Consensus on the diagnosis and treatment of hepatic fibrosis (2019)

Lu, Lun Gen; You, Hong; Xie, Wei; Jia, Ji Dong

doi:10.1111/1751-2980.12854

Cited by 22 publications

(13 citation statements)

References 59 publications

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“…Therefore, FibroScan was used to track the improvement in liver stiffness brought on by TCM, and the results showed that the rate of improvement after treatment was 40.63%, which was much better than the 28.79% of the TCM nonusers. APRI and FIB-4 are relatively mature serum noninvasive detection models, in which the sensitivity and specificity of APRI in evaluating liver fibrosis after hepatitis B are 0.87 and 0.66 [ 18 ] and of FIB-4 are 0.78 and 0.65 [ 19 ], respectively. According to results of our research, both of them effectively predicted the improvement of TCM on liver fibrosis.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Liver Fibrosis after Hepatitis B with TCM Combined with NAs Evaluated by Noninvasive Diagnostic Methods: A Retrospective Study

Zhou

Lin-Yi

et al. 2023

Evidence-Based Complementary and Alternative Medicine

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Objective. Chronic hepatitis B liver fibrosis is an important intermediate link in the development of liver cirrhosis. A retrospective cohort study was conducted in Longhua Hospital affiliated to the Shanghai University of Traditional Chinese Medicine in order to prove whether integrated traditional Chinese and Western medicine could improve the incidence of CHB complications and clinical prognosis. There are 130 patients with hepatitis B liver fibrosis (being treated from 2011–2021) included in the study, and the patients were divided into 64 TCM users (NAs combined with TCM) and 66 TCM nonusers (NAs antiviral therapy). The serum noninvasive diagnostic model (APRI, FIB-4) and LSM value were used to classify the stages of fibrosis. The results showed that the LSM value was decreased significantly in TCM users compared with TCM nonusers (40.63% versus 28.79%). Indicators of FIB-4 and APRI of TCM users have improved significantly compared with that of TCM nonusers (32.81% versus 10.61% and 35.94% versus 24.24%). The AST, TBIL, and HBsAg levels in TCM users were lower than those in TCM nonusers, and the HBsAg level was inversely correlated with the CD3+, CD4+, and CD8+ in TCM users. The PLT and spleen thickness of TCM users also were improved considerably. The incidence rate of end-point events (decompensated cirrhosis/liver cancer) in TCM nonusers was higher than that of TCM users (16.67% versus 1.56%). The long course of the disease and a family history of hepatitis B were the risk factors for disease progression, and long-term oral administration of TCM was the protective factor. As a result, the serum noninvasive fibrosis index and imaging parameters in TCM users were lower than those of TCM nonusers. Patients in the treatment of NAs combined with TCM had better prognoses such as a lower HBsAg level, a more stable lymphocyte function, and a lower incidence of end-point events. The present findings suggest the effect of TCM combined with NAs in the treatment of chronic hepatitis B liver fibrosis is better than that of single drug treatment.

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Section: Discussionmentioning

confidence: 99%

Treatment of Liver Fibrosis after Hepatitis B with TCM Combined with NAs Evaluated by Noninvasive Diagnostic Methods: A Retrospective Study

Zhou

Lin-Yi

et al. 2023

Evidence-Based Complementary and Alternative Medicine

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“…A minimum of 1.5 cm of liver tissue with at least 6 portal tracts was required for diagnosis. According to Scheuer's classification, the degree of inflammatory activity and fibrosis were divided into 0–4 grades (G) and 0–4 stages (S) ( 19 ) by two pathologists blinded to the clinical data. G1-2, S0-2 were defined as mild-moderate CHB; G3, S1-3 were defined as severe CHB, G4, S2-4 were defined as cirrhosis.…”

Section: Methodsmentioning

confidence: 99%

“…G1-2, S0-2 were defined as mild-moderate CHB; G3, S1-3 were defined as severe CHB, G4, S2-4 were defined as cirrhosis. When the opinions of the two experts were inconsistent, the higher G score was used ( 19 ).…”

Section: Methodsmentioning

confidence: 99%

M1 macrophages may be effective adjuvants for promoting Th‑17 differentiation in HBeAg positive hepatitis patients with ALT ≤2ULN

Sun

Zhang

et al. 2023

Mol Med Rep

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Hepatitis B virus (HBV) infection can activate macrophages to accelerate liver disease progression, including inflammation and fibrosis. However, the exact mechanism remains undetermined. The present study assessed the effects of macrophage polarization and the related cytokines on Th-17 differentiation in HBeAg positive individuals with a HBV infection, and also evaluated the potential association of Th-17 cell frequency with the severity of liver injury. A cross-sectional study design was used to collect the clinical parameters, blood samples and liver tissue samples of patients with alanine transaminase £2× upper limit of normal and confirmed hepatitis B who underwent liver puncture in Qishan Hospital between January 2019-December 2021. Macrophage and Th-17 cell related factors were assayed using ELISA. The expression and quantification of cell surface antigen and intracellular markers in cells were assessed using flow cytometry. Pathological staining, including hematoxylin and eosin, reticular fiber staining and immunohistochemical staining were used to assess inflammation and fibrosis in the liver tissue. In the peripheral blood of patients with HBV infection, the number of CD14 + macrophages was significantly increased compared with the healthy control, especially in the hepatitis B e antigen (HBeAg) positive group. CD14 + macrophages were predominantly of the M1 type based on the assessment of the phenotype using flow cytometry and cytokine secretion. Furthermore, the percentage of M1 phenotype and related cytokines were positively correlated with Th-17 differentiation. IL-17A secreted by Th-17 was positively correlated with the degree of liver inflammation and fibrosis, as well as with the severity of liver disease, which indicated that the differentiation of Th-17 may be involved in the progression of liver disease. HBeAg may promote Th-17 differentiation and IL-17A production by M1 macrophages to accelerate the pathogenesis of liver inflammation and fibrosis in CHB patients.

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“…As per Scheuer’s classification ( 15 ), two pathologists who were blinded to the clinical data performed the histological grading of necro-inflammation (G0–G4) and the staging of liver fibrosis (S0–S4). SHCHI were established as grade ≥ G2 inflammation and/or stage ≥ S2 fibrosis ( 16 ). According to the definition of SHCHI in literature 16, the five levels of inflammation and fibrosis were classified into two categories, but the five levels were not compared separately ( Figure 1 ).…”

Section: Methodsmentioning

confidence: 99%

Establishment and validation of a diagnostic nomogram for significant histopathologic changes of hepatic injury in HBV-infected patients

Sun¹,

Wang²,

Zhang³

et al. 2023

Ann Transl Med

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Background: Significant histopathologic changes of hepatic injury (SHCHI) play a decisive role in evaluating the condition and initiating antiviral in HBV-infected patients, especially those with normal or mildly elevated alanine transaminase levels. Considering that non-invasive methods were established through experience with chronic hepatitis C, the aim of this study was to establish and verify a nomogram based on hepatitis B for diagnosing SHCHI.Methods: Three hundred eighty-four patients who fulfilled requirements for participation were randomly assigned to training cohort (n=270) and validation cohort (n=114) according to 7:3. The selection criteria for clinical factors were based on the previous research papers. SHCHI was subgrouped as followed: grade ≥ G2 inflammation and/or stage ≥ S2 fibrosis. The predictive accuracy and discriminative ability of nomogram were determined by a concordance index (C-index), calibration curve and the area under the receiveroperating characteristic curve (AUROC). We also compared diagnostic value of nomogram with model for AST-to-PLT ratio index (APRI) score and model for Fibrosis-4 (FIB-4) score. Results: Two hundred and two patients (74.44%) and 87 patients (76.32%) were diagnosed as SHCHI, in the training and validation cohort. Logistic regression analysis illustrated that hepatitis B e antigen (HBeAg), aspartate aminotransferase (AST), γ-glutamyl transferase (GGT), and prothrombin time (PT) all independently served as risk factors for SHCHI (P<0.05) and were thus utilized to create the nomogram. The nomogram had well-fitted calibration curves and attained excellent concordance indices of 0.80 and 0.75. The sensitivity of nomogram in the diagnosis of SHCHI was 79.7%, the specificity was 68.1%. The area under the curve {AUC; 0.80 [95% confidence interval (CI): 0.74-0.86]} for diagnosing SHCHI by the nomogram was greater in comparison to that of APRI [0.78 (95% CI: 0.71-0.84)], and FIB-4 [0.76 (95% CI: 0.69-0.82)]. Patients with nomogram scores less than 119 were considered to have a lower risk of SHCHI. Conclusions: The constructed nomogram is suitable to serve as a SHCHI screening tool in chronic HBV-infected patients. But the dependability of the nomogram will necessitate further confirmation in a prospective study and further external validation is needed.

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Consensus on the diagnosis and treatment of hepatic fibrosis (2019)

Cited by 22 publications

References 59 publications

Treatment of Liver Fibrosis after Hepatitis B with TCM Combined with NAs Evaluated by Noninvasive Diagnostic Methods: A Retrospective Study

Treatment of Liver Fibrosis after Hepatitis B with TCM Combined with NAs Evaluated by Noninvasive Diagnostic Methods: A Retrospective Study

M1 macrophages may be effective adjuvants for promoting Th‑17 differentiation in HBeAg positive hepatitis patients with ALT ≤2ULN

Establishment and validation of a diagnostic nomogram for significant histopathologic changes of hepatic injury in HBV-infected patients

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