The present letter to the editor is related to the review with the title“Past,present,and future of long-term treatment for hepatitis B virus.”Chronic hepatitis B(CHB)represents an important and pressing public heal...The present letter to the editor is related to the review with the title“Past,present,and future of long-term treatment for hepatitis B virus.”Chronic hepatitis B(CHB)represents an important and pressing public health concern.Timely identification and effective antiviral therapy hold the potential to reduce liver-related mortality attributable to chronic infection with hepatitis B virus(HBV)substantially.However,the current global treatment rates for CHB remain conspicuously low,with the excessively stringent treatment criteria advocated by national CHB guidelines being a contributing factor to these low rates.Nevertheless,recent strides in comprehending this malady and the emergence of novel antiviral agents prompt the imperative re-evaluation of treatment standards to extend the sphere of potential beneficiaries.An impending need arises for a novel paradigm for the classification of patients with CHB,the expansion of antiviral treatment eligibility for HBV-infected individuals,and even the streamlining of the diagnostic process for CHB to amplify cost-effectiveness and augment survival prospects.展开更多
BACKGROUND Within the normal range,elevated alanine aminotransferase(ALT)levels are associated with an increased risk of metabolic dysfunction-associated fatty liver disease(MAFLD).AIM To investigate the associations ...BACKGROUND Within the normal range,elevated alanine aminotransferase(ALT)levels are associated with an increased risk of metabolic dysfunction-associated fatty liver disease(MAFLD).AIM To investigate the associations between repeated high-normal ALT measurements and the risk of new-onset MAFLD prospectively.METHODS A cohort of 3553 participants followed for four consecutive health examinations over 4 years was selected.The incidence rate,cumulative times,and equally and unequally weighted cumulative effects of excess high-normal ALT levels(ehALT)were measured.Cox proportional hazards regression was used to analyse the association between the cumulative effects of ehALT and the risk of new-onset MAFLD.RESULTS A total of 83.13%of participants with MAFLD had normal ALT levels.The incidence rate of MAFLD showed a linear increasing trend in the cumulative ehALT group.Compared with those in the low-normal ALT group,the multivariate adjusted hazard ratios of the equally and unequally weighted cumulative effects of ehALT were 1.651[95%confidence interval(CI):1.199-2.273]and 1.535(95%CI:1.119-2.106)in the third quartile and 1.616(95%CI:1.162-2.246)and 1.580(95%CI:1.155-2.162)in the fourth quartile,respectively.CONCLUSION Most participants with MAFLD had normal ALT levels.Long-term high-normal ALT levels were associated with a cumulative increased risk of new-onset MAFLD.展开更多
We write a letter to the editor commenting the article“Who to screen and how to screen for celiac disease”.We discuss the present literature on cirrhosis and celiac disease(CD)and recommend screening and treating CD...We write a letter to the editor commenting the article“Who to screen and how to screen for celiac disease”.We discuss the present literature on cirrhosis and celiac disease(CD)and recommend screening and treating CD in individuals with cryptogenic cirrhosis.展开更多
BACKGROUND The clinical and histological features of chronic hepatitis B(CHB)patients who fall into the"grey zone(GZ)"and do not fit into conventional natural phases are unclear.AIM To explore the impact of ...BACKGROUND The clinical and histological features of chronic hepatitis B(CHB)patients who fall into the"grey zone(GZ)"and do not fit into conventional natural phases are unclear.AIM To explore the impact of varying the threshold of alanine aminotransferase(ALT)levels in identifying significant liver injury among GZ patients.METHODS This retrospective analysis involved a cohort of 1617 adult patients diagnosed with CHB who underwent liver biopsy.The clinical phases of CHB patients were determined based on the European Association for the Study of the Liver 2017 Clinical Practice Guidelines.GZ CHB patients were classified into four groups:GZ-A(HBeAg positive,normal ALT levels,and HBV DNA≤10^(7) IU/mL),GZ-B(HBeAg positive,elevated ALT levels,and HBV DNA<10^(4) or>10^(7) IU/mL),GZC(HBeAg negative,normal ALT levels,and HBV DNA≥2000 IU/mL),and GZ-D(HBeAg negative,elevated ALT levels,and HBV DNA≤2000 IU/mL).Significant hepatic injury(SHI)was defined as the presence of notable liver inflammation(≥G2)and/or significant fibrosis(≥S2).RESULTS The results showed that 50.22%of patients were classified as GZ,and 63.7%of GZ patients developed SHI.The study also found that lowering the ALT treatment thresholds to the American Association for the Study of Liver Diseases 2018 treatment criteria(35 U/L for men and 25 U/L for women)can more accurately identify patients with significant liver damage in the GZ phases.In total,the proportion of patients with ALT≤40 U/L who required antiviral therapy was 64.86%[(221+294)/794].When we lowered the ALT treatment threshold to the new criteria(30 U/L for men and 19 U/L for women),the same outcome was revealed,and the proportion of patients with ALT≤40 U/L who required antiviral therapy was 75.44%[(401+198)/794].Additionally,the proportion of SHI was 49.1%in patients under 30 years old and increased to 55.3%in patients over 30 years old(P=0.136).CONCLUSION These findings suggest the importance of redefining the natural phases of CHB and using new ALT treatment thresholds for better diagnosis and management of CHB patients in the GZ phases.展开更多
BACKGROUND Coronavirus disease 2019(COVID-19)has spread rapidly,resulting in a pandemic in January 2020.Few studies have focused on the natural history and consequences of acute liver injury(ALI)in mild or asymptomati...BACKGROUND Coronavirus disease 2019(COVID-19)has spread rapidly,resulting in a pandemic in January 2020.Few studies have focused on the natural history and consequences of acute liver injury(ALI)in mild or asymptomatic COVID-19 patients,manifested by elevated aminotransferase levels.ALI is usually expected for severe COVID-19 cases.Here,we present a COVID-19 case with mild respiratory symptoms and significantly elevated alanine aminotransferase(ALT)and aspartate aminotransferase(AST)levels.CASE SUMMARY A 60-year-old woman without medical history or chronic illness received three COVID-19 vaccinations since the start of the pandemic.The patient was infected with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)and presented with mild symptoms on July 12th,2022.Post-recovery,she underwent an examination at our hospital on August 30th,2022.AST and ALT levels in the liver function test were 207 U/L(normal value<39,5.3-fold increase)and 570 U/L(normal value<52,10.9-fold increase),respectively.The patient was diagnosed with ALI,and no treatment was prescribed.The following week,blood tests showed a reduction in both levels(ALT 124 U/L,AST 318 U/L).Two weeks later,AST and ALT levels had decreased to near the expected upper limits(ALT 40 U/L,AST 76 U/L).CONCLUSION Clinicians should pay attention to liver function testing during COVID-19 recovery regardless of the disease’s severity.展开更多
本研究目的是探讨血清N-聚糖模型在285例丙氨酸转移酶(alanine aminotransferase,ALT)水平正常(<40 U·L^(-1))的慢性乙型肝炎(慢性乙肝)患者中诊断显著肝纤维化和肝硬化的临床意义。入组患者均进行肝组织活检,并使用Ishak评分...本研究目的是探讨血清N-聚糖模型在285例丙氨酸转移酶(alanine aminotransferase,ALT)水平正常(<40 U·L^(-1))的慢性乙型肝炎(慢性乙肝)患者中诊断显著肝纤维化和肝硬化的临床意义。入组患者均进行肝组织活检,并使用Ishak评分系统评估患者肝组织纤维化程度。应用基于DNA测序仪的荧光糖电泳技术检测患者血清N-聚糖图谱,每例患者的血清样本中共鉴定出9个N-聚糖峰。利用机器学习算法,即随机森林(random forest,RF)构建更理想的血清N-聚糖模型,以诊断显著肝纤维化(≥F3)和肝硬化(≥F5),并比较血清N-聚糖模型和其他纤维化标志物的诊断效能。肝组织活检结果显示,有显著肝纤维化和肝硬化患者分别占63.86%(182/285)和16.49%(47/285),有显著炎症患者为4.91%(14/285)。血清N-聚糖RF-A模型具有很好的诊断显著肝纤维化(≥F3)的效能,其受试者工作特征曲线下面积(area under receiver operating characteristic curve,AUROC)为0.94,与肝活检的符合率为90.45%。在诊断肝硬化(≥F5)时,血清N-聚糖RF-B模型的AUROC为0.97,与肝组织活检的符合率为88.94%。血清N-聚糖模型(RF-A和RF-B)的诊断效能优于肝硬度值测量(liver stiffness measurement,LSM)、基于4因子的纤维化指数(fibrosis index based on the four factors,FIB-4)和天冬氨酸转氨酶与血小板比率指数(aspartate aminotransferase-to-platelet ratio index,APRI)。在ALT水平正常的慢性乙肝患者中,血清N-聚糖模型可作为诊断显著肝纤维化或肝硬化的潜在生物标志物。展开更多
BACKGROUND Serum alanine aminotransferase(ALT) levels are often considered a marker to evaluate liver disease and its severity.AIM To investigate the association between ALT levels and all-cause and cause-specific mor...BACKGROUND Serum alanine aminotransferase(ALT) levels are often considered a marker to evaluate liver disease and its severity.AIM To investigate the association between ALT levels and all-cause and cause-specific mortality in patients with nonalcoholic fatty liver disease(NAFLD).METHODS The Third National Health and Nutrition Examination Survey(NHANES-Ⅲ) from 1988 to 1994 and NHANES-Ⅲ-related mortality data from 2019 onward were used to obtain the necessary data for the study. NAFLD was defined as hepatic steatosis, as diagnosed by ultrasound, with no other liver diseases. ALT levels were categorized into four groups according to the different recommended upper limits of normal(ULN) in men and women: < 0.5 ULN, 0.5-1 ULN, 1-2 ULN, and ≥ 2 ULN. The hazard ratios for all-cause mortality and cause-specific mortality were analyzed using the Cox proportional hazard model.RESULTS Multivariate logistic regression analysis demonstrated that the odds ratio of NAFLD correlated positively with increased serum ALT levels. In patients with NAFLD, all-cause mortality and cardiovascular mortality were the highest when ALT was < 0.5 ULN, yet cancer-related mortality was the highest when ALT was ≥ 2 ULN. The same results could be found in both men and women. Univariate analysis showed that severe NAFLD with normal ALT levels had the highest allcause and cause-specific mortality, but the difference was not statistically significant after adjustment for age and multivariate factors.CONCLUSION The risk of NAFLD was positively correlated with ALT level, but all-cause and cardiovascular mortality were the highest when ALT was < 0.5 ULN. Regardless of the severity of NAFLD, normal or lower ALT levels were associated with higher mortality than elevated ALT levels. Clinicians should be aware that high ALT levels indicate liver injury, but low ALT levels are associated with a higher risk of death.展开更多
BACKGROUND Previously,some studies have proposed that total laparoscopic gastrectomy(TLG)is superior to laparoscopic-assisted gastrectomy(LAG)in terms of safety and feasibility based on the related intraoperative oper...BACKGROUND Previously,some studies have proposed that total laparoscopic gastrectomy(TLG)is superior to laparoscopic-assisted gastrectomy(LAG)in terms of safety and feasibility based on the related intraoperative operative parameters and incidence of postoperative complications.However,there are still few studies on the changes in postoperative liver function in patients undergoing LG.The present study compared the postoperative liver function of patients with TLG and LAG,aiming to explore whether there is a difference in the influence of TLG and LAG on the liver function of patients.AIM To investigate whether there is a difference in the influence of TLG and LAG on the liver function of patients.METHODS The present study collected 80 patients who underwent LG from 2020 to 2021 at the Digestive Center(including the Department of Gastrointestinal Surgery and the Department of General Surgery)of Zhongshan Hospital affiliated with Xiamen University,including 40 patients who underwent TLG and 40 patients who underwent LAG.Alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP),γ-glutamyltransferase(GGLT),total bilirubin(TBIL),direct bilirubin(DBIL)and indirect bilirubin(IBIL),and other liver function-related test indices were compared between the 2 groups before surgery and on the 1^(st),3^(rd),and 5^(th) d after surgery.RESULTS The levels of ALT and AST in the 2 groups were significantly increased on the 1st to 2nd postoperative days compared with those before the operation.The levels of ALT and AST in the TLG group were within the normal range,while the levels of ALT and AST in the LAG group were twice as high as those in the TLG group(P<0.05).The levels of ALT and AST in the 2 groups showed a downward trend at 3-4 d and 5-7 d after the operation and gradually decreased to the normal range(P<0.05).The GGLT level in the LAG group was higher than that in the TLG group on postoperative days 1-2,the ALP level in the TLG group was higher than that in the LAG group on postoperative days 3-4,and the TBIL,DBIL and IBIL levels in the TLG group were higher than those in the LAG group on postoperative days 5-7(P<0.05).No significant difference was observed at other time points(P>0.05).CONCLUSION Both TLG and LAG can affect liver function,but the effect of LAG is more serious.The influence of both surgical approaches on liver function is transient and reversible.Although TLG is more difficult to perform,it may be a better choice for patients with gastric cancer combined with liver insufficiency.展开更多
The association between heavy metals in the blood and obesity has been examined in many studies.However,inconsistencies have been observed in the results of these studies.The present study was conducted using data fro...The association between heavy metals in the blood and obesity has been examined in many studies.However,inconsistencies have been observed in the results of these studies.The present study was conducted using data from 119,181 participants of the Korea National Health and Nutrition Examination Survey(KNHANES)for 11 years in 2005 and between 2008 and 2017.The subjects with missing heavy metal blood tests,health interview data,and health examination data were excluded from the study.The study population comprised 1,844 individuals(972 men,and 872 women)who were eligible for inclusion.It was found that obesity and abdominal obesity were associated with an increase in both blood mercury(P<0.001)and alanine aminotransferase(ALT)(P<0.001).After adjusting the confounding factors,those with concurrent high levels of ALT and the highest tertile of mercury showed an increased risk of obesity(odds ratio 4.46,95%confidence interval 2.23-8.90,P<0.001)as well as abdominal obesity(odds ratio 5.36,95%confidence interval 2.57-11.17,P<0.001).The interrelationship of mercury and ALT with the parameters of body mass index(P for interaction=0.009)and waist circumference(P for interaction=0.012),respectively,have been observed to be significant,suggesting that the reciprocal relationship could contribute to obesity and abdominal obesity.展开更多
For several decades,serum levels of alanine(ALT) and aspartate(AST) aminotransferases have been regarded as markers of liver injury,including a wide range of etiologies from viral hepatitis to fatty liver.The increasi...For several decades,serum levels of alanine(ALT) and aspartate(AST) aminotransferases have been regarded as markers of liver injury,including a wide range of etiologies from viral hepatitis to fatty liver.The increasing worldwide prevalence of metabolic syndrome and cardiovascular disease revealed that transaminases are strong predictors of type 2 diabetes,coronary heart disease,atherothrombotic risk profile,and overall risk of metabolic disease.Therefore,it is plausible to suggest that aminotransferases are surrogate biomarkers of "liver metabolic functioning" beyond the classical concept of liver cellular damage,as their enzymatic activity might actually reflect key aspects of the physiology and pathophysiology of the liver function.In this study,we summarize the background information and recent findings on the biological role of ALT and AST,and review the knowledge gained from the application of genome-wide approaches and "omics" technologies that uncovered new concepts on the role of aminotransferases in human diseases and systemic regulation of metabolic functions.Prediction of biomolecular interactions between the candidate genes recently discovered to be associated with plasma concentrations of liver enzymes showed interesting interconnectivity nodes,which suggest that regulation of aminotransferase activity is a complex and highly regulated trait.Finally,links between aminotransferase genes and metabolites are explored to understand the genetic contributions to the metabolic diversity.展开更多
Rhabdomyolysis is a syndrome of skeletal muscle injury with release of cellular constituents such as potassium,phosphate,urate and intracellular proteins such as myoglobin into the circulation,which may cause complica...Rhabdomyolysis is a syndrome of skeletal muscle injury with release of cellular constituents such as potassium,phosphate,urate and intracellular proteins such as myoglobin into the circulation,which may cause complications including acute kidney injury,electrolyte disturbance and cardiac instability.Abnormal liver function tests are frequently observed in cases of severe rhabdomyolysis.Typically,there is an increase in serum aminotransferases,namely aspartate aminotransferase and alanine aminotransferase.This raises the question of liver injury and often triggers a pathway of investigation which may lead to a liver biopsy.However,muscle can also be a source of the increased aminotransferase activity.This review discusses the dilemma of finding abnormal liver function tests in the setting of muscle injury and the potential implications of such an association.It delves into some of the clinical and experimental evidence for correlating muscle injury to raised aminotransferases,and discusses pathophysiological mechanisms such as oxidative stress which may cause actual liver injury.Serum aminotransferases lack tissue specificity to allow clinicians to distinguish primary liver injury from muscle injury.This review also explores potential approaches to improve the accuracy of our diagnostic tools,so that excessive or unnecessary liver investigations can be avoided.展开更多
Large and small doses of drugs for improving blood circulation and removing blood stasis were used in model rats to treat mild chronic hepatic damage induced by carbon tetrachloride (CCl4). The results show that large...Large and small doses of drugs for improving blood circulation and removing blood stasis were used in model rats to treat mild chronic hepatic damage induced by carbon tetrachloride (CCl4). The results show that large dose of Dang Gui (当归 Radix Angelicae Sinensis) and Dan Shen (丹参 Radix Salviae Miltiorrhizae) (drugs for regulating blood flow) and small dose of Yu Jin (郁金 Radix Curcumae) and Niu Xi (牛膝 Radix Achyranthis Bidentatae) (drugs for activating blood flow) can significantly elevate the activity of SOD (P<0.05) and/or lower the T/K ratio, markedly reduce the MDA content (P<0.05 or P<0.01) and significantly decrease the activities of ALT and AST (P<0.05 or P<0.01), demonstrating that these drugs are effective in combating oxygen free radicals (OFR) in chronic liver damage. On the contrary, large dose of Tu Bie Chong (土鳖虫 Eupolyphaga seu Steleophaga) and E Zhu (莪术 Rhizoma Curcumae) (drugs for removing blood stasis) tend to increase the ALT and AST (P<0.05) activities. The results suggest that the synergism of elevation of the SOD activity and reduction of T/K ratio contributes to the action of drugs for improving blood circulation and removing blood stasis in combating the liver damage induced by CCl4.展开更多
AIM:To evaluate the association of nonalcoholic fatty liver disease(NAFLD)with acute ischemic stroke severity and in-hospital outcome.METHODS:We prospectively studied all patients who were admitted in our Department w...AIM:To evaluate the association of nonalcoholic fatty liver disease(NAFLD)with acute ischemic stroke severity and in-hospital outcome.METHODS:We prospectively studied all patients who were admitted in our Department with acute ischemic stroke between September 2010 and August 2012(n=415;39.5%males,mean age 78.8±6.6 years).The severity of stroke was assessed with the National Institutes of Health Stroke Scale(NIHSS)score at admission.NALFD was defined as serum alanine aminotransferase and/or aspartate aminotransferase levels above the upper limit of normal in the absence of other causes of elevated aminotransferases levels[chronic hepatitis B or C,drug toxicity,increased alcohol consumption(】21 and】14 drinks per week in men and women,respectively),cholestatic diseases or rhabdomyolysis].The outcome was assessed with the modified Rankin scale(mRS)score at discharge and in-hospital mortality.Adverse outcome was defined as mRS score at discharge≥2.Dependency at discharge was defined as mRS score between 2 to 5.RESULTS:NAFLD was present in 7.7%of the study population.Patients with NAFLD had lower serum high-density lipoprotein cholesterol and higher triglyceride levels than patients without NAFLD(P【0.05 for both comparisons).Demographic data,the prevalence of other cardiovascular risk factors and the prevalence of established CVD did not differ between the two groups.At admission,the NIHSS score did not differ between patients with and without NAFLD(6.3±6.4and 8.8±9.6,respectively;P=NS).At discharge,the mRS score did not differ between the two groups(1.9±2.2 and 2.6±2.2 in patients with and without NAFLD,respectively;P=NS).Rates of dependency at discharge were also similar in patients with and without NAFLD(36.8%and 55.0%,respectively;P=NS)as were the rates of adverse outcome(42.9%and58.6%,respectively;P=NS).In-hospital mortality rates also did not differ between the 2 groups(8.0%and 7.0%in patients with and without NAFLD,respectively;P=NS).CONCLUSION:The presence of NAFLD in patients admitted for acute ischemic stroke does not appear to be associated with more severe stroke or with worse in-hospital outcome.展开更多
Serum aminotransferases have been used as surrogate markers for liver ischemia-reperfusion injury that follows liver surgery. Some studies have suggested that rises in serum alanine aminotransferase(ALT) correlate wit...Serum aminotransferases have been used as surrogate markers for liver ischemia-reperfusion injury that follows liver surgery. Some studies have suggested that rises in serum alanine aminotransferase(ALT) correlate with patient outcome after liver resection. We assessed whether postoperative day 1(POD 1) ALT could be used to predict patient morbidity and mortality following liver resection. We reviewed our prospectively held database and included consecutive adult patients undergoing elective liver resection in our institution between January 2013 and December 2014. Primary outcome assessed was correlation of POD 1 ALT with patient's morbidity and mortality. We also assessed whether concurrent radiofrequency ablation, neoadjuvant chemotherapy and use of the Pringle maneuver significantly affected the level of POD 1 ALT. A total of 110 liver resections were included in the study. The overall in-hospital patient morbidity and mortality were 31.8% and 0.9%, respectively. The median level of POD 1 ALT was 275 IU/L. No correlation was found between POD 1 serum ALT levels and patient morbidity after elective liver resection, whilst correlation with mortality was not possible because of the low number of mortalities. Patients undergoing concurrent radiofrequency ablation were noted to have an increased level of POD 1 serum ALT but not those given neoadjuvant chemotherapy and those in whom the Pringle maneuver was used. Our study demonstrates POD 1 serum ALT does not correlate with patient morbidity after elective liver resection.展开更多
AIM:To investigate the usefulness of mild iron depletion and the factors predictive for histological improvement following phlebotomy in Caucasians with chronic hepatitis C(CHC). METHODS:We investigated 28 CHC Caucasi...AIM:To investigate the usefulness of mild iron depletion and the factors predictive for histological improvement following phlebotomy in Caucasians with chronic hepatitis C(CHC). METHODS:We investigated 28 CHC Caucasians with persistently elevated serum aminotransferase levels and non responders to,or unsuitable for,antiviral therapy who underwent mild iron depletion(ferritin≤70 ng/mL) by long-term phlebotomy.Histological improvement,as defined by at least one point reduction in the staging score or,in case of unchanged stage,as at least two points reduction in the grading score(Knodell),was evaluated in two subsequent liver biopsies(before and at the end of phlebotomy,48±16 mo apart).RESULTS:Phlebotomy showed an excellent safety profile.Histological improvement occurred in 12/28 phlebotomized patients.Only males responded to phlebotomy.At univariate logistic analysis alcohol intake(P=0.034),high histological grading(P=0.01) and high hepatic iron concentration(HIC)(P=0.04) before treatment were associated with histological improvement.Multivariate logistic analysis showed that in males high HIC was the only predictor of histological improvement following phlebotomy(OR=1.41, 95%CI:1.03-1.94,P=0.031).Accordingly,12 out of 17(70%)patients with HIC≥20μmol/g showed histological improvements at the second biopsy. CONCLUSION:Male CHC Caucasian non-responders to antiviral therapy with low-grade iron overload can benefit from mild iron depletion by long-term phlebotomy.展开更多
Objective:To investigate the ability of the methanolic extract of pineapple peel to modulate alcohol-induced lipid peroxidation,changes in catalase activities and hepatic biochemical marker levels in blood plasma.Meth...Objective:To investigate the ability of the methanolic extract of pineapple peel to modulate alcohol-induced lipid peroxidation,changes in catalase activities and hepatic biochemical marker levels in blood plasma.Methods:Oxidative stress was induced by oral administration of ethanol(20%w/v) at a dosage of 5 niL/kg bw in rats.After 28 days of treatment,the rats were fasted overnight and sacrificed by cervical dislocation.Blood was collected with a 2 mL syringe by cardiac puncture and was centrifuged at 3000 rpm for 10 min.The plasma was analyzed to evaluate malondialdehyde(MDA),catalase activity,aspartate aminotransferase(AST),alkaline phosphatase(ALP) and alanine aminotransferase(ALT) concentrations.Results:Administration of alcohol caused a drastic increase(87.74%) in MDA level compared with the control.Pineapple peel extract significantly reduced the MDA level by 60.16%at 2.S mL/kg bw.Rats fed alcohol only had the highest catalase activity,treatment with pineapple peel extract at 2.5 mL/kg bw however, reduced the activity.Increased AST,ALP and ALT activities were observed in rats fed alcohol only respectively,treatment with pineapple peel extract drastically reduced their activities. Conclusions:The positive modulation of lipid peroxidation,catalase activities as well as hepatic biomarker levels of blood plasma by the methanolic extract of pineapple peels under alcoholinduced oxidative stress is an indication of its protective ability in the management of alcoholinduced toxicity.展开更多
BACKGROUND Researchers have investigated the diagnostic value of protein induced by vitamin K absence or antagonist II (PIVKA-II) and alpha-fetoprotein (AFP) in hepatitis B virus (HBV)-related hepatocellular carcinoma...BACKGROUND Researchers have investigated the diagnostic value of protein induced by vitamin K absence or antagonist II (PIVKA-II) and alpha-fetoprotein (AFP) in hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC), and obtained abundant clinical diagnostic data. However, PIVKA-II and AFP have unsatisfactory specificity and sensitivity in the diagnosis of early-stage HBV-related HCC. Gamma-glutamyltransferase (γ-GT) and aspartate aminotransferase (AST) are common biomarkers for evaluating liver function, and we hypothesized that the γ-GT/AST ratio in combination with PIVKA-II and AFP would improve the diagnosis of early-stage HBV-related HCC. AIM To evaluate the diagnostic value of γ-GT/AST ratio alone or in combination with PIVKA-II and AFP in HBV-related HCC. METHODS Serum levels of γ-GT, AST, PIVKA-II, and AFP were detected and analysed in 176 patients with HBV-related HCC and in 359 patients with chronic hepatitis B. According to tumour size and serum level of HBV DNA, HBV-related HCC patients were divided into the following categories: Early-stage HCC patients, HCC patients, HBV DNA positive (HBV DNA+) HCC patients, and HBV DNA negative (HBV DNA-) HCC patients. Receiver-operating characteristic (ROC) curves were used to analyse and compare the diagnostic value of the single and combined detection of various biomarkers in different types of HBV-related HCC. RESULTS Tumour size was positively correlated with serum levels of PIVKA-II and AFP in HCC patients (r = 0.529, aP < 0.001 and r = 0.270, bP < 0.001, respectively), but there was no correlation between tumour size and the γ-GT/AST ratio (r = 0.073, P = 0.336). The areas under the receiver-operating characteristic curves (AUROCs) of the γ-GT/AST ratio in early-stage HCC patients, HBV DNA+ HCC patients and HBV DNA- HCC patients were not significantly different from that in the total HCC patients (0.754, 0.802, and 0.705 vs 0.779, respectively;P > 0.05). When PIVKA-II was combined with the γ-GT/AST ratio in the diagnosis of earlystage HCC, HCC, and HBV DNA+ HCC, the AUROCs of PIVKA-II increased, with values of 0.857 vs 0.835, 0.925 vs 0.913, and 0.958 vs 0.954, respectively. When AFP was combined with the γ-GT/AST ratio in the diagnosis of early-stage HCC, HCC, HBV DNA+ HCC, and HBV DNA- HCC, the AUROCs of AFP increased, with values of 0.757 vs 0.621, 0.837 vs 0.744, 0.868 vs 0.757, and 0.840 vs 0.828, respectively. CONCLUSION The γ-GT/AST ratio may be better than PIVKA-II and AFP in the diagnosis of early-stage HBV-related HCC, and its combination with PIVKA-II and AFP can improve the diagnostic value for HBV-related HCC.展开更多
AIM: To investigate the association between liver markers and the risk of type 2 diabetes(T2DM) and impaired fasting glucose(IFG).METHODS: A total of 8863 participants(3408 men and 5455 women) over 30 years of age wer...AIM: To investigate the association between liver markers and the risk of type 2 diabetes(T2DM) and impaired fasting glucose(IFG).METHODS: A total of 8863 participants(3408 men and 5455 women) over 30 years of age were analyzed from the fifth Korean National Health and Nutrition Examination Survey(2010-2011). The associations of serum liver markers such as aspartate aminotransferase(AST), alanine aminotransferase(ALT), AST/ALT, and gamma-glutamyltransferase(GGT) with T2 DM and IFG were analyzed using logistic regression models. Participants were divided into sex-specific quartiles on the basis of liver markers.RESULTS: The prevalence of T2 DM and IFG were 11.3% and 18.3%. Increasing quartiles of ALT and GGT were positively and AST/ALT were negatively correlated with T2 DM and IFG. Analysis of the liver marker combinations showed that if any two or more markers were in the highest risk quartile, the risks of both T2 DM and IFG increased significantly. The risk was greatest when the highest ALT and GGT and lowest AST/ALT quartile were combined, with the riskof T2 DM at 3.21(95%CI: 1.829-5.622, P < 0.001) in men and 4.60(95%CI: 3.217-6.582, P < 0.001) in women. Men and women with the highest AST and ALT and lowest AST/ALT quartile had a 1.99 and 2.40 times increased risk of IFG.CONCLUSION: Higher levels of GGT and ALT and lower AST/ALT within the physiological range are independent, additive risk factors of T2 DM and IFG.展开更多
AIM: To investigate the combined diagnostic accuracy of acoustic radiation force impulse(ARFI), aspartate aminotransferase to platelet ratio index(APRI) and Forns index for a non-invasive assessment of liver fibrosis ...AIM: To investigate the combined diagnostic accuracy of acoustic radiation force impulse(ARFI), aspartate aminotransferase to platelet ratio index(APRI) and Forns index for a non-invasive assessment of liver fibrosis in patients with chronic hepatitis B(CHB). METHODS: In this prospective study, 206 patients had CHB with liver fibrosis stages F0-F4 classified by METAVIR and 40 were healthy volunteers were measured by ARFI, APRI and Forns index separately or combined as indicated. RESULTS: ARFI, APRI or Forns index demonstrated a significant correlation with the histological stage(all P < 0.001). According to the AUROC of ARFI and APRI for evaluating fibrotic stages more than F2, ARFI showed an enhanced diagnostic accuracy than APRI(P < 0.05). The combined measurement of ARFI and APRI exhibited better accuracy than ARFI alone when evaluating ≥ F2 fibrotic stage(Z = 2.77, P = 0.006). Combination of ARFI, APRI and Forns index did not obviously improve the diagnostic accuracy compared to the combination of ARFI and APRI(Z = 0.958, P = 0.338). CONCLUSION: ARFI + APRI showed enhanced diagnostic accuracy than ARFI or APRI alone for significant liver fibrosis and ARFI + APRI + Forns index shows the same effect with ARFI + APRI.展开更多
文摘The present letter to the editor is related to the review with the title“Past,present,and future of long-term treatment for hepatitis B virus.”Chronic hepatitis B(CHB)represents an important and pressing public health concern.Timely identification and effective antiviral therapy hold the potential to reduce liver-related mortality attributable to chronic infection with hepatitis B virus(HBV)substantially.However,the current global treatment rates for CHB remain conspicuously low,with the excessively stringent treatment criteria advocated by national CHB guidelines being a contributing factor to these low rates.Nevertheless,recent strides in comprehending this malady and the emergence of novel antiviral agents prompt the imperative re-evaluation of treatment standards to extend the sphere of potential beneficiaries.An impending need arises for a novel paradigm for the classification of patients with CHB,the expansion of antiviral treatment eligibility for HBV-infected individuals,and even the streamlining of the diagnostic process for CHB to amplify cost-effectiveness and augment survival prospects.
基金National Natural Science Foundation of China,No.72101236China Postdoctoral Science Foundation,No.2022M722900+1 种基金Collaborative Innovation Project of Zhengzhou City,No.XTCX2023006Nursing Team Project of the First Affiliated Hospital of Zhengzhou University,No.HLKY2023005.
文摘BACKGROUND Within the normal range,elevated alanine aminotransferase(ALT)levels are associated with an increased risk of metabolic dysfunction-associated fatty liver disease(MAFLD).AIM To investigate the associations between repeated high-normal ALT measurements and the risk of new-onset MAFLD prospectively.METHODS A cohort of 3553 participants followed for four consecutive health examinations over 4 years was selected.The incidence rate,cumulative times,and equally and unequally weighted cumulative effects of excess high-normal ALT levels(ehALT)were measured.Cox proportional hazards regression was used to analyse the association between the cumulative effects of ehALT and the risk of new-onset MAFLD.RESULTS A total of 83.13%of participants with MAFLD had normal ALT levels.The incidence rate of MAFLD showed a linear increasing trend in the cumulative ehALT group.Compared with those in the low-normal ALT group,the multivariate adjusted hazard ratios of the equally and unequally weighted cumulative effects of ehALT were 1.651[95%confidence interval(CI):1.199-2.273]and 1.535(95%CI:1.119-2.106)in the third quartile and 1.616(95%CI:1.162-2.246)and 1.580(95%CI:1.155-2.162)in the fourth quartile,respectively.CONCLUSION Most participants with MAFLD had normal ALT levels.Long-term high-normal ALT levels were associated with a cumulative increased risk of new-onset MAFLD.
文摘We write a letter to the editor commenting the article“Who to screen and how to screen for celiac disease”.We discuss the present literature on cirrhosis and celiac disease(CD)and recommend screening and treating CD in individuals with cryptogenic cirrhosis.
基金The Natural Science Foundation of Guangdong Province for Distinguished Young Scholar,No.2022B1515020024National Natural Science Foundation of China,No.82070574The Natural Science Foundation Team Project of Guangdong Province,No.2018B030312009.
文摘BACKGROUND The clinical and histological features of chronic hepatitis B(CHB)patients who fall into the"grey zone(GZ)"and do not fit into conventional natural phases are unclear.AIM To explore the impact of varying the threshold of alanine aminotransferase(ALT)levels in identifying significant liver injury among GZ patients.METHODS This retrospective analysis involved a cohort of 1617 adult patients diagnosed with CHB who underwent liver biopsy.The clinical phases of CHB patients were determined based on the European Association for the Study of the Liver 2017 Clinical Practice Guidelines.GZ CHB patients were classified into four groups:GZ-A(HBeAg positive,normal ALT levels,and HBV DNA≤10^(7) IU/mL),GZ-B(HBeAg positive,elevated ALT levels,and HBV DNA<10^(4) or>10^(7) IU/mL),GZC(HBeAg negative,normal ALT levels,and HBV DNA≥2000 IU/mL),and GZ-D(HBeAg negative,elevated ALT levels,and HBV DNA≤2000 IU/mL).Significant hepatic injury(SHI)was defined as the presence of notable liver inflammation(≥G2)and/or significant fibrosis(≥S2).RESULTS The results showed that 50.22%of patients were classified as GZ,and 63.7%of GZ patients developed SHI.The study also found that lowering the ALT treatment thresholds to the American Association for the Study of Liver Diseases 2018 treatment criteria(35 U/L for men and 25 U/L for women)can more accurately identify patients with significant liver damage in the GZ phases.In total,the proportion of patients with ALT≤40 U/L who required antiviral therapy was 64.86%[(221+294)/794].When we lowered the ALT treatment threshold to the new criteria(30 U/L for men and 19 U/L for women),the same outcome was revealed,and the proportion of patients with ALT≤40 U/L who required antiviral therapy was 75.44%[(401+198)/794].Additionally,the proportion of SHI was 49.1%in patients under 30 years old and increased to 55.3%in patients over 30 years old(P=0.136).CONCLUSION These findings suggest the importance of redefining the natural phases of CHB and using new ALT treatment thresholds for better diagnosis and management of CHB patients in the GZ phases.
文摘BACKGROUND Coronavirus disease 2019(COVID-19)has spread rapidly,resulting in a pandemic in January 2020.Few studies have focused on the natural history and consequences of acute liver injury(ALI)in mild or asymptomatic COVID-19 patients,manifested by elevated aminotransferase levels.ALI is usually expected for severe COVID-19 cases.Here,we present a COVID-19 case with mild respiratory symptoms and significantly elevated alanine aminotransferase(ALT)and aspartate aminotransferase(AST)levels.CASE SUMMARY A 60-year-old woman without medical history or chronic illness received three COVID-19 vaccinations since the start of the pandemic.The patient was infected with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)and presented with mild symptoms on July 12th,2022.Post-recovery,she underwent an examination at our hospital on August 30th,2022.AST and ALT levels in the liver function test were 207 U/L(normal value<39,5.3-fold increase)and 570 U/L(normal value<52,10.9-fold increase),respectively.The patient was diagnosed with ALI,and no treatment was prescribed.The following week,blood tests showed a reduction in both levels(ALT 124 U/L,AST 318 U/L).Two weeks later,AST and ALT levels had decreased to near the expected upper limits(ALT 40 U/L,AST 76 U/L).CONCLUSION Clinicians should pay attention to liver function testing during COVID-19 recovery regardless of the disease’s severity.
基金supported by the Major Science and Technology Special Project of China Thirteenth Five-year Plan(2018ZX10732401-003-015)the National Science and Technology Major Project(2013ZX10002005 and 2017ZX10203202)。
文摘本研究目的是探讨血清N-聚糖模型在285例丙氨酸转移酶(alanine aminotransferase,ALT)水平正常(<40 U·L^(-1))的慢性乙型肝炎(慢性乙肝)患者中诊断显著肝纤维化和肝硬化的临床意义。入组患者均进行肝组织活检,并使用Ishak评分系统评估患者肝组织纤维化程度。应用基于DNA测序仪的荧光糖电泳技术检测患者血清N-聚糖图谱,每例患者的血清样本中共鉴定出9个N-聚糖峰。利用机器学习算法,即随机森林(random forest,RF)构建更理想的血清N-聚糖模型,以诊断显著肝纤维化(≥F3)和肝硬化(≥F5),并比较血清N-聚糖模型和其他纤维化标志物的诊断效能。肝组织活检结果显示,有显著肝纤维化和肝硬化患者分别占63.86%(182/285)和16.49%(47/285),有显著炎症患者为4.91%(14/285)。血清N-聚糖RF-A模型具有很好的诊断显著肝纤维化(≥F3)的效能,其受试者工作特征曲线下面积(area under receiver operating characteristic curve,AUROC)为0.94,与肝活检的符合率为90.45%。在诊断肝硬化(≥F5)时,血清N-聚糖RF-B模型的AUROC为0.97,与肝组织活检的符合率为88.94%。血清N-聚糖模型(RF-A和RF-B)的诊断效能优于肝硬度值测量(liver stiffness measurement,LSM)、基于4因子的纤维化指数(fibrosis index based on the four factors,FIB-4)和天冬氨酸转氨酶与血小板比率指数(aspartate aminotransferase-to-platelet ratio index,APRI)。在ALT水平正常的慢性乙肝患者中,血清N-聚糖模型可作为诊断显著肝纤维化或肝硬化的潜在生物标志物。
文摘BACKGROUND Serum alanine aminotransferase(ALT) levels are often considered a marker to evaluate liver disease and its severity.AIM To investigate the association between ALT levels and all-cause and cause-specific mortality in patients with nonalcoholic fatty liver disease(NAFLD).METHODS The Third National Health and Nutrition Examination Survey(NHANES-Ⅲ) from 1988 to 1994 and NHANES-Ⅲ-related mortality data from 2019 onward were used to obtain the necessary data for the study. NAFLD was defined as hepatic steatosis, as diagnosed by ultrasound, with no other liver diseases. ALT levels were categorized into four groups according to the different recommended upper limits of normal(ULN) in men and women: < 0.5 ULN, 0.5-1 ULN, 1-2 ULN, and ≥ 2 ULN. The hazard ratios for all-cause mortality and cause-specific mortality were analyzed using the Cox proportional hazard model.RESULTS Multivariate logistic regression analysis demonstrated that the odds ratio of NAFLD correlated positively with increased serum ALT levels. In patients with NAFLD, all-cause mortality and cardiovascular mortality were the highest when ALT was < 0.5 ULN, yet cancer-related mortality was the highest when ALT was ≥ 2 ULN. The same results could be found in both men and women. Univariate analysis showed that severe NAFLD with normal ALT levels had the highest allcause and cause-specific mortality, but the difference was not statistically significant after adjustment for age and multivariate factors.CONCLUSION The risk of NAFLD was positively correlated with ALT level, but all-cause and cardiovascular mortality were the highest when ALT was < 0.5 ULN. Regardless of the severity of NAFLD, normal or lower ALT levels were associated with higher mortality than elevated ALT levels. Clinicians should be aware that high ALT levels indicate liver injury, but low ALT levels are associated with a higher risk of death.
基金The study was reviewed and approved by the Institutional review board of Zhongshan Hospital Xiamen University(approval No.2022-257).
文摘BACKGROUND Previously,some studies have proposed that total laparoscopic gastrectomy(TLG)is superior to laparoscopic-assisted gastrectomy(LAG)in terms of safety and feasibility based on the related intraoperative operative parameters and incidence of postoperative complications.However,there are still few studies on the changes in postoperative liver function in patients undergoing LG.The present study compared the postoperative liver function of patients with TLG and LAG,aiming to explore whether there is a difference in the influence of TLG and LAG on the liver function of patients.AIM To investigate whether there is a difference in the influence of TLG and LAG on the liver function of patients.METHODS The present study collected 80 patients who underwent LG from 2020 to 2021 at the Digestive Center(including the Department of Gastrointestinal Surgery and the Department of General Surgery)of Zhongshan Hospital affiliated with Xiamen University,including 40 patients who underwent TLG and 40 patients who underwent LAG.Alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP),γ-glutamyltransferase(GGLT),total bilirubin(TBIL),direct bilirubin(DBIL)and indirect bilirubin(IBIL),and other liver function-related test indices were compared between the 2 groups before surgery and on the 1^(st),3^(rd),and 5^(th) d after surgery.RESULTS The levels of ALT and AST in the 2 groups were significantly increased on the 1st to 2nd postoperative days compared with those before the operation.The levels of ALT and AST in the TLG group were within the normal range,while the levels of ALT and AST in the LAG group were twice as high as those in the TLG group(P<0.05).The levels of ALT and AST in the 2 groups showed a downward trend at 3-4 d and 5-7 d after the operation and gradually decreased to the normal range(P<0.05).The GGLT level in the LAG group was higher than that in the TLG group on postoperative days 1-2,the ALP level in the TLG group was higher than that in the LAG group on postoperative days 3-4,and the TBIL,DBIL and IBIL levels in the TLG group were higher than those in the LAG group on postoperative days 5-7(P<0.05).No significant difference was observed at other time points(P>0.05).CONCLUSION Both TLG and LAG can affect liver function,but the effect of LAG is more serious.The influence of both surgical approaches on liver function is transient and reversible.Although TLG is more difficult to perform,it may be a better choice for patients with gastric cancer combined with liver insufficiency.
基金This study was supported by the Jungwon University Research Grant(2021-044).
文摘The association between heavy metals in the blood and obesity has been examined in many studies.However,inconsistencies have been observed in the results of these studies.The present study was conducted using data from 119,181 participants of the Korea National Health and Nutrition Examination Survey(KNHANES)for 11 years in 2005 and between 2008 and 2017.The subjects with missing heavy metal blood tests,health interview data,and health examination data were excluded from the study.The study population comprised 1,844 individuals(972 men,and 872 women)who were eligible for inclusion.It was found that obesity and abdominal obesity were associated with an increase in both blood mercury(P<0.001)and alanine aminotransferase(ALT)(P<0.001).After adjusting the confounding factors,those with concurrent high levels of ALT and the highest tertile of mercury showed an increased risk of obesity(odds ratio 4.46,95%confidence interval 2.23-8.90,P<0.001)as well as abdominal obesity(odds ratio 5.36,95%confidence interval 2.57-11.17,P<0.001).The interrelationship of mercury and ALT with the parameters of body mass index(P for interaction=0.009)and waist circumference(P for interaction=0.012),respectively,have been observed to be significant,suggesting that the reciprocal relationship could contribute to obesity and abdominal obesity.
基金Supported by(in part)Grants PICT 2010-0441 and PICT 2012-0159(Agencia Nacional de Promoción Científica y Tecnológica)and UBACYT CM04(Universidad de Buenos Aires)
文摘For several decades,serum levels of alanine(ALT) and aspartate(AST) aminotransferases have been regarded as markers of liver injury,including a wide range of etiologies from viral hepatitis to fatty liver.The increasing worldwide prevalence of metabolic syndrome and cardiovascular disease revealed that transaminases are strong predictors of type 2 diabetes,coronary heart disease,atherothrombotic risk profile,and overall risk of metabolic disease.Therefore,it is plausible to suggest that aminotransferases are surrogate biomarkers of "liver metabolic functioning" beyond the classical concept of liver cellular damage,as their enzymatic activity might actually reflect key aspects of the physiology and pathophysiology of the liver function.In this study,we summarize the background information and recent findings on the biological role of ALT and AST,and review the knowledge gained from the application of genome-wide approaches and "omics" technologies that uncovered new concepts on the role of aminotransferases in human diseases and systemic regulation of metabolic functions.Prediction of biomolecular interactions between the candidate genes recently discovered to be associated with plasma concentrations of liver enzymes showed interesting interconnectivity nodes,which suggest that regulation of aminotransferase activity is a complex and highly regulated trait.Finally,links between aminotransferase genes and metabolites are explored to understand the genetic contributions to the metabolic diversity.
文摘Rhabdomyolysis is a syndrome of skeletal muscle injury with release of cellular constituents such as potassium,phosphate,urate and intracellular proteins such as myoglobin into the circulation,which may cause complications including acute kidney injury,electrolyte disturbance and cardiac instability.Abnormal liver function tests are frequently observed in cases of severe rhabdomyolysis.Typically,there is an increase in serum aminotransferases,namely aspartate aminotransferase and alanine aminotransferase.This raises the question of liver injury and often triggers a pathway of investigation which may lead to a liver biopsy.However,muscle can also be a source of the increased aminotransferase activity.This review discusses the dilemma of finding abnormal liver function tests in the setting of muscle injury and the potential implications of such an association.It delves into some of the clinical and experimental evidence for correlating muscle injury to raised aminotransferases,and discusses pathophysiological mechanisms such as oxidative stress which may cause actual liver injury.Serum aminotransferases lack tissue specificity to allow clinicians to distinguish primary liver injury from muscle injury.This review also explores potential approaches to improve the accuracy of our diagnostic tools,so that excessive or unnecessary liver investigations can be avoided.
文摘Large and small doses of drugs for improving blood circulation and removing blood stasis were used in model rats to treat mild chronic hepatic damage induced by carbon tetrachloride (CCl4). The results show that large dose of Dang Gui (当归 Radix Angelicae Sinensis) and Dan Shen (丹参 Radix Salviae Miltiorrhizae) (drugs for regulating blood flow) and small dose of Yu Jin (郁金 Radix Curcumae) and Niu Xi (牛膝 Radix Achyranthis Bidentatae) (drugs for activating blood flow) can significantly elevate the activity of SOD (P<0.05) and/or lower the T/K ratio, markedly reduce the MDA content (P<0.05 or P<0.01) and significantly decrease the activities of ALT and AST (P<0.05 or P<0.01), demonstrating that these drugs are effective in combating oxygen free radicals (OFR) in chronic liver damage. On the contrary, large dose of Tu Bie Chong (土鳖虫 Eupolyphaga seu Steleophaga) and E Zhu (莪术 Rhizoma Curcumae) (drugs for removing blood stasis) tend to increase the ALT and AST (P<0.05) activities. The results suggest that the synergism of elevation of the SOD activity and reduction of T/K ratio contributes to the action of drugs for improving blood circulation and removing blood stasis in combating the liver damage induced by CCl4.
文摘AIM:To evaluate the association of nonalcoholic fatty liver disease(NAFLD)with acute ischemic stroke severity and in-hospital outcome.METHODS:We prospectively studied all patients who were admitted in our Department with acute ischemic stroke between September 2010 and August 2012(n=415;39.5%males,mean age 78.8±6.6 years).The severity of stroke was assessed with the National Institutes of Health Stroke Scale(NIHSS)score at admission.NALFD was defined as serum alanine aminotransferase and/or aspartate aminotransferase levels above the upper limit of normal in the absence of other causes of elevated aminotransferases levels[chronic hepatitis B or C,drug toxicity,increased alcohol consumption(】21 and】14 drinks per week in men and women,respectively),cholestatic diseases or rhabdomyolysis].The outcome was assessed with the modified Rankin scale(mRS)score at discharge and in-hospital mortality.Adverse outcome was defined as mRS score at discharge≥2.Dependency at discharge was defined as mRS score between 2 to 5.RESULTS:NAFLD was present in 7.7%of the study population.Patients with NAFLD had lower serum high-density lipoprotein cholesterol and higher triglyceride levels than patients without NAFLD(P【0.05 for both comparisons).Demographic data,the prevalence of other cardiovascular risk factors and the prevalence of established CVD did not differ between the two groups.At admission,the NIHSS score did not differ between patients with and without NAFLD(6.3±6.4and 8.8±9.6,respectively;P=NS).At discharge,the mRS score did not differ between the two groups(1.9±2.2 and 2.6±2.2 in patients with and without NAFLD,respectively;P=NS).Rates of dependency at discharge were also similar in patients with and without NAFLD(36.8%and 55.0%,respectively;P=NS)as were the rates of adverse outcome(42.9%and58.6%,respectively;P=NS).In-hospital mortality rates also did not differ between the 2 groups(8.0%and 7.0%in patients with and without NAFLD,respectively;P=NS).CONCLUSION:The presence of NAFLD in patients admitted for acute ischemic stroke does not appear to be associated with more severe stroke or with worse in-hospital outcome.
文摘Serum aminotransferases have been used as surrogate markers for liver ischemia-reperfusion injury that follows liver surgery. Some studies have suggested that rises in serum alanine aminotransferase(ALT) correlate with patient outcome after liver resection. We assessed whether postoperative day 1(POD 1) ALT could be used to predict patient morbidity and mortality following liver resection. We reviewed our prospectively held database and included consecutive adult patients undergoing elective liver resection in our institution between January 2013 and December 2014. Primary outcome assessed was correlation of POD 1 ALT with patient's morbidity and mortality. We also assessed whether concurrent radiofrequency ablation, neoadjuvant chemotherapy and use of the Pringle maneuver significantly affected the level of POD 1 ALT. A total of 110 liver resections were included in the study. The overall in-hospital patient morbidity and mortality were 31.8% and 0.9%, respectively. The median level of POD 1 ALT was 275 IU/L. No correlation was found between POD 1 serum ALT levels and patient morbidity after elective liver resection, whilst correlation with mortality was not possible because of the low number of mortalities. Patients undergoing concurrent radiofrequency ablation were noted to have an increased level of POD 1 serum ALT but not those given neoadjuvant chemotherapy and those in whom the Pringle maneuver was used. Our study demonstrates POD 1 serum ALT does not correlate with patient morbidity after elective liver resection.
文摘AIM:To investigate the usefulness of mild iron depletion and the factors predictive for histological improvement following phlebotomy in Caucasians with chronic hepatitis C(CHC). METHODS:We investigated 28 CHC Caucasians with persistently elevated serum aminotransferase levels and non responders to,or unsuitable for,antiviral therapy who underwent mild iron depletion(ferritin≤70 ng/mL) by long-term phlebotomy.Histological improvement,as defined by at least one point reduction in the staging score or,in case of unchanged stage,as at least two points reduction in the grading score(Knodell),was evaluated in two subsequent liver biopsies(before and at the end of phlebotomy,48±16 mo apart).RESULTS:Phlebotomy showed an excellent safety profile.Histological improvement occurred in 12/28 phlebotomized patients.Only males responded to phlebotomy.At univariate logistic analysis alcohol intake(P=0.034),high histological grading(P=0.01) and high hepatic iron concentration(HIC)(P=0.04) before treatment were associated with histological improvement.Multivariate logistic analysis showed that in males high HIC was the only predictor of histological improvement following phlebotomy(OR=1.41, 95%CI:1.03-1.94,P=0.031).Accordingly,12 out of 17(70%)patients with HIC≥20μmol/g showed histological improvements at the second biopsy. CONCLUSION:Male CHC Caucasian non-responders to antiviral therapy with low-grade iron overload can benefit from mild iron depletion by long-term phlebotomy.
文摘Objective:To investigate the ability of the methanolic extract of pineapple peel to modulate alcohol-induced lipid peroxidation,changes in catalase activities and hepatic biochemical marker levels in blood plasma.Methods:Oxidative stress was induced by oral administration of ethanol(20%w/v) at a dosage of 5 niL/kg bw in rats.After 28 days of treatment,the rats were fasted overnight and sacrificed by cervical dislocation.Blood was collected with a 2 mL syringe by cardiac puncture and was centrifuged at 3000 rpm for 10 min.The plasma was analyzed to evaluate malondialdehyde(MDA),catalase activity,aspartate aminotransferase(AST),alkaline phosphatase(ALP) and alanine aminotransferase(ALT) concentrations.Results:Administration of alcohol caused a drastic increase(87.74%) in MDA level compared with the control.Pineapple peel extract significantly reduced the MDA level by 60.16%at 2.S mL/kg bw.Rats fed alcohol only had the highest catalase activity,treatment with pineapple peel extract at 2.5 mL/kg bw however, reduced the activity.Increased AST,ALP and ALT activities were observed in rats fed alcohol only respectively,treatment with pineapple peel extract drastically reduced their activities. Conclusions:The positive modulation of lipid peroxidation,catalase activities as well as hepatic biomarker levels of blood plasma by the methanolic extract of pineapple peels under alcoholinduced oxidative stress is an indication of its protective ability in the management of alcoholinduced toxicity.
文摘BACKGROUND Researchers have investigated the diagnostic value of protein induced by vitamin K absence or antagonist II (PIVKA-II) and alpha-fetoprotein (AFP) in hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC), and obtained abundant clinical diagnostic data. However, PIVKA-II and AFP have unsatisfactory specificity and sensitivity in the diagnosis of early-stage HBV-related HCC. Gamma-glutamyltransferase (γ-GT) and aspartate aminotransferase (AST) are common biomarkers for evaluating liver function, and we hypothesized that the γ-GT/AST ratio in combination with PIVKA-II and AFP would improve the diagnosis of early-stage HBV-related HCC. AIM To evaluate the diagnostic value of γ-GT/AST ratio alone or in combination with PIVKA-II and AFP in HBV-related HCC. METHODS Serum levels of γ-GT, AST, PIVKA-II, and AFP were detected and analysed in 176 patients with HBV-related HCC and in 359 patients with chronic hepatitis B. According to tumour size and serum level of HBV DNA, HBV-related HCC patients were divided into the following categories: Early-stage HCC patients, HCC patients, HBV DNA positive (HBV DNA+) HCC patients, and HBV DNA negative (HBV DNA-) HCC patients. Receiver-operating characteristic (ROC) curves were used to analyse and compare the diagnostic value of the single and combined detection of various biomarkers in different types of HBV-related HCC. RESULTS Tumour size was positively correlated with serum levels of PIVKA-II and AFP in HCC patients (r = 0.529, aP < 0.001 and r = 0.270, bP < 0.001, respectively), but there was no correlation between tumour size and the γ-GT/AST ratio (r = 0.073, P = 0.336). The areas under the receiver-operating characteristic curves (AUROCs) of the γ-GT/AST ratio in early-stage HCC patients, HBV DNA+ HCC patients and HBV DNA- HCC patients were not significantly different from that in the total HCC patients (0.754, 0.802, and 0.705 vs 0.779, respectively;P > 0.05). When PIVKA-II was combined with the γ-GT/AST ratio in the diagnosis of earlystage HCC, HCC, and HBV DNA+ HCC, the AUROCs of PIVKA-II increased, with values of 0.857 vs 0.835, 0.925 vs 0.913, and 0.958 vs 0.954, respectively. When AFP was combined with the γ-GT/AST ratio in the diagnosis of early-stage HCC, HCC, HBV DNA+ HCC, and HBV DNA- HCC, the AUROCs of AFP increased, with values of 0.757 vs 0.621, 0.837 vs 0.744, 0.868 vs 0.757, and 0.840 vs 0.828, respectively. CONCLUSION The γ-GT/AST ratio may be better than PIVKA-II and AFP in the diagnosis of early-stage HBV-related HCC, and its combination with PIVKA-II and AFP can improve the diagnostic value for HBV-related HCC.
基金the Division of Chronic Disease Surveillance of the Korean Center for Disease Control and Prevention who conducted the national survey and everyone who contributed to this project
文摘AIM: To investigate the association between liver markers and the risk of type 2 diabetes(T2DM) and impaired fasting glucose(IFG).METHODS: A total of 8863 participants(3408 men and 5455 women) over 30 years of age were analyzed from the fifth Korean National Health and Nutrition Examination Survey(2010-2011). The associations of serum liver markers such as aspartate aminotransferase(AST), alanine aminotransferase(ALT), AST/ALT, and gamma-glutamyltransferase(GGT) with T2 DM and IFG were analyzed using logistic regression models. Participants were divided into sex-specific quartiles on the basis of liver markers.RESULTS: The prevalence of T2 DM and IFG were 11.3% and 18.3%. Increasing quartiles of ALT and GGT were positively and AST/ALT were negatively correlated with T2 DM and IFG. Analysis of the liver marker combinations showed that if any two or more markers were in the highest risk quartile, the risks of both T2 DM and IFG increased significantly. The risk was greatest when the highest ALT and GGT and lowest AST/ALT quartile were combined, with the riskof T2 DM at 3.21(95%CI: 1.829-5.622, P < 0.001) in men and 4.60(95%CI: 3.217-6.582, P < 0.001) in women. Men and women with the highest AST and ALT and lowest AST/ALT quartile had a 1.99 and 2.40 times increased risk of IFG.CONCLUSION: Higher levels of GGT and ALT and lower AST/ALT within the physiological range are independent, additive risk factors of T2 DM and IFG.
基金Shenzhen Municipal Science and Technology Innovation Fund,Nos.CXZZ20130322170220544 and JCYJ20140411112047885
文摘AIM: To investigate the combined diagnostic accuracy of acoustic radiation force impulse(ARFI), aspartate aminotransferase to platelet ratio index(APRI) and Forns index for a non-invasive assessment of liver fibrosis in patients with chronic hepatitis B(CHB). METHODS: In this prospective study, 206 patients had CHB with liver fibrosis stages F0-F4 classified by METAVIR and 40 were healthy volunteers were measured by ARFI, APRI and Forns index separately or combined as indicated. RESULTS: ARFI, APRI or Forns index demonstrated a significant correlation with the histological stage(all P < 0.001). According to the AUROC of ARFI and APRI for evaluating fibrotic stages more than F2, ARFI showed an enhanced diagnostic accuracy than APRI(P < 0.05). The combined measurement of ARFI and APRI exhibited better accuracy than ARFI alone when evaluating ≥ F2 fibrotic stage(Z = 2.77, P = 0.006). Combination of ARFI, APRI and Forns index did not obviously improve the diagnostic accuracy compared to the combination of ARFI and APRI(Z = 0.958, P = 0.338). CONCLUSION: ARFI + APRI showed enhanced diagnostic accuracy than ARFI or APRI alone for significant liver fibrosis and ARFI + APRI + Forns index shows the same effect with ARFI + APRI.
