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J Viral Hepat：采用瞬时弹性成像预测HCV疾病进展到肝硬化的时间与肝纤维化进展率评估时间相似

2017-12-18 MedSci MedSci原创

CHC肝纤维化肝硬化瞬时弹性呈现meta-analysis
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HCV的无创预测指标与FPRs在预测疾病进展到肝硬化时间方面是一致的，但需要更多肝硬度的纵向研究来获得精确的估计。

慢性丙型肝炎感染是导致肝纤维化或肝硬化的主要原因。肝纤维化分期传统使用肝组织学进行评估，采用肝纤维化进展率（FPRs； 组织学阶段进展的年概率）对预后进行评估。然而，非侵入性检测正在迅速取代肝穿。一种选择是瞬时弹性成像(TE)，通过测量肝脏硬度来量化纤维化。鉴于此，(1)本研究旨在用基于TE的肝硬度进展率(LSPR)作为FPRs的一种替代方法，来评估初治CHC患者的预后，(2)比较LSPRs和FPRs间的一致性。

使用多个数据库进行系统文献检索(从1990年1月到2016年2月)。采用直接法（考虑到系列LSMs和时间流逝的差异）或间接法（考虑到单次LSM和利用随机效应荟萃分析估计感染的持续时间）计算LSPRs。为了验证，还估计了FPRs。采用随机元回归研究两者间异质性。

本研究共纳入27项研究，共报告了39组患者(N=5，874)，其中35组患者采用间接法评估LSPR，8组采用直接法评估LSPR。大多数(~58%)患者为HIV/HCV共感染。TE与活组织检查估计患者疾病进展到肝硬化的时间分别为39岁和38岁。在单变量回归中，男性、HIV阳性、评估时年龄，与LSPRs呈负相关。

HCV的无创预测指标与FPRs在预测疾病进展到肝硬化时间方面是一致的，但需要更多肝硬度的纵向研究来获得精确的估计。

原始出处

Erman A， Sathya A， Nam A， et al. Estimating Chronic Hepatitis C Prognosis Using Transient Elastography-Based Liver Stiffness： A Systematic Review and Meta-Analysis. J Viral Hepat， 2017， Dec 14. doi： 10.1111/jvh.12846.

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    2018-02-25 旅苦化文_208

    #瞬时弹性成像#

    0

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    2018-02-03 jj000001

    #肝纤维#

    0

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    2018-03-25 mjldent

    #疾病进展#

    0

  4. 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channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NcXNhUvfhzd2VdicMnaLeK2Im5gKx4Ucxd8Bwu6S7RG0uILBFQx5HTW2bU4VricDYlQqN20ibASSMYAeGrZrrTpy2Q/0, createdBy=7dcf1938111, createdName=1e0e5a1fm42(暂无匿称), createdTime=Tue Dec 19 09:56:36 CST 2017, time=2017-12-19, status=1, ipAttribution=)]
    2018-10-16 tamgche

    #弹性成像#

    0

  5. 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channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NcXNhUvfhzd2VdicMnaLeK2Im5gKx4Ucxd8Bwu6S7RG0uILBFQx5HTW2bU4VricDYlQqN20ibASSMYAeGrZrrTpy2Q/0, createdBy=7dcf1938111, createdName=1e0e5a1fm42(暂无匿称), createdTime=Tue Dec 19 09:56:36 CST 2017, time=2017-12-19, status=1, ipAttribution=)]
    2017-12-24 半夏微凉

    学习了谢谢分享

    0

  6. 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channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NcXNhUvfhzd2VdicMnaLeK2Im5gKx4Ucxd8Bwu6S7RG0uILBFQx5HTW2bU4VricDYlQqN20ibASSMYAeGrZrrTpy2Q/0, createdBy=7dcf1938111, createdName=1e0e5a1fm42(暂无匿称), createdTime=Tue Dec 19 09:56:36 CST 2017, time=2017-12-19, status=1, ipAttribution=)]
    2017-12-20 ymljack

    #HCV#

    0

  7. 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objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Wed Dec 20 06:48:37 CST 2017, time=2017-12-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=270756, encodeId=f7512e075667, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzR8ylhYfiaoAUx2BsaYHVia1IKhG3Cg8CT84rBrn6iaVRkyAibJxBcLEXabOQ5p19vWgDe34ib5ErxNgx/0, createdBy=8a701629084, createdName=jihuaijun1112, createdTime=Wed Dec 20 01:34:57 CST 2017, time=2017-12-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=270580, encodeId=56f42e05807e, content=henhao, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NcXNhUvfhzd2VdicMnaLeK2Im5gKx4Ucxd8Bwu6S7RG0uILBFQx5HTW2bU4VricDYlQqN20ibASSMYAeGrZrrTpy2Q/0, createdBy=7dcf1938111, createdName=1e0e5a1fm42(暂无匿称), createdTime=Tue Dec 19 09:56:36 CST 2017, time=2017-12-19, status=1, ipAttribution=)]
    2017-12-20 gwc384

    #EPA#

    0

  8. 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channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NcXNhUvfhzd2VdicMnaLeK2Im5gKx4Ucxd8Bwu6S7RG0uILBFQx5HTW2bU4VricDYlQqN20ibASSMYAeGrZrrTpy2Q/0, createdBy=7dcf1938111, createdName=1e0e5a1fm42(暂无匿称), createdTime=Tue Dec 19 09:56:36 CST 2017, time=2017-12-19, status=1, ipAttribution=)]
    2017-12-20 1dd8c52fm63(暂无匿称)

    学习学习.了解了解

    0

  9. 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objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Wed Dec 20 06:48:37 CST 2017, time=2017-12-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=270756, encodeId=f7512e075667, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzR8ylhYfiaoAUx2BsaYHVia1IKhG3Cg8CT84rBrn6iaVRkyAibJxBcLEXabOQ5p19vWgDe34ib5ErxNgx/0, createdBy=8a701629084, createdName=jihuaijun1112, createdTime=Wed Dec 20 01:34:57 CST 2017, time=2017-12-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=270580, encodeId=56f42e05807e, content=henhao, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NcXNhUvfhzd2VdicMnaLeK2Im5gKx4Ucxd8Bwu6S7RG0uILBFQx5HTW2bU4VricDYlQqN20ibASSMYAeGrZrrTpy2Q/0, createdBy=7dcf1938111, createdName=1e0e5a1fm42(暂无匿称), createdTime=Tue Dec 19 09:56:36 CST 2017, time=2017-12-19, status=1, ipAttribution=)]
    2017-12-20 jihuaijun1112

    学习学习学习

    0

  10. 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channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NcXNhUvfhzd2VdicMnaLeK2Im5gKx4Ucxd8Bwu6S7RG0uILBFQx5HTW2bU4VricDYlQqN20ibASSMYAeGrZrrTpy2Q/0, createdBy=7dcf1938111, createdName=1e0e5a1fm42(暂无匿称), createdTime=Tue Dec 19 09:56:36 CST 2017, time=2017-12-19, status=1, ipAttribution=)]
    2017-12-19 1e0e5a1fm42(暂无匿称)

    henhao

    0

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总之，研究结果表明，SOF、DCV等直接抗病毒药物联合利巴韦林治疗显著改善了慢性丙型肝炎患者肝脏功能和临床治疗效果。

CHC2017:TAVR 会成为主动脉瓣疾病主要手段吗？

在昨天进行的结构性心脏病论坛上，来自德国的瓣膜介入治疗先驱Eberhard Grube 教授和阜外医院杨跃进教授对经导管主动脉瓣置换术（TAVR）临床治疗现状及进展做了精彩报告。Grube 教授认为，TAVR 的很多问题已得到了较好的解决，随着技术的进一步进展，临床研究数据的进一步完善，TAVR 有望成为主动脉瓣疾病患者的主要治疗选择。

Gut：乙型肝炎相关慢加急性肝衰竭新的诊断标准和预后评分系统

无论肝硬化是否存在，TB≥12 mg/ dL和INR≥1.5的慢性乙型肝炎患者都应该被诊断为ACLF。近20%的HBV-ACLF患者被诊断出，从而增加了他们获得及时治疗管理的机会。

Liver Int：Daclatasvir治疗CHC患者疗效显著

总之，研究表明，daclatasvir治疗后，99%的患者达到的可持续病毒学应答状态能够持续。肝脏疾病进展和新发肝细胞癌的病例少见。NS5A替换在非应答患者中的持续时间超过NS3替换。

SCI REP：维生素D补充改善了CHC患者肝纤维化发生相关的血清标志物！

通过使用CHC患者为模型，研究提供了更多的证据表明VD在肝脏纤维化的逆转过程中起着重要的作用。

SCI REP：糖尿病是慢性丙型肝炎患者发生肝硬化的一个重要危险因素！

总之，糖尿病与CHC患者发生肝硬化的风险增加相关。此外，在CHC和DM的患者中，女性发生肝硬化的风险增加。