Article

Grading and staging of hepatic fibrosis, and its relationship with noninvasive diagnostic parameters.

World Journal of Gastroenterology 01/2003;
Source: DOAJ

ABSTRACT AIM: To explore the grade and stage of pathology and the relationship between grading and staging of hepatic fibrosis and noninvasive diagnostic parameters.
METHODS: Inflammatory activity and fibrosis of consecutive liver biopsies from 200 patients with chronic liver disease were determined according to the Diagnostic Criteria of Chronic Hepatitis in China, 1995. A comparative analysis was made in these patients comparing serum markers, Doppler ultrasonography, CT and/or MR imaging with the findings of liver biopsy.
RESULTS: With increase of inflammatory activity, the degree of fibrosis also rose. There was a close correlation between liver fibrosis and inflammatory activity. AST, GGT, albumin, albumin/globulin, ALP, AFP, hyaluronic acid, N-terminal procollagen III(P III NP), collagen type IV(Col IV), tissue inhibitors of metalloproteinases-1 (TIMP-1), alpha-2-macroglobulin, natural killer cells(NK), some parameters of Doppler ultrasonography, CT and/or MR imaging were all related to the degree of inflammatory activity. GGT, albumin, albumin/globulin, ALP, AFP, hyaluronic acid, Col IV, TIMP-1, alpha-2- macroglobulin, transforming growth factor-beta 1 (TGFbeta1), NK, some parameters of Doppler ultrasonography, CT and/or MR imaging were all related to the staging of fibrosis. By regression analysis, the parameters used in combination to differentiate the presence or absence of fibrosis were age, GGT, the parameter of blood flow of portal vein per minute, the maximum oblique diameter of right liver by B ultrasound, the wavy hepatic surface contour by CT and/or MR. The sensitivity, specificity and accuracy of the above parameters were 80.36%, 86.67%, and 81.10%, respectively.
CONCLUSION: There is close correlation between liver fibrosis and inflammatory activity. The grading and staging of liver fibrosis are related to serum markers, Doppler ultrasonography, CT and/or MR imaging. The combination of the above mentioned noninvasive parameters are quite sensitive and specific in the diagnosis of hepatic fibrosis.

0 Bookmarks
 · 
48 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Hepatectomy can comprise excision of peripheral tumors as well as major surgeries like trisegmentectomies or central resections. Patients can be healthy, have localized liver disease or possess a cirrhotic liver with high operative risk. The preoperative evaluation of the risk of postoperative liver failure is critical in determining the appropriate surgical procedure. The nature of liver disease, its severity and the operation to be performed should be considered for correct preparation. Liver resection should be evaluated in relation to residual parenchyma, especially in cirrhotic patients, subjects with portal hypertension and when large resections are needed. The surgeon should assess the rationale for the use of hepatic volumetry. Child-Pugh, MELD and retention of indocyanine green are measures for assessing liver function that can be used prior to hepatectomy. Extreme care should be taken regarding the possibility of infectious complications with high morbidity and mortality in the postoperative period. Several centers are developing liver surgery in the world, reducing the number of complications. The development of surgical technique, anesthesia, infectious diseases, oncology, intensive care, possible resection in patients deemed inoperable in the past, will deliver improved results in the future.
    Revista do Colégio Brasileiro de Cirurgiões 10/2010; 37(5):370-5.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Aim: In the current study, we aimed at identifying independent laboratory parameter to predict liver damage. Background: Although liver biopsy is frequently recommended in assessing disease severity and selecting antiviral treatment candidates, it has several limitations. Patients and methods: A total of 527 patients with untreated chronic hepatitis B virus infection were selected. A percutaneous liver biopsy was obtained. All of the patients were graded and staged for liver fibrosis (1-6) and inflammatory activity (1-18). Complete blood count, biochemical blood tests and Serum viral markers were detected for these patients. Results: 106 patients had moderate to severe necroinflammatory activity. Compared to patients with mild activity, this group was older and had significantly higher aspartate aminotransferase (AST), alanine aminotrasferase (ALT), alkaline phosphatase (Alk. P) and AST to platelet ratio index (APRI) and significantly lowers hemoglobin (Hb), fasting blood sugar (FBS) and platelet (PLT). By multiple regressions analysis Hb, AST, FBS and PLT were independently predictive of moderate to severe necroinflammatory activity. 109 patients had moderate to severe fibrosis. Compared to patients with mild fibrosis, the former patients were older. In addition, the mean of AST, ALT, PT and APRI were significantly higher, and WBC, serum Alb and PLT were significantly lower in patients with moderate to severe fibrosis. Also by multiple regressions analysis age, AST, serum Alb and PLT were independently predictive of moderate to severe fibrosis. Conclusion: Our study demonstrates the utility of biochemical markers for the diagnosis of moderate histological lesions in patients with chronic hepatitis B. Whereas millions of patients with chronic hepatitis B in the world are living, this approach will be useful and cost-benefit.
    Gastro Hepat FBB. 01/2010; 3(2):71-6..
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Studying the predictors of SVR to pegylated interferon (PEG-INF) alfa-2a and ribavirin (RBV) therapy in chronic hepatitis C-infected patients is crucial for selecting those who would benefit from therapy. Increasing HPCs in hepatitis C-infected patients were shown to be correlated with increased fibrosis and response to therapy. HPCs could be detected in the liver by immunohistochemical expressions of cytokeratin (CK) 7 and CK19. This study aims to; 1. Evaluate the response rate to interferon based treatment in chronic hepatitis C-infected patients. 2. Detect the predictors of SVR to treatment. 3. Study the correlations between CK7 and CK19 expressions and treatment response. Subjects and Methods: This study included 483 chronic hepatitis C-infected patients who fulfilled the study criteria and underwent clinical, biochemical and virological assessments before treatment and at 12, 24, 48 and 72 weeks post-treatment. Only 330 patients completed the course and were included in the statistical analysis. Only 50 specimens were examined for CK7 and CK19 expression using avidin, biotin, peroxidase technique. Results: SVR was achieved in 132/330 (40%) of patients. SVR was significantly higher in females (P<0.01), younger age group (P<0.004), and patients who had lower body mass index; BMI (P<0.001). There was significant inverse relation between SVR and aspartate aminotransferase (AST) and alpha feto-protein (AFP); P<0.000 and <0.000 respectively. The independent predictors of SVR were younger age and lower AST (P<0.02 and <0.02 respectively). There was significant association between CK7 and/or CK19 expressions and grade of necro-inflammation (P<0.033 and <0.026 respectively), and/or advanced stage of fibrosis (P<0.001 and <0.000 respectively). There were significant inverse relations between SVR and the stage of hepatic fibrosis (P<0.001), and CK19 expression (P<0.000). Conclusions: Forty % of patients with chronic hepatitis C who completed the course of combination therapy achieved SVR. Younger age and lower pre-treatment AST are independent predictors of SVR. In chronic hepatitis C, progenitor cell activation is correlated with the grade and stage of disease. Proliferating HPCs as assessed by CK7 and CK19 expressions may play a role in hepatic regeneration occurring in this setting and could be incorporated in assessment of treatment response of patients with HCV infection.
    Scientific Medical Journal. 01/2011; 23(4):1-14.

Full-text

View
1 Download
Available from