Clinical and Experimental Hepatology最新文献

Aim of the study: This study was performed to investigate the hepatic expression of glucocorticoid receptors (GR) and 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) in pediatric autoimmune hepatitis (AIH) patients and its relation to the steroid response.

Material and methods: This study included 100 patients diagnosed with AIH on immunosuppressive therapy with different responses to treatment. The patients were subjected to full history taking and thorough clinical examination, laboratory investigations, abdominal ultrasound and liver biopsy for histopathological evaluation and assessment of the hepatic expression of GR and 11β-HSD1.

Results: Out of the 100 cases, 82 cases showed a complete response, 11 a partial response and 7 cases were non-responders. The sex, age distribution and clinical presentation of the disease were comparable among the different response groups. Glucocorticoid receptors reactivity was significantly more intense in patients with a complete response than both patients with a partial response and non-responders. 11β-HSD intensity was higher in complete and partial responders in comparison with non-responders but without significance. The percentage of patients with a GR intensity score ≥ 200 was significantly higher in patients with a complete response than patients with a partial response and non-responders (p < 0.05). The GR intensity score had a significant positive correlation with intensity of 11β-HSD (r = 0.369, p < 0.0001).

Conclusions: Glucocorticoid receptors expression was significantly variable in children with AIH and closely related to the response to therapy. However, the 11β-HSD expression was comparable between different response groups.

Aim of the study: Over the past few years, diffusion-weighted imaging (DWI) has become an increasingly important diagnostic tool in the diagnosis of liver lesions. The objective of the present study was to evaluate the diagnostic benefit of high b-value computed diffusion-weighted imaging (c-DWI) compared with standard DWI in patients with hepatocellular carcinoma (HCC) and whether there is an association with microvascular invasion (MVI).

Material and methods: In total, 37 patients with histopathologically confirmed HCC were retrospectively ana-lyzed. DWI was acquired with b-values of 50, 400, and 800 or 1000 s/mm² on a 1.5 T magnetic resonance imaging (MRI) scanner. The c-DWI was calculated using a monoexponential model with high b-values of 1000, 2000, 3000, 4000, and 5000 s/mm². All high b-value c-DWI images were compared to the standard DWI in terms of volume, detectability of hepatic lesions, and image quality.

Results: Regarding lesion volume and image quality there were no statistically significant differences between standard and c-DWI. HCC lesions measured on DWI images were statistically significantly larger compared to c-DWI images starting from a b value of 2000 s/mm² (DWI vs. c-DWI b 2000 s/mm²: 2 cm³ [1-12] cm³ vs. 1 cm³ [0-17] cm³, p < 0.05). Moreover, there was deterioration of image quality starting at b = 2000 s/mm². There were no significant differences in terms of lesion signal intensity in DWI and c-DWI images. There were no differences for the DWI parameters according to MVI status.

Conclusions: C-DWI images with high b-values up to b = 1000 s/mm² demonstrate comparable detectability of HCC compared to standard DWI. The investigated DWI parameters were not associated with MVI status. Further research is needed to evaluate the potential benefit of high b-value c-DWI.

Aim of the study: This study aimed to establish an objective, simple, and minimally invasive screening method to detect patients with biliary atresia during neonatal checkups by using indocyanine green (ICG) fluorescence in the stool.

Material and methods: We produced a rat model of extrahepatic biliary obstruction (group O, n = 9) and compared the stools from these rats with those of control group rats (group C, n = 6) by a fluorescence technique. ICG was administered (0.5 mg/kg) through the caudal vein; group O received ICG at the end of surgery.

Results: In group C, we collected stools at 3, 6, 12, 24, 48, and 72 hours, and fluorescence disappeared at 48 hours. In group O, stools were collected at 24, 48, 72, 96, and 120 hours after surgery, and fluorescence continued at 120 hours without the loss of fluorescence. Quantitative assessment of lightness showed significant differences between the groups at 48 and 72 hours (p = 0.0016 and p = 0.0004, respectively).

Conclusions: This study shows that ICG is excreted into the gastrointestinal tract via a route other than the bile duct in a rat model of extrahepatic biliary obstruction. Our findings also suggest that ICG has the potential for initial screening of biliary congestive disease in the neonatal period, which could be followed up by detailed testing.

Aim of the study: Jaundice in newborns is a sign of skin and sclera pigmentation. Hyperbilirubinemia and these phenomena do, however, have a relationship. According to many clinical studies, elevated blood bilirubin and low vitamin E (VE) levels in newborns are associated. The aim of the study was to investigate the association of oxidative stress of neonatal hyperbilirubinemia in patients who underwent phototherapy with additional vitamin E supplementation (25 mg/kg/day over the course of three days) and patients without additional vitamin E.

Material and methods: A set of 100 neonatal indirect hyperbilirubinemia patients was enrolled at neonatal intensive care units (NICUs) of the pediatric departments at Al Azhar University Hospitals during the period from February 2021 to October 2022 after obtaining signed written informed consent of all neonates' parents with an explanation of the aim of study.

Results: Significant differences were found between the studied groups regarding serum bilirubin on the third day of admission (p = 0.039). Patients who were treated with vitamin E had lower serum bilirubin on the third day of admission (8.25 ±3.41) than the control group (11.66 ±3.22). Also, among the VE group, serum bilirubin was significantly decreased on the third day of admission (8.25 ±3.41) compared to zero days of admission (14.10 ±4.39) (p = 0.041).

Conclusions: Vitamin E supplementation has an important role in treatment of indirect hyperbilirubinemia in neonates. Early administration of vitamin E in preterm neonates resulted in a significant decrease of serum bilirubin and increased total antioxidant capacity. Vitamin E supplementation in full term decreased the duration of phototherapy.

Aim of the study: Texture analysis derived from computed tomography (CT) involves quantitative imaging parameters characterizing possible valuable associations with clinical purposes. Their prognostic capability in patients undergoing percutaneous CT-guided liver biopsy to identify associations with postinterventional bleeding complications and biopsy success is not sufficiently explored.

Material and methods: Three hundred fifteen patients (124 female, 39%) with a mean age of 62.5 ±10.2 years underwent percutaneous CT-guided liver biopsy and were analyzed regarding clinical, procedure-related, and CT texture features.

Results: Thirty patients (9.5%) presented with bleeding after biopsy (including two requiring interventional treatment), whereas 46 patients (14.6%) had negative biopsy successes. Distance of lesion from liver capsule was statistically significantly different in patients with and without bleeding (p = 0.015). Several texture features were statistically significantly different between the groups, S(0,1)SumAverg having the highest significance (p = 0.004). Regarding unsuccessful biopsy results, liver fibrosis was the only clinical feature with statistical significance (p = 0.049). Only two texture features (S(4,-4)InvDfMom and Teta3) were statistically different between the groups according to the biopsy result.

Conclusions: Several CT texture features of the target lesion and the length from the capsule to the lesion were associated with bleeding complications after CT-guided percutaneous liver biopsy. This could be used to identify patients at risk at the beginning of the procedure.

Aim of the study: Non-alcoholic fatty liver disease (NAFLD) is one of the most important causes of chronic liver disease (CLD) in both Western and Asian populations. There is wide inter-individual variability in the occurrence of NAFLD and progression to non-alcoholic steatohepatitis (NASH) even after correcting environmental factors, and its true explanation can be provided by heritability. Two such genetic variations, the glucokinase regulator (GCKR) and membrane bound O-acyltransferase domain containing 7 (MBOAT7) genes, in NAFLD patients were studied in the Indian population.

Material and methods: A cross sectional analytical study was conducted in the Department of Gastroenterology at a tertiary care centre. In total 100 subjects in the age range of 18-65 years were included in the study; 50 were patients with NAFLD including fatty liver, NASH and NASH related cirrhosis, and 50 were healthy subjects (No NAFLD). The polymorphisms rs780094 and rs1260326 for GCKR and rs641738 for MBOAT7 were determined using PCR followed by the PCR-RFLP.

Results: GCKR rs780094 minor allele A was more common in NAFLD patients (p = 0.00001). Within the spectrum of NAFLD, the A allele was present frequently among cirrhotics as compared to NASH and fatty liver (p = 0.00001). Morbidly obese individuals showed significant association with the homozygous A allele (p = 0.028). These results were not seen with GCKR rs1260326 across all alleles. In MBOAT7 (rs641738) the frequency of the minor allele T for NAFLD was 84% vs. 80% in healthy subjects (p = 0.79). The association of the T allele among the spectrum of NAFLD was not statistically significant (p = 0.79).

Conclusions: GCKR genetic variant rs780094 was found to be significantly associated with NAFLD. The MBOAT7 (rs641738) genetic variant was not found to be significantly associated with NAFLD.

Aim of the study: To assess the serum level of Mac-2 binding protein glycosylation isomer as a potential biomarker for hepatocellular carcinoma (HCC) in hepatitis C virus (HCV) cirrhotic patients.

Material and methods: Ninety patients were separated into two groups for the current research. Group I consisted of 45 patients with HCV that resulted in liver cirrhosis but no HCC. Group II consisted of 45 patients who had HCC and hepatic cirrhosis caused by HCV. Each patient underwent a complete clinical examination, thorough history taking, and laboratory tests, serum Mac-2 BPGI, abdominal ultrasound and triphasic computed tomography (CT) of the liver.

Results: Serum Mac-2 BPGI was significantly higher in group II than group I and was statistically significantly higher in patients with portal vein invasion and in patients with lymph node metastases than those without, there was a statistically significant difference between mean values of serum M2BPGI, the BCLC score was higher in group C, and also a significant positive relation between tumor size and serum M2BPGI was found.

Conclusions: Serum Mac-2 BPGI can be used as diagnostic and prognostic markers for HCC.

Aim of the study: Metabolic associated steatotic liver disease (MASLD) is one of the most frequent chronic liver diseases in the world; macrophage activation is reflected by increased expression of CD163, which sheds as serum soluble CD163 that is linked to hepatic steatosis, inflammation, and fibrosis. Aim of the study was assessment of liver macrophage activation and hepatic histopathological changes in patients with MASLD.

Material and methods: A total of 30 patients with MASLD and equal numbers of age- and sex-matched healthy controls were enrolled in the study. Quantitative serum levels of soluble CD163 (sCD163) were determined using a commercially available standard sandwich ELISA kit. Core liver biopsies were obtained from patients with MASLD and evaluation of CD163 using anti-CD163 Ab-1 (Clone 10D6) - mouse monoclonal antibody.

Results: The median sCD163 level was significantly higher in patients with MASLD compared with healthy controls. It can discriminate patients with MASLD from healthy controls at a cut-off value of 814 pg/ml. sCD163 level and intrahepatic total CD163-positive cell count were positively correlated, and both showed positive correlations with nonalcoholic fatty liver disease activity score.

Conclusions: Soluble CD163 can discriminate MASLD patients from healthy controls after the exclusion of other causes of inflammation.

Managing patients with liver cirrhosis and gastric hyperplastic polyps (GHPs) is challenging. Despite being the standard technique for resection of GHPs, hot snare polypectomy (HSP) is risky in the setting of coagulation disorders associated with liver cirrhosis. The aim of the study was to assess the efficacy and safety of endoscopic band ligation (EBL), compared to HSP in resecting GHPs in cirrhotic patients. One hundred consecutive adults with liver cirrhosis and sessile or pedunculated GHPs were enrolled from December 2018 to December 2020. Cases were non-blindly randomized (1 : 1) to two groups to have GHPs managed by either EBL (group I) or HSP (group II). Data of demographic, clinical, and pathological factors, hospitalization expenses and outcomes of both treatment maneuvers were collected and statistically analyzed. Upper endoscopy was repeated for all patients at 3, 6 and 12 months after treatment for recurrence detection. Between the two procedures, the mean operational time was significantly shorter in the EBL than the HSP group (15.1 ±3.80 min vs. 36.6 ±6.72 min, p < 0.001). Concerning complications, 94% of EBL cases had reported no complications compared to 78% with HSP. Bleeding occurred only with HSP (20%) with urgent need for adrenaline and/or argon plasma coagulation (p = 0.003). Regarding cost, it was significantly lower in EBL than HSP (280 ±2.02 EGP vs. 390 ±181.8 EGP, p < 0.001). However, the recurrence rate of GHPs and number of needed sessions were not significantly different. EBL proved to be a safer, more rapid, and economic maneuver when compared to HSP on resecting GHPs in patients with liver cirrhosis.

Aim of the study: Hepatitis delta virus (HDV) causes the most aggressive and rapidly progressive form of viral hepatitis. However, detailed data about epidemiology and risk factors in Polish population are still lacking. Thus, the aim of this retrospective study was to determine the prevalence of HDV infection among a Silesian population of patients infected with HBV.

Material and methods: 177 patients with confirmed hepatitis B virus (HBV) infection were examined for HDV infection. The diagnostic methods used in this study were measurement of HDV antibodies and HDV antigen levels. A telephone follow-up of patients who tested positive indicating HDV infection was conducted, in which they were asked about their current health status, the course of HDV infection and possible risk factors.

Results: The prevalence of HDV infection was 3.4%. Four of six patients already had an advanced level of liver fibrosis (F3 or higher) before starting treatment, one of them having undergone liver transplantation. Alanine aminotransferase (ALT) levels in HDV patients were above normal in half of the cases. Except for two cases, no risk factors were identified that may favor HDV infection.

Conclusions: Hepatitis D is a serious disease that requires more attention. Due to the limitations of our study, larger-scale studies answering the question of the prevalence of HDV in Poland are needed.