (sensitivity 100%, specificity 64.7%). The cut-off value for serum ET-1 concentration to separate medium fibrosis from cirrhosis was 12.4 pg/mL (sensitivity 96.8%, specificity 94.4%). A positive correlation between SACE activity and ET-1 concentration was registered (Spearman's ? = 0.438, p = 0.004). Both SACE activity and ET-1 concentration were increased in all stages of liver fibrosis. Cut-off points for SACE activity and ET-1 concentration could be a biochemical marker for the progression of fibrosis. Positive correlation between SACE activity and ET-1 concentration might indicate their interaction in the development of liver cirrhosis.     

Circulating transforming growth factor beta(1) as an indicator of hepatic function impairment in liver cirrhosis

In the liver, transforming growth factor (TGF) -beta(1)is primarily responsible for activation of fat-storing cells, which are the main source of extracellular matrix proteins. Their deposition play a key role in the development of liver cirrhosis. The aim of this study was to evaluate plasma TGF-beta(1)in patients with different stages of liver cirrhosis and its possible use as an indicator of liver function impairment. TGF-beta(1)was measured in the plasma of 40 patients with liver cirrhosis. To estimate possible effect of liver insufficiency on plasma TGF-beta(1), patients were divided into three groups: A, B and C, univocal with Child-Pugh classes. Normal values were collected from 13 healthy volunteers. Liver cirrhosis resulted in a significant increase of plasma concentration of TGF-beta(1)(39.3+/-3.8 ng/ml), which doubled normal values (18.3+/-1.6 ng/ml). The highest concentrations were observed in alcoholic patients (44.4+/-4.7 ng/ml). TGF-beta(1)level increased depending on the degree of liver insufficiency, demonstrated by a significant positive correlation with Child-Pugh score (r=0.591). Values in group A were similar to normal, but were significantly elevated in groups B and C. These findings suggest possible use of plasma TGF-beta(1)measurement as an indicator of liver function impairment and possible marker of hepatic fibrosis progression in cirrhotic patients.     

Bone-marrow-derived cells cultured in serum-free medium reduce liver fibrosis and improve liver function in carbon-tetrachloride-treated cirrhotic mice

We have previously developed autologous bone marrow cell infusion (ABMi) therapy for liver cirrhosis patients. One problem associated with ABMi therapy is that general anesthesia is required to obtain 400 ml bone marrow fluid from liver cirrhosis patients. However, many patients with decompensated cirrhosis do not meet the criteria, because of decreased liver function or an increased bleeding tendency. To overcome these issues, our aim is to derive liver repair cells from small amounts of autologous bone marrow aspirates obtained under local anesthesia and to use these cells in liver cirrhosis patients. Here, we conducted, by using a mouse model, basic research aimed at achieving novel liver regeneration therapy. We cultured bone marrow cells aspirated from the femurs of C57 BL/6 Tg14 (act-EGFP) OsbY01 mice (green fluoresent protein [GFP]-transgenic mice). After 14 days of culture with serum-free medium (good manufacturing practice grade), the obtained spindle-shaped GFP-positive cells were injected (1×10⁴ cells) via the caudal vein into mice with carbon tetrachloride (CCl₄)-induced cirrhosis. Numerous cultured macrophages and some mesenchymal stem cells repopulated the cirrhotic liver. The results showed that serum albumin, liver fibrosis and liver function were significantly improved in the group treated with cultured bone marrow cells (P<0.01). Moreover, matrix metalloproteinase-9 expression was increased in the liver (P<0.01). Thus, infusion of bone-marrow-derived cultured cells improved liver function and liver fibrosis in mice with CCl₄-induced cirrhosis.     

SF方案治疗肝硬化的疗效观察

目的：观察SF方案对代偿性乙型肝炎肝硬化患者的治疗作用。方法：代偿性乙肝肝硬化患者63例,分为治疗组33例,对照组30例。治疗组采用SF方案进行治疗,对照组采用常规护肝疗法,疗程为9～12个月,定期监测肝功能指标变化。结果：SF方案对肝硬化有较好的疗效,一是肝脏炎症反应减轻,肝功能恢复,血清ALT、AST、TBiL经治疗后治疗组均显著低于治疗前和同期对照组;二是阻止肝纤维化进展,肝纤维化指标明显好转;三是免疫功能得以改善,外周血CD4／CD8淋巴细胞比值回升,补体C3水平上升;四是抗病毒效果显著,HBVDNA阴转率达54．5％。结论：SF方案有显著改善患者肝功能,恢复患者免疫功能,抑制病毒增殖的作用,可扩大样本量进一步研究。     

Genetics factors determining predisposition to chronic course of virus hepatitis and fibrosis in liver

Polymorphic variants of several genes IL4 C(-590)T, IL4RA Ile50Val, TNF G(-308)A were studied for their association with extent of the disease chronization which is marked by hepatic fibrosis stage. Gradual decrease in A allele frequency of polymorphic marker G(-308)A in TNF gene, from patients with weak fibrosis to patients with cirrhosis. Group of patients with weak fibrosis was characterized by higher frequency of A allele (24.5%) comparing with patients with moderate and pronounced fibrosis (13.4%) and cirrhosis (8.7%). Differences in heterozygous genotype frequencies of IL4 C(-590)T were found between patients with cirrhosis (68.2%) and groups of patients with moderate and marked fibrosis (39.1%).