BACKGROUND The treatment of hepatitis C with direct-acting antiviral agents(DAAs)produces a high rate of sustained virological response(SVR)with fewer adverse events than interferon(IFN)therapy with a similar effect i...BACKGROUND The treatment of hepatitis C with direct-acting antiviral agents(DAAs)produces a high rate of sustained virological response(SVR)with fewer adverse events than interferon(IFN)therapy with a similar effect in inhibiting carcinogenesis as IFN therapy.The age-male-albumin-bilirubin-platelets(aMAP)score is useful for stratifying the risk of hepatocellular carcinoma in chronic hepatitis patients,and the velocity of shear waves(Vs)measured by shear wave elastography has also been shown to be useful for diagnosing the level of fibrotic progression in hepatitis C and predicting carcinogenic risk.Combining these two may improve the prediction of carcinogenic risk.AIM To determine whether combining the aMAP score with Vs improves carcinogenic risk stratification in medium-to-high-risk hepatitis C patients.METHODS This retrospective,observational study involved hepatitis C patients treated with DAAs who achieved SVR.Vs was measured before treatment(baseline),at the end of treatment(EOT),and 12 wk(follow-up 12)and 24 wk(follow-up 24)after treatment.The patients were followed for at least six months after EOT to determine whether cancer developed.Multiple regression analysis was used to identify factors contributing to hepatic carcinogenesis.The diagnostic performances of clinical parameters for predicting the presence of hepatocellular carcinoma were evaluated using receiver-operating characteristic(ROC)curve analyses.RESULTS A total of 279 patients(mean age 65.9 years,118 males,161 females)were included in the analysis.Multiple regression analysis was performed with carcinogenesis as the target variable and alanine aminotransferase,platelets,α-fetoprotein,Vs,and the Fib-4 index as explanatory variables;only Vs was found to be significant(P=0.0296).The cut-off value for Vs for liver carcinogenesis calculated using the ROC curve was 1.53 m/s.Carcinoma developed in 2.0%(3/151)of those with Vs<1.53 m/s and in 10.5%(9/86)of those with Vs≥1.53 m/s.CONCLUSION In hepatitis C patients after SVR,combining the aMAP score and Vs to stratify the risk of carcinogenesis is more efficient than uniform surveillance of all patients.展开更多
BACKGROUND Shear wave speed(SWS),shear wave dispersion(SWD),and attenuation imaging(ATI)are new diagnostic parameters for non-alcoholic fatty liver disease.To differentiate between non-alcoholic steatohepatitis(NASH)a...BACKGROUND Shear wave speed(SWS),shear wave dispersion(SWD),and attenuation imaging(ATI)are new diagnostic parameters for non-alcoholic fatty liver disease.To differentiate between non-alcoholic steatohepatitis(NASH)and non-alcoholic fatty liver(NAFL),we developed a clinical index we refer to as the“NASH pentagon”consisting of the 3 abovementioned parameters,body mass index(BMI),and Fib-4 index.AIM To investigate whether the area of the NASH pentagon we propose is useful in discriminating between NASH and NAFL.METHODS This non-invasive,prospective,observational study included patients diagnosed with fatty liver by abdominal ultrasound between September 2021 and August 2022 in whom shear wave elastography,SWD,and ATI were measured.Histological diagnosis based on liver biopsy was performed in 31 patients.The large pentagon group(LP group)and the small pentagon group(SP group),using an area of 100 as the cutoff,were compared;the NASH diagnosis rate was also investigated.In patients with a histologically confirmed diagnosis,receiveroperating characteristic(ROC)curve analyses were performed.RESULTS One hundred-seven patients(61 men,46 women;mean age 55.1 years;mean BMI 26.8 kg/m2)were assessed.The LP group was significantly older(mean age:60.8±15.2 years vs 46.4±13.2 years;P<0.0001).Twenty-five patients who underwent liver biopsies were diagnosed with NASH,and 6 were diagnosed with NAFL.On ROC curve analyses,the areas under the ROC curves for SWS,dispersion slope,ATI value,BMI,Fib-4 index,and the area of the NASH pentagon were 0.88000,0.82000,0.58730,0.63000,0.59333,and 0.93651,respectively;the largest was that for the area of the NASH pentagon.CONCLUSION The NASH pentagon area appears useful for discriminating between patients with NASH and those with NAFL.展开更多
文摘BACKGROUND The treatment of hepatitis C with direct-acting antiviral agents(DAAs)produces a high rate of sustained virological response(SVR)with fewer adverse events than interferon(IFN)therapy with a similar effect in inhibiting carcinogenesis as IFN therapy.The age-male-albumin-bilirubin-platelets(aMAP)score is useful for stratifying the risk of hepatocellular carcinoma in chronic hepatitis patients,and the velocity of shear waves(Vs)measured by shear wave elastography has also been shown to be useful for diagnosing the level of fibrotic progression in hepatitis C and predicting carcinogenic risk.Combining these two may improve the prediction of carcinogenic risk.AIM To determine whether combining the aMAP score with Vs improves carcinogenic risk stratification in medium-to-high-risk hepatitis C patients.METHODS This retrospective,observational study involved hepatitis C patients treated with DAAs who achieved SVR.Vs was measured before treatment(baseline),at the end of treatment(EOT),and 12 wk(follow-up 12)and 24 wk(follow-up 24)after treatment.The patients were followed for at least six months after EOT to determine whether cancer developed.Multiple regression analysis was used to identify factors contributing to hepatic carcinogenesis.The diagnostic performances of clinical parameters for predicting the presence of hepatocellular carcinoma were evaluated using receiver-operating characteristic(ROC)curve analyses.RESULTS A total of 279 patients(mean age 65.9 years,118 males,161 females)were included in the analysis.Multiple regression analysis was performed with carcinogenesis as the target variable and alanine aminotransferase,platelets,α-fetoprotein,Vs,and the Fib-4 index as explanatory variables;only Vs was found to be significant(P=0.0296).The cut-off value for Vs for liver carcinogenesis calculated using the ROC curve was 1.53 m/s.Carcinoma developed in 2.0%(3/151)of those with Vs<1.53 m/s and in 10.5%(9/86)of those with Vs≥1.53 m/s.CONCLUSION In hepatitis C patients after SVR,combining the aMAP score and Vs to stratify the risk of carcinogenesis is more efficient than uniform surveillance of all patients.
文摘BACKGROUND Shear wave speed(SWS),shear wave dispersion(SWD),and attenuation imaging(ATI)are new diagnostic parameters for non-alcoholic fatty liver disease.To differentiate between non-alcoholic steatohepatitis(NASH)and non-alcoholic fatty liver(NAFL),we developed a clinical index we refer to as the“NASH pentagon”consisting of the 3 abovementioned parameters,body mass index(BMI),and Fib-4 index.AIM To investigate whether the area of the NASH pentagon we propose is useful in discriminating between NASH and NAFL.METHODS This non-invasive,prospective,observational study included patients diagnosed with fatty liver by abdominal ultrasound between September 2021 and August 2022 in whom shear wave elastography,SWD,and ATI were measured.Histological diagnosis based on liver biopsy was performed in 31 patients.The large pentagon group(LP group)and the small pentagon group(SP group),using an area of 100 as the cutoff,were compared;the NASH diagnosis rate was also investigated.In patients with a histologically confirmed diagnosis,receiveroperating characteristic(ROC)curve analyses were performed.RESULTS One hundred-seven patients(61 men,46 women;mean age 55.1 years;mean BMI 26.8 kg/m2)were assessed.The LP group was significantly older(mean age:60.8±15.2 years vs 46.4±13.2 years;P<0.0001).Twenty-five patients who underwent liver biopsies were diagnosed with NASH,and 6 were diagnosed with NAFL.On ROC curve analyses,the areas under the ROC curves for SWS,dispersion slope,ATI value,BMI,Fib-4 index,and the area of the NASH pentagon were 0.88000,0.82000,0.58730,0.63000,0.59333,and 0.93651,respectively;the largest was that for the area of the NASH pentagon.CONCLUSION The NASH pentagon area appears useful for discriminating between patients with NASH and those with NAFL.
