https://aasldpubs.onlinelibrary.wiley.com/doi/epdf/10.1002/hep.29800

Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance

Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China; Department of Infectious Diseases, Center for Liver Diseases, Peking University First Hospital, Beijing, China; The Institute of Translational Hepatology, 302 Hospital of PLA, Peking University, Beijing, China; Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China; Institute for Viral Hepatitis, the Key Laboratory of Molecular Biology for Infectious Diseases, the second Affiliated Hospital of Chongqing Medical University, Chongqing, China; Department of Microbiology of Peking University Health Science Center, Beijing, China; State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Serious Illness Medicine Inpatient Area, Beijing Youan Hospital, Capital Medical University, Beijing, China; Department of Pathology, 302 Hospital of PLA, Peking University, Beijing, China; Artificial Liver Center, Beijing Youan Hospital, Capital Medical University, Beijing, China; Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China; Center of Infectious Diseases, West China Hospital of Sichuan University, Division of Infectious Diseases, State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China; Department of Infectious Diseases, Shanghai Jiao Tong University School of Medicine Affiliated Ruijin Hospital, Shanghai, China; Hepatology Institute, Peking University People’s Hospital, Beijing, China

/pdf/guideline-of-prevention-and-treatment-for-chronic-hepatitis-4kac97ide0.pdf

Guideline of Prevention and Treatment for Chronic Hepatitis B (2015 Update).

American Gastroenterological Association Institute Technical Review on the Role of Elastography in Chronic Liver Diseases.

Machine-learning-based classification of real-time tissue elastography for hepatic fibrosis in patients with chronic hepatitis B.

Background/aims 
The accuracy of noninvasive markers to discriminate nonalcoholic steatohepatitis (NASH) is unsatisfactory We investigated whether transient elastography (TE) could discriminate patients with NASH from those with nonalcoholic fatty liver disease (NAFLD)
Methods 
The patients suspected of NAFLD who underwent liver biopsy and concomitant TE were recruited from five tertiary centers between November 2011 and December 2013
Results 
The study population (n = 183) exhibited a mean age of 406 years and male predominance (n = 111, 607%) Of the study participants, 89 (486%) had non-NASH and 94 (514%) had NASH The controlled attenuation parameter (CAP) and liver stiffness (LS) were significantly correlated with the degrees of steatosis (r = 0656, P 250 dB/m; P = 0013, OR 3399, 95% CI 1295–8291 for LS>70 kPa; and P 60 IU/L], we developed a novel CLA model for discriminating patients with NASH The CLA model showed good discriminatory capability, with an area under the receiver operating characteristic curve (AUROC) of 0812 (95% CI 0724–0880) To assess discriminatory power, the AUROCs, as determined by the bootstrap method, remained largely unchanged between iterations, with an average value of 0833 (95% CI 0740–0893)
Conclusion 
This novel TE-based CLA model showed acceptable accuracy in discriminating NASH from simple steatosis However, further studies are required for external validation

/pdf/discrimination-of-nonalcoholic-steatohepatitis-using-2rhdrchv2o.pdf

Discrimination of Nonalcoholic Steatohepatitis Using Transient Elastography in Patients with Nonalcoholic Fatty Liver Disease.

Background and Aim

Liver stiffness measurement (LSM) using transient elastography (FibroScan) is a useful tool to assess fibrosis in various chronic liver diseases. However, studies were mainly performed in Western countries and largely focused on chronic hepatitis C (CHC). We therefore carried out a multicenter study to validate the accuracy of LSM in the assessment of liver fibrosis in a large cohort of Chinese patients with chronic hepatitis B (CHB).



Methods

We compared LSM results to histological staging and serum fibrosis markers (five direct markers, APRI and FIB-4) using Spearman correlation analysis and area under receiver operating characteristic (ROC) curves (AUROCs).



Results

Four hundred sixty-nine patients were enrolled and eligible for statistical analysis. LSM in F0 to F4 was 5.5 ± 1.7, 5.8 ± 2.2, 7.6 ± 3.4, 14.5 ± 10.8, and 22.3 ± 13.6 kPa, respectively (correlation with fibrosis stage r = 0.522, P   5x the upper limit of normal values had significantly higher stiffness values than stage-matched patients with normal alanine aminotransferase.



Conclusion

Transient elastography is a reliable noninvasive technique to predict significant liver fibrosis in Chinese patients with CHB, being superior to current biomarker panels. However, enhanced inflammatory activity can lead to elevated stiffness values unrelated to histological fibrosis stage.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/jgh.12840

Xiqi Hu

Papers

Transient elastography compared to serum markers to predict liver fibrosis in a cohort of Chinese patients with chronic hepatitis B.