Chinese Hepatolgy

Current status of antiviral therapy for chronic HCV infection in China

LU Jie, CHEN Li-chang, ZHOU Hui-juan, XIE Qing, LIN Lan-yi

2019, 24(11): 1230-1233.

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Objective To investigate the current usage of antiviral therapy in Chinese chronic hepatitis C population.Methods Patients with chronic hepatitis C virus (HCV) infection who visited our department from July 2017 to March 2019 were enrolled. Clinical characteristics and options of antiviral therapy were collected and then analyzed according to current international practice guidelines. Results A total of 165 patients were included, among which 15% (25/165) hadn′t started treatment. Almost 5% (8/165) of them were treated with polyglycol interferon combined ribavirin therapy. The proportions of patients treated with genotype-specific and pan-genotypic direct-acting antiviral agents (DAAs) were 27% (44/165) and 51% (85/165), respectively. Although sofosbuvir/velpatasvir is most popular among patients with all genotypes, genotype-specific DAAs (40%) were used more favorably than pan-genotypic DAAs (7%) among genotype 1b population due to efficacy, safety and most importantly price.Conclusion Pan-genotypic DAAs are recognized as the first-line treatment options among chronic hepatitis C population. Treatment cost, other than efficacy and safety, takes a big part in treatment option.

Changes of serum alkaline phosphatase in patients with HBV-related acute-on-chronic liver failure and its significance

GU Jing, CHEN Zu-tao, SUN Wei, GAN Jian-he

2019, 24(11): 1234-1236.

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Objective To investigate the changes of serum alkaline phosphatase (ALP) in patients with hepatitis B virus (HBV)- related acute-on-chronic liver failure (HBV-ACLF) and its significance.Methods A total of 92 HBV-ACLF patients hospitalized in our hospital from January 2015 to December 2018 were enrolled in the study, as well as 40 patients with chronic hepatitis B (CHB) and 34 healthy controls. ALP levels in peripheral blood of the 3 groups were compared. Differences of the dynamic changes in ALP levels from admission to 1 week after admission were studied. In HBV-ACLF patients, survival rates between increasing ALP group and decreasing ALP group were compared. The associations of the increase of ALP with pre-albumin level and model for end-stage liver disease (MELD) score were analyzed. Results The ALP levels of HBV-ACLF group, CHB group and control group were (421.37 ± 136.35), (116.14 ± 38.62) and (104.23 ± 35.19) U/L, respectively, and the differences among groups were significant (F=77.193, P<0.05). The ALP level of HBV-ACLF group was significantly higher than that of CHB group and control group (Q=3.704 and 4.548, respectively, P<0.05 for both). In HBV-ACLF patients, the increase of ALP of survival subgroup was significantly higher than that of death subgroup, and the difference was statistically significant [(86.17 ± 19.36) vs (29.46 ± 8.21) U/L, t=4.78, P<0.05]. The survival rate of increasing ALP subgroup was higher than that of decreasing ALP subgroup, and the difference was statistically significant (73.08% vs 32.5%, χ² = 33.48, P<0.05). One week after admission, the MELD score of patients with HBV-ACLF was (35.63 ± 5.81), and the pre-albumin level was (73.57 ± 32.69) g/L. The increase of ALP was negatively correlated with MELD score, and positively correlated with pre-albumin level (r=-0.725 and 0.763, respectively, P<0.05 for both).Conclusion The continuous increase of peripheral blood ALP in patients with HBV-ACLF is a predictor of good prognosis.

Application of transient elastography in diagnosis of non-cirrhotic portal hypertension

LV Yu-cui, HE Li-juan

2019, 24(11): 1237-1239.

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Objective To investigate application value of transient elastography (TE) in diagnosis of non-cirrhotic portal hypertension (PHT).Methods A total of 86 patients diagnosed with PHT in our hospital from October 2016 to October 2018 who underwent TE were enrolled. They were divided into non-cirrhotic PHT group (51 cases) and cirrhotic PHT group (35 cases) according to biopsy results. The liver stiffness value, spleen stiffness value, liver function indexes and coagulation function indexes were compared between the 2 groups. The diagnostic values of liver stiffness value and spleen stiffness value in non-cirrhotic PHT were evaluated by receiver operating characteristic (ROC) curves. Results The liver stiffness value of non-cirrhotic PHT group was lower than that of cirrhotic PHT group [(6.21 ± 5.27) vs (24.15 ± 15.79) kPa, P<0.05]. The spleen stiffness value of non-cirrhotic PHT group was higher than that of cirrhotic PHT group [(59.56 ± 17.22) vs (40.49 ± 13.78) kPa, P<0.05]. The levels of total bilirubin, aspartate aminotransferase and alanine aminotransferase in non-cirrhotic PHT group were lower than those in cirrhotic PHT group [(16.26 ± 4.28) vs (24.94 ± 5.24) μmol/L, (38.64 ± 5.69) vs (59.64 ± 9.33) U/L, (40.23 ± 5.74) vs (60.32 ± 8.14) U/L, P<0.05]. However, there was no significant difference in platelet or prothrombin time between the 2 groups (P>0.05). Besides, the area under ROC curve (AUC) and 95% confidence interval (CI) of liver stiffness value to diagnose non-cirrhotic PHT were 0.934 and 0.871-0.998, respectively, with the cutoff value of 14.05 kPa. The AUC and 95% CI of spleen stiffness value were 0.824 and 0.736-0.913, respectively, with the cutoff value of 52.8 kPa.Conclusion TE is simple and non-invasive with high accuracy to diagnose non-cirrhotic PHT. When the liver stiffness value is 14.05 kPa and spleen stiffness value is 52.84 kPa, Youden index for diagnosis of non-cirrhotic PHT is the maximum.

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