Chronic Viral Hepatitis Patients Research Articles

Liver and spleen stiffness and their ratio assessed by real-time two dimensional-shear wave elastography in patients with liver fibrosis and cirrhosis due to chronic viral hepatitis.

To investigate the performance of real-time 2D shear wave elastography (RT 2D-SWE) for non-invasive staging of liver disease in patients with chronic viral hepatitis (CVH). Naive CVH patients underwent liver (LS) and spleen stiffness (SS) measurements by an intercostal approach. Patients with ALT >3× upper limit of normal, cholestasis as revealed by dilated intrahepatic biliary tree, and liver congestion were excluded. Results were expressed in kPa and compared to histological stage (Ishak) of liver fibrosis (LF). Patients with decompensated liver cirrhosis (LC) were diagnosed using standard clinical, ultrasound, and endoscopic criteria. Of 123 patients, LS was successfully measured in 79.7% and SS in 53.7%. LS accurately differentiated between liver disease stages, with cut-off values of 8.1 (AUC 0.991) for F ≥ 3, 10.8 kPa (AUC 0.954) for F ≥ 5, and 27 kPa (AUC 0.961) for decompensated LC. SS was significantly different between non-cirrhotic stages (F0-4) and LC (cut-off 24 kPa; AUC 0.821). While both LS and SS increased with liver disease progression, the difference between them decreased, as reflected by the stiffness ratio index. RT 2D-SWE can accurately differentiate between the stages of LF, and can distinguish LF from LC and compensated from decompensated LC. • RT 2D-SWE is an accurate method for assessment of liver fibrosis. • RT 2D-SWE is applicable in 80% of patients with chronic viral hepatitis. • RT 2D-SWE accurately differentiates compensated from decompensated liver cirrhosis. • Both liver and spleen stiffness increase with progression of liver fibrosis. • In cirrhosis, the difference between liver and spleen stiffness decreases.

Prevalence of Vitamin D Deficiency among Non-cirrhotic Pakistani Patients with Chronic Viral Hepatitis and Non-alcoholic Fatty Liver Disease

Introduction: Vitamin D deficiency is common among patients with chronic viral hepatitis and nonalcoholic fatty liver disease (NAFLD). There is no published data on vitamin D levels in Pakistani patients with chronic viral hepatitis or NAFLD. Objective: To determine the prevalence of vitamin D deficiency in Pakistani patients with chronic viral hepatitis B and C and NAFLD. Methods: Patients with chronic viral hepatitis B and C but not cirrhosis were prospectively tested for vitamin D levels. 25- hydroxyvitamin D levels were measured using a direct competitive immunoluminometric assay. Results: Of the 400 patients enrolled in the study, 110 (27%) had chronic hepatitis B and 190 (48%) had chronic hepatitis C and 100 (25%) had NAFLD. 224 (56%) patients were male and the average age was 52 years. Overall, 154 (39%) had vitamin D deficiency (<10 ng/ml), 212 (53%) had vitamin D insufficiency (10-30 ng/ml), and 34 (8%) were vitamin D sufficient (>30 ng/ml). Among chronic hepatitis C patients, 59 (31%) were vitamin D deficient and 112 (59%) were vitamin D insufficient. Of chronic hepatitis B patients, 52 (47%) were vitamin D deficient and 51 (46%) were vitamin D insufficient. Among NAFLD patients, 43 (43%) were vitamin D deficient, 49 (49%) were vitamin D insufficient. Conclusion: Vitamin D deficiency or insufficiency affects greater than 90% of non-cirrhotic, chronic viral hepatitis and NAFLD patients in Pakistan. Further studies are needed to assess this problem in a larger cohort of patients and in cirrhotic patients, and to determine its impact on treatment outcomes in Pakistani patients.

A Study on the Anxiety of the Chronic Viral Hepatitis Patients Receiving Pegylated Interferon Therapy

MethodsZZThe subjects were 30 patients with hepatitis B and C viral infections who were waiting to receive PEG-IFN treatment. For assessment of depressive and anxiety symptoms, the Beck Depression Inventory and the State-Trait Anxiety Inventory were used. Patients were examined before treatment and then prospectively during the 2 weeks, 4 weeks and 1 years of therapy. We analyzed the changes in anxiety and depression symptoms, and applied multiple regression analysis to identify factors that significantly affect the anxiety symptoms.

Mean platelet volume is an important predictor of hepatitis C but not hepatitis B liver damage.

Background:The mean platelet volume (MPV) is the most commonly used measure of platelet size and is a potential marker of platelet reactivity. In this study, we aimed to explore the relationship between hepatic histopathology in viral hepatitis and MPV levels, which are associated with platelet count and activity.Materials and Methods:We performed a retrospective case-control study of baseline histological and clinical parameters in chronic hepatitis B and C patients in our tertiary reference center between January 2005 and January 2011. Two hundred and five chronic hepatitis B patients and 133 chronic hepatitis C patients who underwent liver biopsy were included in the study. The patients were divided into two groups: Chronic hepatitis B and chronic hepatitis C and were additionally divided into groups of two according to histological activity index (HAI) and fibrosis scores obtained by liver biopsy results (according to the Ishak scoring system). The clinical characteristics of chronic viral hepatitis patients, including demographics, laboratory (especially MPV), and liver biopsy findings, were reviewed.Results:One hundred and forty-three patients were male (69.1%), and the mean age was 41.9 ± 12.75 with an age range of 18-71 years in hepatitis B patients. In the classification made according to HAI, 181 patients were in the low activity group (88.3%) and 24 in the high activity group (11.7%). In the evaluation made according to fibrosis score, 169 patients were found to have early fibrosis (82.4%) and 36 were found to have advanced fibrosis (17.6%). In patients with hepatitis B, there was no statistically significant difference in terms of their MPV values between the two groups, separated according to their degree of activity and fibrosis. Sixty-three patients were male (47.3%), and the mean age was 50.03 ± 12.75 with an age range of 19-75 years. In the classification made according to HAI, 109 patients were in low activity group (81.9%) and 24 in high activity group (18.1%). In the evaluation made according to fibrosis score, 101 patients were found to have early fibrosis (75.9%) and 32 have advanced fibrosis (24.1%). There was a statistically significant difference between the activity and fibrosis groups of the hepatitis C patients (P = 0.04 and P = 0.02, respectively).Conclusion:MPV values are more reliable in hepatitis C patients than hepatitis B for predicting the advanced damage in liver histology. This finding might be useful for the detection of early fibrosis and also starting early treatment, which is important in hepatitis C.

Profile of liver biopsies in a tertiary care centre in coastal eastern India

The aim of this study was to evaluate the profile of liver biopsies in a tertiary referral centre in eastern India. A total of 54 patients over a period of 1 year, diagnosed by clinical, biochemical, radiological and histopathological parameters, were evaluated for aetiology. Investigations included serological tests for the markers of hepatitis B virus (HBV) and hepatitis C virus (HCV). Autoimmune markers, including antinuclear antibody (ANA), antismooth muscle antibody (ASMA) and antimitochondrial antibody (AMA-M2), were carried out where clinically indicated. Histopathological study with routine haematoxylin and eosin (HE) stain and special stains, including Masson’s trichrome and reticulin stain, were carried out. A total of 24 (46%) patients had non-alcoholic fatty liver disease (NAFLD), 18 (34%) patients had chronic viral hepatitis and 10 (20%) patients had other liver disorders. HBV was present in 16 (88.2%) cases and HCV in 2 (11.8%) cases in the category of clinically chronic viral hepatitis patients. None had infection with both viruses. Cholestatic liver disease, cirrhosis and amyloidosis were the aetiological factors, amongst others. Biopsy was inadequate in two cases. This study showed NAFLD, closely followed by HBV infection, as the most common cause of liver disease in the study population. Alcoholics were excluded from the study. The study reflects the referral pattern in a tertiary centre. However, larger and longer studies are required to delineate the exact prevalence of liver disease in this geographical area

Assessment of the histopathological key features in autoimmune hepatitis.

In this study, we aimed to evaluate the use of typical histological features of both the revised original (1999) and simplified (2008) criteria in the diagnosis of autoimmune hepatitis (AIH) in clinical practice. We performed a detailed histopathological evaluation of the pretreatment biopsies of 63 AIH patients, and used biopsies of 62 untreated chronic viral hepatitis patients [hepatitis B (n = 21) or hepatitis C (n = 41)] as a reference cohort. Biopsies were systematically reviewed for inflammation, fibrosis and the presence of interface hepatitis, plasma cells, rosettes and emperipolesis with a well-defined assessment method. AIH biopsies showed more interface hepatitis (87% versus 63%, P = 0.002), more plasma cell-rich infiltrates (48% versus 27%, P = 0.02), more rosettes (49% versus 23%, P = 0.004) and more emperipolesis (78% versus 50%, P = 0.001) than chronic viral hepatitis biopsies. Emperipolesis (P = 0.01) and rosettes (P < 0.01) were superior to plasma cells and interface hepatitis as independent predictors for AIH. Moderate to severe lymphocytic cholangitis was found in 28% of AIH patients. Emperipolesis and rosette formation are superior histological predictors of AIH than the classic hallmark features of interface hepatitis and plasma cells. In addition, moderate to severe lymphocytic cholangitis does not preclude the diagnosis of AIH.

Peculiarities of cerebral blood flow in patients with chronic diffuse liver diseases of viral etiology

Aim. To study the features of cerebral blood flow at different structural and functional levels of the brain vascular system in patients with chronic hepatitis and cirrhosis of viral etiology. Methods. A comprehensive ultrasound examination of the brain vascular system using an algorithm of cerebral arterial and venous blood flow examination based on the concept of the brain vascular system construction considering five structural and functional levels was performed in 65 chronic viral hepatitis patients and 61 patients with liver cirrhosis of viral etiology. The examination of the main brain arteries was performed using duplex scanning ultrasound SSD-5500 scanner («Aloka», Japan) with 5-12 MHz linear transducers. Examination of intracranial vessels was performed by transcranial color duplex scanning using ultrasonic SSD-5500 and «Sonoline G60» scanners («Siemens», Germany) with linear and phased 2.1-2.5 MHz transducers. Control group consisted of 50 healthy persons. Results. Remodeling of the cerebral arteries: the expansion of the lumen of the main cerebral vessels, reduction of blood flow in the carotid and middle cerebral arteries, decreased elasticity and increased vascular wall rigidity and, as a consequence, a change in vascular resistance and cerebral blood flow disturbance occurs in patients with chronic viral liver diseases. Identified changes of blood flow parameters at all levels of structural and functional brain perfusion indicate the presence of cerebral microangiopathy and arteriopathy based on the development of arteriosclerosis of main arteries and all penetrating arteries and arterioles in patients with chronic diffuse liver diseases. Conclusion. Adaptive remodeling of the vascular wall of the main cerebral arteries which provides an adequate regulatory response is found in patients with hepatitis B and C-associated liver cirrhosis. The reduction of blood supply to the brain, depletion of functional vascular reserve and development of intracranial venous circulatory distress are seen in patients with liver cirrhosis associated with viral hepatitis.

Caregiver burden and its determinants among family members of patients with chronic viral hepatitis in Shanghai, China: a community-based survey

BackgroundIn China, caregivers of chronic viral hepatitis patients experience considerable burdens, stress and disruption of their own well-being and social activities. Measurement of the effect on caregivers is an under-researched area. The Family Burden Interview Schedule (FBIS) was primarily devised for the caregivers of schizophrenia patients, and the adverse effect of the disease was similar to the effect of chronic viral hepatitis on family caregivers. In this study, we prospectively evaluated the psychometric properties of FBIS in the field of chronic viral hepatitis and used it to determine the factors affecting the caregiver burden on the family members of chronic viral hepatitis patients in Shanghai, China.MethodsA representative sample of patients (n = 1478) and caregivers (n = 1478) was randomly obtained through a multi-stage cluster sampling in Shanghai, China. Reliability and validity tests were used to verify the psychometric properties of the instrument. The two-level random intercept model was applied to determine the factors of the caregiver burden between the household and the community level.ResultsCronbach’s alpha coefficient was 0.90 for the overall instrument with statistical significance. Factor analysis suggested a three-factor model for the FBIS and confirmed that the adjusted unidimensional model and the second-order multidimensional model had better fit statistics. The average score of the caregiver burden in Shanghai was 12.62 ± 10.74, and financial burden constituted the major effect. The two-level random intercept model demonstrated that the risk factors were hospitalisation (β 1.69, 95%CI 0.48 to 2.90), elevated serum alanine aminotransferase levels (β 1.05, 95%CI 0.15 to 1.95), HCV infection (β 4.49, 95%CI 1.22 to 7.77), and acceptance of the hepatitis B vaccine (β 2.20, 95%CI 0.56 to 3.85), whereas the protective factors were no consumption of alcohol (β -2.69, 95%CI −5.19 to −0.19), average monthly costs for patients less than or equal to 100 US dollars (β -2.96, 95%CI −5.83 to −0.09), and good health status of family caregivers (β -9.91, 95%CI −12.76 to −7.05).ConclusionsFBIS can accurately measure the caregiver burden for chronic hepatitis. Targeting interventions toward the conditions associated with the caregiver burden is of great importance.

Endogenous IFNλ in Viral Hepatitis Patients

Besides type I interferons (IFNs), type III IFNs, including IFNλ1 (interleukin-29 [IL-29]), possess potent antiviral activity. In patients infected with the hepatitis C virus (HCV), it has been demonstrated that viral clearance is associated with genetic variation near the IFNλ3 (IL-28B) gene. The rapid influx of research being conducted on this family of cytokines has led to several inconsistencies and controversies, including the possible correlation of serum cytokine levels with disease in chronic viral hepatitis patients. In a detailed study, well-characterized cohorts of patients with HBV and HCV were evaluated with 3 different immunoassays, and no differences in the levels of serum IFNλ were observed between patient groups, disease stages, or clinical parameters.

The feasibility of shear-wave elastographic methods for non-invasive assessment of liver fibrosis in chronic viral hepatitis patients

The feasibility of shear-wave elastographic methods for non-invasive assessment of liver fibrosis in chronic viral hepatitis patients

Diffusion weighted MRI in chronic viral hepatitis: correlation between ADC values and histopathological scores

ObjectiveTo investigate the utility of apparent diffusion coefficient (ADC) measurement in the diagnosis of chronic viral hepatitis (CVH) and correlation between ADC values and histopathologic severity of CVH.Materials and methodsThe ADC values of liver parenchyma on diffusion-weighted magnetic resonance imaging (DWMRI) were measured in 50 patients with a history of CVH and 51 healthy subjects at b 100, b 600 and b 1,000 gradients. Comparison between mean ADC values of the CVH and control groups and correlation results between ADC values and necroinflammation and fibrosis scores in CVH were obtained.ResultsMean ADC values of CVH patients were significantly lower than mean ADC values of the control group at b 100 and b 600 gradients (P < 0.05). There was no significant difference between the CVH and control groups at the b 1,000 gradient (P > 0.05). No significant correlation was found between ADC values and histopathologic scores of CVH (P > 0.05).ConclusionADC values obtained at the b 100 and b 600 gradients can be used to distinguish between the liver parenchyma of CVH and healthy subjects. ADC measurement was not found to be useful for estimation of the degree of necroinflammation and fibrosis in CVH.Teaching Points• In chronic viral hepatitis apparent coefficient values are decreased in the liver• There is no correlation between ADC values and histopathologic severity of CVH• DW images obtained at low b values have more ability to demonstrate an ADC decrease in viral hepatitis

Disclosure behaviour and experienced reactions in patients with HIV versus chronic viral hepatitis or diabetes mellitus in Germany

Disclosure is a prerequisite to receive disease-specific social support. However, in the case of a stigmatised disease, it can also lead to discrimination. We aimed to assess disclosure rates of HIV patients and the reactions they encountered in comparison to patients with chronic viral hepatitis or diabetes mellitus and patients' general perception of disease-specific discrimination. We constructed a self-report questionnaire, anonymously assessing the size of the social environment, the persons who had been informed, and the experienced reactions as perceived by the disclosing patients, to be rated on 1–4 point Likert scales. In addition, patients were asked whether they perceive general discrimination in Germany. One hundred and seventy-one patients were asked to participate. Five rejected, thus questionnaires from 83 patients with HIV, 42 patients with chronic viral hepatitis B (n=9) or C (n=33), and 41 patients with insulin-dependent diabetes mellitus (type I n=14, type II n=27) were analysed. Whereas the size of the social environment did not differ, HIV-infected patients were least likely to disclose their disease (60.7%, SD±31.9) to their social environment as compared to patients with chronic viral hepatitis (84.2±23.3%, p<0.0001), or diabetes mellitus (94.4 ±10.3%, p<0.0001), respectively. Within the HIV patient group, the mean disclosure rate was highest to partners (90.9%), followed by the public environment (65.2%), friends (59.4%) and family members (43.8%). HIV patients experienced supportive reactions after 79.3±26.4% of disclosures, which was the case in 91.4±19.6% and 75.7±36.1% of patients with hepatitis or diabetes mellitus, respectively. 69.5% of HIV patients stated to perceive general discrimination in Germany. We conclude that HIV patients had experienced supportive reactions after the majority of disclosures, but the low rate points out that their information strategy had been very selective. Societal discrimination of HIV patients is still an issue and needs to be further addressed.

Factors influencing long-term quality of life and depression in German liver transplant recipients: A single-centre cross-sectional study

Health-related quality of life (HRQOL) following orthotopic liver transplantation (OLT) has become increasingly important. Therefore, we aimed to identify factors affecting HRQOL after OLT. This cross-sectional, single-centre study surveyed 281 OLT patients. Survey tools included the Short Form (SF-36) Health Survey, the Patient Health Questionnaire 9 (PHQ9), and a self-designed employment questionnaire. Patient medical records were reviewed. Participants included 187 men (mean age at OLT: 50 [± 11; 13-69] years). Primary indications for OLT were viral hepatitis (28%), alcoholic liver disease (35%), cholestatic liver disease (11%), and others (26%). Follow-up ranged from 2 to 136 months. Clinical factors associated with improved HRQOL were age ≤ 45 years at OLT and current MELD score <=≤ 13. Time after OLT and indication for transplantation affected SF-36 HRQOL. SF-36 physical component summary scales plateaued at 3-years post-OLT and then stabilized. For the SF-36 HRQOL, scores were the lowest in all domains for OLT recipients transplanted for chronic viral hepatitis and for unemployed patients, whereas sex and number of transplantations showed no significant differences. The PHQ9 results showed that depression was significantly more frequent among patients with current MELD score ≥ 13 or impaired liver function and those transplanted for chronic viral hepatitis or unemployed patients. Age and sex did not influence PHQ9 results. Medical and psychosocial support is crucial for long-term HRQOL after OLT. Developing multidisciplinary interventions to address issues such as employment, age, MELD score, and liver function may improve long-term HRQOL in these patients.

Color correction for automatic fibrosis quantification in liver biopsy specimens

Context: For a precise and objective quantification of liver fibrosis, quantitative evaluations through image analysis have been utilized. However, manual operations are required in most cases for extracting fiber areas because of color variation included in digital pathology images. Aims: The purpose of this research is to propose a color correction method for whole slide images (WSIs) of Elastica van Gieson (EVG) stained liver biopsy tissue specimens and to realize automated operation of image analysis for fibrosis quantification. Materials and Methods: Our experimental dataset consisted of 38 WSIs of liver biopsy specimens collected from 38 chronic viral hepatitis patients from multiple medical facilities, stained with EVG and scanned at ×20 using a Nano Zoomer 2.0 HT (Hamamatsu Photonics K.K., Hamamatsu, Japan). Color correction was performed by modifying the color distribution of a target WSI so as to fit to the reference, where the color distribution was modeled by a set of two triangle pyramids. Using color corrected WSIs; fibrosis quantification was performed based on tissue classification analysis. Statistical Analysis Used: Spearman’s rank correlation coefficients were calculated between liver stiffness measured by transient elastography and median area ratio of collagen fibers calculated based on tissue classification results. Results: Statistical analysis results showed a significant correlation r = 0.61-0.68 even when tissue classifiers were trained by using a subset of WSIs, while the correlation coefficients were reduced to r = 0.40-0.50 without color correction. Conclusions: Fibrosis quantification accompanied with the proposed color correction method could provide an objective evaluation tool for liver fibrosis, which complements semi-quantitative histologic evaluation systems.

Antioxidant protective effects of lactitol against endotoxemia in patients with chronic viral hepatitis

Although antiviral drugs are widely used in the clinic, progression to liver cirrhosis and hepatocellular carcinoma cannot yet be entirely prevented. The aim of this study was to determine the effects of lactitol in chronic viral hepatitis patients with endotoxemia. Ninety-four patients with chronic viral hepatitis were separated into two groups based on plasma endotoxin levels: one group with endotoxemia (≥ 45 ng/l, n=60) and one group without endotoxemia (<45 ng/l, n=34). Sixty patients with gut-derived endotoxemia were randomly and evenly divided into a lactitol treatment group and a control group. Plasma endotoxin levels in patients with chronic viral hepatitis exhibited a negative correlation with superoxide dismutase (SOD) activity (P<0.001) and a positive correlation with levels of malondialdehyde (MDA) (P<0.001). The levels of SOD in the lactitol-treated group increased (P<0.01), while the levels of MDA decreased (P<0.01). Plasma endotoxin levels decreased (P<0.01) and the number of lactobacilli and bifidobacteria in the intestinal tract increased (P<0.01 for all). These results suggest that lactitol administration is capable of reducing injury caused by oxidants through regulating intestinal flora and decreasing gut-derived endotoxemia in patients with chronic viral hepatitis.

Patients with Nonalcoholic Fatty Liver Disease (NAFLD) have Higher Oxidative Stress in Comparison to Chronic Viral Hepatitis

Oxidative stress and cytokines play an important role in the pathogenesis of nonalcoholic fatty liver disease (NAFLD). We compared the presence of oxidative stress and cytokines in 25 patients with NAFLD with 25 age, sex and BMI-matched patients with chronic viral hepatitis (CVH) and 25 healthy volunteers (HV). Oxidative stress was studied biochemically by markers of lipid peroxidation and biochemical assessment of anti-oxidant status and various cytokines were studied by ELISA. Patients with NAFLD had significantly higher levels of malondialdehyde (MDA) (p=0.000) and conjugated dienes (CD) (p=0.000) in comparison to HVs. Patients with NAFLD also had significantly higher MDA levels (p=0.000) in comparison to CVH patients. Patients with NAFLD had significantly lower GSH levels (p=0.004) in comparison to HVs. Patients with NAFLD had higher GPx activity (p=0.028) in comparison to HVs. Catalase activity was significantly decreased in both NAFLD (p=0.001) and CVH patients (p=0.000) in comparison to HVs. Patients with NAFLD had significantly higher SOD activity (p=0.000) in comparison to CVH patients. There was no difference in serum levels of IL-1β and TNF-α amongst three groups. Patients with CVH were found to have higher IL-8 serum levels (p=0.039) in comparison to HVs. CVH patients also had higher TGF-β levels (p=0.002) in comparison to both NAFLD patients and HVs. Differences in the markers of oxidative stress and anti-oxidant status betweenNAFLD, CVH and healthy volunteers suggest presence of higher oxidative stress in patients with NAFLD.

A practical scoring system for predicting cirrhosis in patients with chronic viral hepatitis.

The purpose of the current study was to develop a simple model for predicting cirrhosis in chronic viral hepatitis patients and to evaluate the usefulness of decision tree algorithms. Serum markers of fibrosis were compared with the stage of fibrosis in liver biopsy specimens prospectively obtained from 526 subjects with chronic HBV and HCV infections (estimation set, 367; validation set, 159). Univariate analysis revealed that age, bilirubin, platelet count, APRI, ALP, hyaluronic acid (HA), α2-macroglobulin, MMP-2, TIMP-1, and procollagen III N-terminal peptide (PIIINP) were significantly different between patients with (F4) and without cirrhosis (F0123). Multivariate logistic regression analysis identified platelet count, HA and PIIINP as independent predictors of cirrhosis. We categorized the individual variable into the most appropriate cut-off value by calculating the likelihood ratio for predicting cirrhosis and constructed a score system expressed by the following simple formula: PHP index = platelet score + HA score + PIIINP score. For predicting cirrhosis, the area under the receiver operating characteristic curve (AUROC) was 0.824 and 0.759 in the estimation and validation set, respectively. Using a cut-off score of 4, the presence of cirrhosis was predicted with high accuracy. The diagnostic performance of the PHP index was similar to decision tree algorithms (AUROC=0.819) for predicting liver cirrhosis, but more useful in clinical situations. Compared to a decision tree model, a simple score system using a categorized value based on a combination of platelet count, HA and PIIINP identified patients with liver cirrhosis with a higher clinical usability.

The usefulness of measuring liver stiffness by transient elastography for assessing hepatic fibrosis in patients with various chronic liver diseases.

The degree of hepatic fibrosis is an important factor for prognosis and management of patients with chronic liver disease; however, liver biopsy is an invasive method of measuring fibrosis. Here, we investigated the diagnostic utility of liver stiffness, as measured by transient elastography in assessing hepatic fibrosis of viral chronic liver disease and nonalcoholic fatty liver disease (NAFLD). Four hundred and nine eligible patients underwent transient elastography to measure liver stiffness. Liver biopsy for histopathological assessment of fibrosis (F0-F4) was performed in 71 of these patients. Serum levels of hyaluronic acid were determined in 110 patients. We assessed liver stiffness in several chronic liver diseases and compared correlations among liver stiffness, hepatic fibrosis stage and serum hyaluronic acid levels. A steady stepwise increase in liver stiffness was observed with progressing severity of hepatic fibrosis (p<0.0001) in 71 patients who underwent liver biopsy. In 32 chronic viral hepatitis patients, measuring liver stiffness was useful for differentiating between F1, or F2, or F3 and F4, while in 32 NAFLD liver stiffness can differentiate between F0 and F1, F2, or F3, F1 and F3 or F4 and F2 and F4. There was no significant correlation between liver fibrotic stages and serum hyaluronic levels. The present data advocates measuring liver stiffness for assessing hepatic fibrosis is more sensitive in NAFLD than viral chronic diseases, and liver stiffness is useful compared to serum hyaluronic acid level in estimating hepatic fibrosis.

Survey on follow-up status in patients with chronic liver diseases

A questionnaire and telephone survey was conducted on 246 patients with chronic liver diseases in the Outpatient Clinic from August 2010 to May 2011.The distribution of diseases and the causes of losing follow-up were analyzed. Most subjects in this survey (182/246,74.0％ ) were patients with chronic viral hepatitis( HBV or HCV)and cirrhosis; and their follow-up status was better than others (X2 =12.382,P ＜ 0.05). There were no differences in gender( X2 =10.137,P ＞ 0.05),but significant differences in age ( X2 =31.783,P ＜ 0.05 ) and educational levels ( X2 =32.803,P ＜ 0.05 ) between patients with chronic viral hepatitis and cirrhosis and patients with other liver diseases.The main causes of losing follow-up were neglect of disease by patients (38.3％) and lack of good communication between doctors and patients ( 18.3％ ).It is important to reinforce the understanding and awareness of chronic liver diseases for patients. Key words: Liver diseases; Follow-up studies

PS1-101 Peginterferon therapy of chronic viral hepatitis patients differentially regulates plasmacytoid dendritic cell TLR7 and TLR9 function.

PS1-101 Peginterferon therapy of chronic viral hepatitis patients differentially regulates plasmacytoid dendritic cell TLR7 and TLR9 function.