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1.
目的探讨采取系统营养联合节律运动对肝代谢异常人群干预效果的研究。方法选取56名肝代谢异常人群的受试者,每天按时进行系统营养和节律运动联合干预3个月,采用肝脏瞬时弹性成像技术(FibroScan)、生物电全身健康扫描系统(DDFAO)技术,对比干预前后肝脏脂肪衰减度、肝脏硬度以及肝脏区域的生物活性值。结果相比干预前,干预后受试者肝脏脂肪衰减度、肝脏硬度、肝糖原活性值显著降低(P<0.05),肝左叶及胆管区域活性值、肝右叶区域活性值均显著升高(P<0.05)。结论系统营养联合节律运动可显著降低受试者肝代谢异常的风险,对预防肝代谢异常和促进肝脏功能恢复有重要作用。 相似文献
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Harshit Garg Sandeep Aggarwal Rajni Yadav Siddhartha Datta Gupta Lokesh Agarwal Samagra Agarwal 《Surgery for obesity and related diseases》2018,14(1):81-91
Background
Controlled attenuation parameter (CAP) is a novel, noninvasive technique for assessing hepatic steatosis. However, its role in morbidly obese individuals is unclear. The effect of bariatric surgery on inflammation and fibrosis needs to be explored.Objectives
To assess the utility of CAP for assessment of hepatic steatosis in morbidly obese individuals and evaluate the effect of bariatric surgery on hepatic steatosis and fibrosis.Setting
A tertiary care academic hospital.Methods
Baseline details of anthropometric data, laboratory parameters, FibroScan (XL probe), and liver biopsy were collected. Follow-up liver biopsy was done at 1 year.Results
Of the 124 patients screened, 76 patients were included; mean body mass index was 45.2 ± 7.1 kg/m2. FibroScan success rate was 87.9%. The median liver stiffness measurement (LSM) and CAP were 7.0 (5.0–9.5) kPa and 326.5 (301–360.5) dB/m, respectively. On liver histopathology, severe steatosis and nonalcoholic steatohepatitis were present in 5.3% and 15.8%; significant fibrosis (≥stage 2) and cirrhosis in 39.5% and 2.6%, respectively. Area under receiver operator characteristic curve of LSM for prediction of significant fibrosis (F2–4 versus F0–1) and advanced fibrosis (F3–4 versus F0–2) was .65 (95% confidence interval [CI]: .52–.77) and .83 (95% CI: .72–.94), respectively. The area under receiver operator characteristic curve of CAP for differentiating moderate hepatic steatosis (S2–3 versus S0–1) and severe hepatic steatosis (S3 versus S0–2) was .74 (95% CI: .62–.86) and .82 (95% CI: .73–.91), respectively. At 1-year follow-up, 32 patients underwent liver biopsy. In these patients, there was significant improvement in hepatic steatosis (P = .001), lobular inflammation (P = .033), ballooning (P<.001), and fibrosis (P = .003). Nonalcoholic steatohepatitis was resolved in 3 of 4 (75%) patients. LSM and CAP significantly declined.Conclusions
LSM and CAP are feasible and accurate at diagnosing advanced fibrosis and severe hepatic steatosis in morbidly obese individuals. Bariatric surgery is associated with significant improvement in LSM, CAP, steatohepatitis, and fibrosis. 相似文献3.
Longitudinal assessment of hepatic fibrosis in responders to direct‐acting antivirals for recurrent hepatitis C after liver transplantation using noninvasive methods 下载免费PDF全文
Heba Omar Mohamed Said Rasha Eletreby Mai Mehrez Mohamed Bassam Zeinab Abdellatif Adel Hosny Sherif Megawer Mona El Amir Ayman Yosry 《Clinical transplantation》2018,32(8)
Successful eradication of recurrent hepatitis C virus (HCV) infection following liver transplantation (HCV) improves graft survival. This study aimed at evaluation of hepatic fibrosis changes among long‐term responders to DAA therapy for recurrent HCV after liver transplantation using noninvasive methods. Patients with significant hepatic fibrosis (≥F2) who achieved SVR12 after treatment with DAAs for recurrent HCV were included (n = 52). Hepatic fibrosis status was assessed, noninvasively, by calculation of fibrosis‐4 score (FIB‐4) and Aspartate Aminotransferase Platelet Ratio Index (APRI) and by measurement of graft stiffness using FibroScan at baseline and 12 and 18 months post‐treatment. Acoustic radiation force imaging (ARFI) was done for all patients 12 and 18 months post‐treatment. Patients were classified into two groups based on baseline liver stiffness measurement (LSM) by FibroScan; significant fibrosis (F2; n = 28) and advanced fibrosis groups (≥F3). Over 18‐month follow‐up period, there was serial improvement of FIB‐4, APRI, and LSM by FibroScan in both groups. Higher baseline LSM and delayed initiation of antiviral therapy were significant predictors of lack of fibrosis regression (P‐value 0.01 and 0.04, respectively). Fibroindices and LSM improved over time in liver transplant recipients who responded to DAAs. Baseline LSM can predict post‐treatment fibrosis regression. 相似文献
4.
Application of the combined FibroMeter vibration‐controlled transient elastography algorithm in Chinese patients with non‐alcoholic fatty liver disease 下载免费PDF全文
5.
de Lédinghen V Barreiro P Foucher J Labarga P Castéra L Vispo ME Bernard PH Martin-Carbonero L Neau D García-Gascó P Merrouche W Soriano V 《Journal of viral hepatitis》2008,15(6):427-433
Summary. The recent availability of non-invasive tools to measure liver fibrosis has allowed examination of its extent and determination of predictors in all patients with chronic hepatitis C virus (HCV) infection. On the other hand, most information on hepatic fibrosis in HCV/human immunodeficiency virus (HIV)-coinfected patients has been derived from liver biopsies taken before highly active antiretroviral therapy (HAART) was widely available. All consecutive HCV patients with elevated aminotransferases seen during the last 3 years were evaluated and liver fibrosis measured using transient elastography (FibroScan® ) and biochemical indexes. Patients were split according to their HIV serostatus. A total of 656 (69.6%) HCV-monoinfected and 287 (30.4%) HIV/HCV-coinfected patients were assessed. Mean CD4 count of coinfected patients was 493 cells/μL and 88% were under HAART (mean time, 4.2 ± 2.4 years). Advanced liver fibrosis or cirrhosis was recognized in 39% of the coinfected and 18% of the monoinfected patients ( P < 0.005). A good correlation was found between FibroScan® and biochemical indexes [AST to platelet ratio index ( r = 0.405, P < 0.0001), FIB-4 (r = 0.393, P < 0.0001) and Forns ( r = 0.407, P < 0.0001)], regardless of the HIV status. In the multivariate analysis, age >45 years, body mass index (BMI) >25 kg/m2 , and HIV infection were independently associated with advanced liver fibrosis or cirrhosis. HIV/HCV-coinfected patients have more advanced liver fibrosis than HCV-monoinfected patients despite the immunologic benefit of HAART. 相似文献
6.
Cho HJ Seo YS Lee KG Hyun JJ An H Keum B Kim JH Yim HJ Jeen YT Lee HS Chun HJ Um SH Kim CD Ryu HS 《Journal of gastroenterology and hepatology》2011,26(3):492-500
Background and Aim: It is still uncertain whether the accuracy of transient elastography (TE) in predicting the fibrosis stage is similar in chronic hepatitis B (CHB) and chronic hepatitis C (CHC). The present study was carried out to evaluate whether the underlying cause of chronic viral hepatitis affects the predictive accuracy of TE. Methods: Patients with CHB or CHC who were admitted for a liver biopsy were enrolled. Patients underwent TE and laboratory tests on the same day as the liver biopsy. The predictive accuracy was analyzed by comparing the areas under the receiver‐operating characteristic curves (AUCs). Results: Two‐hundred and seven patients were enrolled, comprising 121 CHB patients and 86 CHC patients). The patients were aged 44 ± 14 years, and 121 (58.5%) of them were men. AUCs for predicting significant fibrosis were significantly lower in CHB patients than in CHC patients (P = 0.043). The serum alanine aminotransferase (ALT) level was associated with overestimation and underestimation of the fibrosis stage, while the cause of chronic hepatitis was not. AUCs for predicting significant fibrosis were significantly lower in patients with ALT levels >70 IU/L (AUC, 0.830; 95% CI, 0.742–0.898) than in patients with ALT levels ≤70 IU/L (0.944; 0.882–0.979; P = 0.015). Conclusions: Although the predictive accuracy of TE in predicting significant fibrosis differed significantly with the cause of chronic hepatitis, this difference was due to the degree of serum ALT levels rather than to the cause of hepatitis itself. Avoiding performing TE in patients with elevated ALT levels is recommended to guarantee the predictive accuracy of TE. 相似文献
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Percutaneous liver biopsy (LB) remains an important tool in the diagnosis and management of parenchymal liver diseases. In current practice, it is most frequently performed to assess the inflammatory grade and fibrotic stage of commonly encountered liver diseases, with the diagnostic role relegated to secondary importance. The role of LB remains a vastly controversial and debated subject, with an ever-increasing burden of evidence that questions its routine application in all patients with liver dysfunction. It remains, essentially, an invasive procedure with certain unavoidable risks and complications. It also suffers shortcomings in diagnostic accuracy since a large liver sample is required for an ideal assessment, which in clinical practice is not feasible. LB is also open to observer interpretation and prone to sampling errors. In recent years, a number of noninvasive biomarkers have evolved, each with an impressive range of diagnostic certainty approaching that achieved with LB. These noninvasive tests represent a lower-cost option, are easily reproducible, and serve as suitable alternatives to assess hepatic inflammation and fibrosis. This article aims to debate the shortcomings of LB while simultaneously demonstrating the diagnostic accuracy, reliability and usefulness of noninvasive markers of liver disease thereby making the case for their utilization as suitable alternatives to LB in many, although not all, circumstances. 相似文献
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目的 运用多元回归分析的方法,寻找影响FibroScan测定肝纤维化的独立预测因子。方法 选取住院及门诊需行肝穿刺活组织检查确诊的患者181例,于肝活检手术当天进行FibroScan检测肝脏硬度值(LSM),同时收集患者临床信息及±3d的常规血液检测指标。将筛选出的10个自变量进行多元回归分析。结果 多元回归分析结果显示,血小板(PLT)、血清白蛋白(ALB)、凝血酶原活动度(PTA)、体质量指数(BMI)为独立预测因子。结论 在FibroScan检测肝脏硬度时,PLT、ALB、PTA和BMI值可能会对检测结果产生影响。 相似文献
10.
目的:探讨FibroTest联合FibroScan对慢性乙型肝炎肝纤维化的诊断价值。方法留取2011年8月至2013年7月天津市第二人民医院的99例行肝活组织检查的慢性乙型肝炎患者的血清,检测α2-巨球蛋白(α2-MG)、结合珠蛋白(HP)和载脂蛋白A1(apoAⅠ),记录TBil和GGT的数值,并根据其结果结合患者的年龄和性别计算出FibroTest的数值。并对99例慢性乙型肝炎患者用FibroScan测定肝脏硬度值。根据Scheuer肝纤维化分期标准设定2个判定点,分别为显著肝纤维化(S2~S4期),严重肝纤维化(S3~S4期)。以肝活组织检查病理结果为金标准绘制出FibroTest及FibroScan的受试者工作特征曲线下面积(AUROC)。评价两者对慢性乙型肝炎肝纤维化的诊断价值,并应用 Logistic 逐步回归分析方法探讨联合诊断价值。结果 FibroTest 与 Fi-broScan对S2~S4期的AUROC分别0.805(95%CI:0.713~0.897,P<0.001),0.896(95%CI:0.833~0.959,P<0.001),对S3~S4期的AUROC值分别为0.834(95%CI:0.741~0.928,P<0.001),0.945(95%CI:0.891~0.999,P<0.001)。两者联合后对显著纤维化(S2~S4期)的AUROC值为0.911(95%CI:0.854~0.967,P<0.001)。结论 FibroTest联合FibroScan可以更准确地估计慢性乙型肝炎患者肝脏有无显著纤维化,提高诊断特异度,并保证较高的诊断准确率,对于慢性乙型肝炎预后评估及治疗决策有指导意义。 相似文献