RESUMO
BACKGROUND & AIMS: A novel controlled attenuation parameter (CAP) using the signals acquired by the FibroScan® has been developed as a method for evaluating steatosis. The aim of this study is to assess the performance of the CAP for the detection and quantification of steatosis in patients with chronic hepatitis B (CHB). MATERIAL AND METHODS: 136 subjects with CHB underwent liver biopsy and FibroScan® within 60 days. CAP was evaluated retrospectively using raw FibroScan® data. Steatosis was graded as follows: S0 (steatosis < 10% of hepatocytes), S1 (10 to < 30%), S2 (30 to < 60%) or S3 (≥ 60%). Performance was evaluated by area under the receiver operating characteristic (AUROC) curve. RESULTS: Proportions of each steatosis grade (S0-S3) were 78, 10, 9 and 3%, respectively. Using univariate analysis, liver stiffness measurement (LMS) significantly correlated with fibrosis (τ = 0.43; P < 10-10), sex, necro-inflammatory activity, steatosis, age, NASH, and perisinusoidal fibrosis, and with liver fibrosis (P < 10-8) and perisinusoidal fibrosis (P = 0.008) using multivariate analysis. CAP correlated with steatosis (τ = 0.38, P < 10-7), body mass index, NASH, fibrosis and perisinusoidal fibrosis using univariate analysis, but only steatosis (P < 10-10) and perisinusoidal fibrosis (P = 0.002) using multivariate analysis. AUROCs for LSM were: 0.77 (0.69-0.85), 0.87 (0.80-0.95), and 0.93 (0.83-1.00), respectively, for fibrosis stages F ≥ 2, F ≥ 3 and F = 4. AUROCs for CAP were: 0.82 (0.73-0.92), 0.82 (0.69-0.95), and 0.97 (0.84-1.00) for ≥ S1, ≥ S2 and S3 steatosis, respectively. CONCLUSIONS: In conclusión CAP is a novel, accurate non-invasive tool and may be suitable for detecting and quantifying steatosis in CHB patients.
Assuntos
Técnicas de Imagem por Elasticidade , Fígado Gorduroso/diagnóstico por imagem , Hepatite B Crônica/complicações , Fígado/diagnóstico por imagem , Área Sob a Curva , Biópsia , Fígado Gorduroso/patologia , Fígado Gorduroso/virologia , Feminino , França , Hepatite B Crônica/diagnóstico , Humanos , Fígado/patologia , Fígado/virologia , Masculino , Análise Multivariada , Valor Preditivo dos Testes , Prognóstico , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de DoençaRESUMO
Cyproterone acetate (CPA) is an oral anti-androgen commonly used to treat advanced prostate cancer. A variety of hepatotoxic reactions has been reported with CPA. Here we describe a case of a male patient who developed severe drug-induced hepatotoxicity during the treatment with CPA. The case, presenting sub-acute hepatitis, was characterized by a rapid evolution of cirrhosis and a protracted activity during the period of a few months despite the treatment withdrawal and an apparent benefits of corticosteroids, suggesting their indication in life threatening cases.
Assuntos
Antineoplásicos/efeitos adversos , Doença Hepática Induzida por Substâncias e Drogas/tratamento farmacológico , Acetato de Ciproterona/efeitos adversos , Glucocorticoides/uso terapêutico , Prednisona/uso terapêutico , Adenocarcinoma/tratamento farmacológico , Idoso , Budesonida/uso terapêutico , Colagogos e Coleréticos/uso terapêutico , Humanos , Masculino , Neoplasias da Próstata/tratamento farmacológico , Ácido Ursodesoxicólico/uso terapêuticoRESUMO
Non-alcoholic fatty liver disease (NAFLD) is a relevant issue in public health owing to its epidemiological burden. It represents the most common chronic liver disease in the general population and is expected to increase in future as a result of an ageing population. Liver biopsy is still considered the "gold standard" for distinguishing the broad range of NAFLD. However, liver biopsy is often not recommended in the NAFLD patients, because of its cost, the potential risk of bleeding and the absence of consensus regarding the histopathological criteria that firmly differentiate between the NAFLD entities. Due to the remarkable increase in the prevalence of NAFLD and the concomitant efforts in developing novel therapies, a non-invasive, simple and reproducible technique is needed in the clinical practice. Transient elastography is a non-invasive technique for liver stiffness measurement (LSM) as a function of the extent of hepatic fibrosis. This review focuses on practical issues in the use of LSM in the NAFLD patients and suggests areas for further research and development.
Assuntos
Técnicas de Imagem por Elasticidade/métodos , Fígado Gorduroso/diagnóstico , Fígado Gorduroso/patologia , Obesidade , Biópsia/métodos , Humanos , Hepatopatia Gordurosa não Alcoólica , Saúde PúblicaRESUMO
Hepatitis C virus subtype 3a (HCV-3a) originates from Asia and has spread widely among injecting drug users as well as other patient groups in industrialized countries. HCV subtype 3a infection remains highly prevalent and frequently transmitted in the population of intravenous drug users. The objective of this study was to understand better the mechanisms of the worldwide HCV-3a epidemics in drug users. Ninety-three sera from HCV-3a-infected IDUs from France, the United States, Brazil, Argentina, and Australia were studied. Phylogenetic analyses of the non-structural 5B region showed no specific clustering according to the continent of the patient's origin. Non-exclusive clusters of viral sequences from South America, Australia, and California were observed, but topologies were not supported by strong bootstrap values. The results suggest that HCV-3a has been transmitted from a common origin through a unique worldwide epidemic that rapidly spread among drug users. Regional transmission occurred in the recent past, leading to an embryonic genetic diversification of HCV-3a among local injecting drug user population.