Fibrosis In Chronic Hepatitis Research Articles

GPR, King's Score and S-Index are superior to other non-invasive fibrosis markers in predicting the liver fibrosis in chronic Hepatitis B patients.

In this study, we investigated the efficacy of nine non-invasive fibrosis markers in the assessment of the degree of fibrosis in patients with chronic Hepatitis B (CHB) in comparison with liver biopsy. A total of 1454 untreated CHB patients from two different centers who underwent liver biopsy were included in the study. Laboratory results of patients were reviewed retrospectively and the pathology slides were re-evaluated in accordance with the Ishak score. Degree of fibrosis ≥ 3 was accepted as "significant fibrosis", ≥ 4 as "advanced fibrosis", and ≥ 5 as cirrhosis. The diagnostic performance of the markers Aspartate aminotransferase to Platelet Ratio Index (APRI), Fibrosis-4 score (FIB-4), Aspartate aminotransferase to Alanine aminotransferase Ratio (AAR), AAR to Platelet Ratio Index (AAPRI), Gamma-glutamyl transpeptidase to Platelet Ratio (GPR), King's Score, Fibro quotient (Fibro-Q), S Index and Platelet to Lymphocyte Ratio (PLR) were evaluated with ROC analysis. In detecting significant fibrosis, APRI, GPR, King's Score and S Index had AUROC values over 0.70. For advanced fibrosis, all of the models except AAPRI; and for cirrhosis, all of the models had AUROC values over 0.70. In accordance with the chosen staging system, GPR, King's Score and S Index had high diagnostic efficacy whereas APRI, FIB-4, FibroQ and PLR had moderate diagnostic efficacy, AAR and AAPRI had low diagnostic efficacy. GPR, King's Score and S Index had moderate diagnostic performance in detecting significant fibrosis and advanced fibrosis, and high diagnostic performance in detecting cirrhosis.

Prediction of Fibrosis in Chronic Hepatitis C by Mean Platelet Volume and Platelet to Lymphocyte Ratio

Abstract: Introduction: Hepatitis C is a chronic inflammatory condition that associated with fibrosis. Novel inflammatory markers have been suggested to be related inflammatory condition. Therefore, we aimed to investigate hemogram derived indices, such as, Mean Platelet Volume (MPV) and Platelet to Lymphocyte ratio (PLR) in hepatitis C subjects and to compare those in healthy controls. Materials and Methods: In present retrospective study, 17 HCV patients having mild fibrosis, 23 patients having advanced fibrosis and 68 control subjects were included whom visited outpatient clinics of our institution between 1.10. 2017 and 30.11.2019. Hemogram indices and laboratory characteristics were compared. Results: Median MPV values of the advanced fibrosis patients [8.3 (6.5-14) fL] was significantly higher than that of the mild fibrosis patients [7.9 (6.5-11.1) fL] (p=0.002) and control subjects [7.2 (4.6-10.7) fL] p<0.001) whereas MPV values of mild and advanced fibrosis patients were similar (p=0.750). Median PLR values of the mild fibrosis, advanced fibrosis and control groups were 103 (58-223) %, 86 (45-358) %, and 77 (64-96) %, respectively (p=0.010). A ROC analysis revealed that a MPV value greater than 7.3 fL determines advanced fibrosis with 76% sensitivity and 59% specificity. A PLR greater than 92% determines advanced fibrosis with 73% sensitivity and 64% specificity. Conclusion: We suggest that elevated PLR and MPV could predict of advanced fibrosis in chronic hepatitis C. Keywords: Hepatitis C, Fibrosis, Platelet to lymphocyte ratio, Mean platelet volume, Hemogram indices, Liver cirrhosis.

Statins for the Treatment of Liver Fibrosis in Chronic Hepatitis-C Patients

Background: Hepatitis C virus (HCV) is one of the most common causes of chronic liver disease and the leading indication for liver transplantation worldwide. Chronic hepatitis C (CHC) leads to cirrhosis and hepatocellular carcinoma (HCC). Statins have gained attention for their pleiotropic effects. There is mounting evidence that statins offer chemoprevention against many malignancies. The aim of this was to determine the efficacy of the statin for the treatment of liver fibrosis in chronic hepatitis C patients.
 Methodology: A randomized control trial was conducted at Hepatitis Clinic, People Medical College Hospital, Nawabshah from August 20, 2020, to February 20, 2021. Non-probability, consecutive sampling was adapted. Patients with chronic hepatitis C infection and liver fibrosis were included. Group-A was administered statins in addition to antiviral treatment while Group-B was given anti-viral medications only. Stages of fibrosis were determined by shear wave elastography at the start of the study and after 6 months. All the data were entered and analyzed in Statistical Packages for Social Sciences (SPSS) v25.0.
 Results: There were 73 patients in each group. Fibrosis progression occurred in 7(9.6%) patients in group-A and 23(31.5%) in group-A. The link between the efficacy of the treatment given with the group-A and group-B was significant with a p-value of 0.001.
 Conclusion: Findings demonstrate a significant reduction in the risk of fibrosis progression among statin users with advanced chronic hepatitis C. These results support a possible role for statins in the prevention of liver disease progression.

Serum ferritin levels are associated with advanced liver fibrosis in treatment-naive autoimmune hepatitis

Background and aimThe association between iron-metabolism-related variables and liver fibrosis in chronic hepatitis C and nonalcoholic fatty liver disease is now well known. However, the relationship has not been extensively studied in autoimmune hepatitis (AIH). We aimed to investigate the association between variables associated with iron metabolism and advanced liver fibrosis among untreated patients with AIH.MethodsNinety-seven untreated AIH patients were enrolled in this cross-sectional study. All participants underwent iron metabolism index detection and liver biopsy. Multiple logistic regression analysis was used to explore the association of iron-metabolism-related variables with advanced liver fibrosis.ResultsAmong the 97 AIH patients, 38 (39.2%) had advanced liver fibrosis, and 59 (60.8%) did not. In multivariate logistic regression analysis, immunoglobulin G (odds ratio [OR], 1.123; 95% confidence interval [CI] 1.023–1.232, P = 0.014), platelet count (OR 0.988; 95% CI 0.979–0.997, P = 0.013), prothrombin time (OR 1.758; 95% CI 1.143–2.704, P = 0.010) and ferritin (OR 1.002; 95% CI 1.001–1.004, P = 0.012) were independent risk factors for predicting advanced liver fibrosis in AIH patients.ConclusionHigher serum ferritin was independently associated with advanced liver fibrosis among patients with treatment-naive AIH.

Deep Learning in the Classification of Stage of Liver Fibrosis in Chronic Hepatitis B with Magnetic Resonance ADC Images.

Liver fibrosis in chronic hepatitis B is the pathological repair response of the liver to chronic injury, which is a key step in the development of various chronic liver diseases to cirrhosis and an important link affecting the prognosis of chronic liver diseases. The further development of liver fibrosis in chronic hepatitis B can lead to the disorder of hepatic lobule structure, nodular regeneration of hepatocytes, formation of a pseudolobular structure, namely, cirrhosis, clinical manifestations of liver dysfunction, and portal hypertension. So far, the diagnosis of liver fibrosis in chronic hepatitis B has been made manually by doctors. However, this is very subjective and boring for doctors. Doctors are likely to be interfered with by external factors, such as fatigue and lack of sleep. This paper proposed a 5-layer deep convolution neural network structure for the automatic classification of liver fibrosis in chronic hepatitis B. In the 5-layer deep convolution neural network structure, there were three convolution layers and two fully connected layers, and each convolution layer was connected with a pooling layer. 123 ADC images were collected, and the following results were obtained: the accuracy, sensitivity, specificity, precision, F1, MCC, and FMI were 88.13% ± 1.47%, 81.45% ± 3.69%, 91.12% ± 1.72%, 80.49% ± 2.94%, 80.90% ± 2.39%, 72.36% ± 3.39%, and 80.94% ± 2.37%, respectively.

Comparison of superb microvascular imaging and shear wave elastography for assessing liver fibrosis in chronic hepatitis B

PurposeThe present study investigated the effectiveness and applicability of superb microvascular imaging (SMI) in determining the degree of liver fibrosis noninvasively in comparison with shear wave elastography (SWE).MethodsNinety-eight consecutive patients with chronic hepatitis B who underwent ultrasound (US)-guided needle biopsy were examined using US combined with SMI and SWE. The predictive performance of the two US techniques in staging liver fibrosis and inflammation was compared with reference to the histological findings obtained from liver biopsy. The intraobserver and interobserver reproducibility of SMI in vascularity scores were evaluated.ResultsSWE values and SMI vascular scores were statistically significantly different among fibrosis stages (χ2(3)=76.3, χ2(3)=81.5, P<0.001). The SWE and SMI models significantly predicted fibrosis stages separately, and SMI scores alone predicted fibrosis stages better than SWE values (50.1% for SWE, 63.5% for SMI, P<0.001). A model with both SMI scores and SWE values together explained 73.2% of variance in fibrosis stages. When other clinical and laboratory predictors were added to the model (81.5%, P<0.001), SWE values and SMI scores remained the main predictors of fibrosis stages. SWE and SMI were also applicable in predicting inflammatory grades, explaining 31% and 34% of variance, respectively, and 37.7% when used together (P<0.001).ConclusionBoth SWE and SMI had good diagnostic performance in determining the degree of liver fibrosis in chronic hepatitis B patients. The efficacy of SMI was better than that of SWE. SMI can improve diagnostic performance for staging liver fibrosis and shows potential for estimating necroinflammation of the liver.

Dynamic monitoring with shear wave elastography predicts outcomes of chronic hepatitis B patients with decompensated cirrhosis.

BackgroundTwo-dimensional shear wave elastography (2D-SWE) can be used to accurately assess significant liver fibrosis in chronic hepatitis B (CHB). However, whether those with decompensated cirrhosis could benefit from surveillance with 2D-SWE remains unclear. We aimed to evaluate the association between dynamic changes in 2D-SWE measurements and the prognosis of CHB-related decompensated cirrhosis.MethodsWe prospectively enrolled 149 consecutive treatment-naive CHB patients with decompensated cirrhosis from a clinical trial (registration number: ChiCTR-DCD-15006000) from February 2015 to December 2018. 2D-SWE was performed at 48-week intervals until December 2020. Liver-related events (LREs) were recorded through electronic medical records and telephone interviews.ResultsThe liver stiffness measurement (LSM) levels persistently reduced after antiviral therapy in patients who did not develop LREs, while patients with LREs showed a fluctuating trend of LSM alterations. Low pre-treatment 2D-SWE LSM, ∆% 2D-SWE LSM pre-virus control, and ∆% 2D-SWE LSM pre-post treatment were characterized by similar prognostic abilities as high levels of these parameters. Post-treatment 2D-SWE LSM was independently correlated with LREs in multivariate Cox regression models after antiviral treatments [hazard ratio (HR) =1.05; 95% confidence interval (CI): 1.02–1.08, P=0.0007 and 1.11; 95% CI: 1.04–1.18, P=0.0026]. Receiver operating characteristic (ROC) curve analysis identified that post-treatment 2D-SWE LSM exhibited the best predictive power for LREs among all the other variables, including parameters of 2D-SWE and serum fibrosis markers (area under the curve =0.75, P<0.001).ConclusionsThe last follow-up LSM, rather than pre-treatment or dynamic changes in 2D-SWE serves as a powerful predictor of LREs, suggesting that sequential monitoring may be beneficial to predicting prognosis.

Role of hepatic Doppler as compared to Fibro-scan in evaluation of post virus C hepatic fibrosis

Abstract Background Chronic infection with hepatitis C virus (HCV) is a disease of global importance with a large burden of morbidity and mortality. hepatitis c virus can cause progressive liver damage which may result in liver cirrhosis and hepato-cellular carcinoma . Aim of the work The aim of our study was to examine the efficacy of hepatic Doppler indices, namely hepatic vein wave form, hepatic vein maximum velocity ,hepatic artery RI and portal vein maximum velocity and portal vein wave form for evaluating the degree of hepatic fibrosis in chronic hepatitis C (CHC) patients as compared to transient elastography. Patients and methods our study was done over period from September 2018 till April 2019 included 40 patients from eldemerdash hospital designed to include all hepatitis c positive patients with any age or sex excluding other cause of liver cirrhosis (negative hepatitis B, negative auto immune hepatitis) in absence of obesity or ascites. hepatic vein maximum velocity, hepatic artery RI, portal vein maximum velocity, TE were performed to all patients. fibrosis was assessed on semi quantitative scoring system (METAVIR score ). we examine the efficacy of each of Doppler indices in differentiating different stages of hepatic fibrosis and their diagnostic accuracy in predicting significant fibrosis and cirrhosis . Results on comparing the fibrosis &amp;non fibrosis groups by TE according to Doppler measurement we found statistically significant higher means of the portal vein maximum velocity (PVmax) for the non fibrosis group as compared to the fibrosis group (24.15±9.71 and 15.94±3.35 respectively with p value&amp;lt;0.001) also found significantly lower HAPSV/PVmax ratio for the non fibrosis as compared to fibrosis group (1.58±0.41 and 2.59±1.17 respectively with p value 0.011) finally, we found that there was significant change of the HV waveform pattern for the non fibrosis (normal triphasic ) as compared to fibrosis (monophasic or biphasic ) (x2=4.353 with p value 0.038)

Role of serum M2BPGi levels in diagnosing significant liver fibrosis and cirrhosis in patients with chronic hepatitis B

Abstract Background and aim Mac-2-binding protein glycosylation isomer (M2BPGi) is a novel serum diagnostic marker for liver fibrosis in various liver diseases. We aimed to evaluate its role in assessment of liver fibrosis in chronic hepatitis B infection (CHB) with reference to liver stiffness measurement (LSM) by transient elastography (Fibroscan). Design and Methods A case control study. 50 CHB patients with LSM by transient elastography technology and retrievable serum samples and 20 normal volunteers as a control group were recruited. Results 50 CHB patients (M: F = 30:20; mean age 43years ± 10.58) and 20 normal control volunteers (M: F = 12:8; mean age 37years ± 14.5) were recruited. The mean M2BPGi values for control group, F0-F1, F2, F3 and F4 progressively increased with more advanced stages of liver fibrosis: 0.282, 0.719, 1.322, 1.65 and 1.904 COI, respectively (p &amp;lt; 0.001). M2BPGi levels correlated well with liver stiffness (r = 0.911) and moderately with FIB-4 (r = 0.682), and with APRI (r = 0.536) (all p &amp;lt; 0.001). Using cut-off values of 0.455, 1.02, 1.16, 1.66 and 1.71COI for control, F0-F1, F2, F3 and F4 groups, respectively, the AUROCs were 0.996, 0.996, 0.691, 0.794 and 1.00 for control, F0-F1, F2, F3 and F4 groups, respectively. There was a statistically significant but with weak positive correlation between M2BPGi serum level and INR (r = 0.333, p = 0.018). And there was a statistically significant but with weak negative correlation between M2BPGi serum level and platelet count (r = -0.41, p = 0.003) and HBV DNA (r = -0.373, p = 0.008).There was a statistically significance between M2BPGi serum level and the history of varices (p = 0.023) Conclusions WFA+-M2BP is an accurate serum indicator for assessing different stages of liver fibrosis. WFA+-M2BP provides a simple and reliable alternative or complementary method to liver biopsy and FibroScan.

Epigenetically-regulated serum GAS5 as a potential biomarker for patients with chronic hepatitis B virus infection.

Long non-coding RNA-growth arrest specific transcript 5 (lncRNA-GAS5) plays a suppressive role in activated hepatic stellate cells (HSCs). LncRNAs could circulate in the blood in a cell-free form and serve as promising biomarkers for various human diseases. Herein, we investigated the feasibility of using serum GAS5 as a biomarker for liver fibrosis in chronic hepatitis B (CHB) patients and whether promoter methylation was responsible for GAS5 down-regulation. Serum GAS5 levels were quantified using quantitative real-time PCR in CHB patients and healthy controls. GAS5 promoter methylation was examined in LX-2 cells and cirrhotic tissues. Compared with the sera from healthy controls, lower GAS5 levels were found in the sera from CHB patients. Receiver operating characteristic curve analysis indicated that serum GAS5 had a significant diagnostic value for liver fibrosis in CHB patients. Serum GAS5 negatively correlated with HAI scores as well as ALT values in CHB patients. GAS5 was additionally reduced in cirrhotic tissues, associated with its hypermethylation promoter. In LX-2 cells, transforming growth factor-β1 treatment led to a reduction in GAS5 expression and an increase in promoter methylation. Hypermethylation of GAS5 was blocked down by DNA methyltransferase (DNMT) inhibitor and restored GAS5 inhibited HSC activation including proliferation and collagen production. Further studies confirmed that GAS5 methylation was mediated by DNMT1. We demonstrate that epigenetically-regulated serum GAS5 could serve as a potential biomarker in CHB patients. Loss of GAS5 is associated with DNMT1-mediated promoter methylation.

Pentraxin-3: A Novel Marker for Indicating Liver Fibrosis in Chronic Hepatitis B Patients?

PTX-3 is an important marker that plays a role in suppressing inflammation and tissue repair. The aim of this study is to investigate the diagnostic and prognostic characteristics of PTX-3 in CHB patients and the relationship between PTX-3 levels and fibrosis. A total of 52 CHB patients and 40 healthy subjects were included in the study. All of the CHB patients underwent liver biopsy and were then scored using a Ishak histologic scoring system. Blood samples were collected to evaluate the PTX-3 levels. Of the subjects who participated in the study, 53% were female. PTX-3 levels were determined as 5.63ng/mL in the control group, and as 0.88ng/mL in the CHB patient group. PTX-3 levels were found to be 1.19ng/mL in stage 1, 0.89ng/mL in stage 2, 0.68ng/mL in stage 3 and 0.55ng/mL in stage 4. Of the CHB patients, 44.2% had significant fibrosis, while 55.7% were identified as not having significant fibrosis. PTX-3 values were 0.64 and 1.0ng/mL in patients with and without significant fibrosis, respectively. The cut-off value for PTX-3 in predicting the absence of significant fibrosis was estimated as 0.9ng/mL. CHB patients were found to have lower serum PTX-3 levels compared to the control group, and these levels decreased even further as the fibrosis stage progressed in these patients. In addition, the significant decrease in PTX-3 levels in patients with stage 1 fibrosis compared to the control group shows that PTX-3 can be used as a non-invasive marker for the early detection of fibrosis (p<0.001).

A Cross-Platform Metabolomics Comparison Identifies Serum Metabolite Signatures of Liver Fibrosis Progression in Chronic Hepatitis C Patients.

Metabolomics offers new insights into disease mechanisms that is enhanced when adopting orthogonal instrumental platforms to expand metabolome coverage, while also reducing false discoveries by independent replication. Herein, we report the first inter-method comparison when using multisegment injection-capillary electrophoresis-mass spectrometry (MSI-CE-MS) and nuclear magnetic resonance (NMR) spectroscopy for characterizing the serum metabolome of patients with liver fibrosis in chronic hepatitis C virus (HCV) infection (n = 20) and non-HCV controls (n = 14). In this study, 60 and 30 serum metabolites were detected frequently (>75%) with good technical precision (median CV < 10%) from serum filtrate samples (n = 34) when using standardized protocols for MSI-CE-MS and NMR, respectively. Also, 20 serum metabolite concentrations were consistently measured by both methods over a 500-fold concentration range with an overall mean bias of 9.5% (n = 660). Multivariate and univariate statistical analyses independently confirmed that serum choline and histidine were consistently elevated (p < 0.05) in HCV patients with late-stage (F2-F4) as compared to early-stage (F0-F1) liver fibrosis. Overall, the ratio of serum choline to uric acid provided optimal differentiation of liver disease severity (AUC = 0.848, p = 0.00766) using a receiver operating characteristic curve, which was positively correlated with liver stiffness measurements by ultrasound imaging (r = 0.606, p = 0.0047). Moreover, serum 5-oxo-proline concentrations were higher in HCV patients as compared to non-HCV controls (F = 4.29, p = 0.0240) after adjustment for covariates (age, sex, BMI), indicative of elevated oxidative stress from glutathione depletion with the onset and progression of liver fibrosis. Both instrumental techniques enable rapid yet reliable quantification of serum metabolites in large-scale metabolomic studies with good overlap for biomarker replication. Advantages of MSI-CE-MS include greater metabolome coverage, lower operating costs, and smaller sample volume requirements, whereas NMR offers a robust platform supported by automated spectral and data processing software.

To determine the diagnostic accuracy of aspartate aminotransferase to platelet ratio index in detecting significant fibrosis in chronic hepatitis C patients by using histopathology as gold standard.

Objective: The objective of the study was to: determine the diagnostic accuracy of AST to platelet ratio index in detecting significant fibrosis in chronic hepatitis C patients by using histopathology as gold standard. Study Design: Cross Sectional study. Settings: Department of Medicine, DHQ Hospital, Faisalabad. Period: 1st Oct 2017 to March 2018. Results: In this study, out of 158 cases, 48.73%(n=77) were between 25-40 years while 51.27%(n=81) were between 41-60 years, mean+SD was calculated as 40.94+9.10 years, 55.06%(n=87) were male and 44.94%(n=71) were females, mean AST and platelet count was calculated as 1.68+0.54 and 191.0+43.75, frequency of significant fibroids in chronic hepatitis C patients by using histopathology as gold standard reveals as 53.16%(n=84) while 46.84%(n=74) had no findings of this morbidity. The diagnostic accuracy of AST to platelet ratio index in detecting significant fibrosis in chronic hepatitis C patients by using histopathology as gold standard was recorded which shows 51.27%(n=81) as true positive, 2.53%(n=4) false positive, 1.89%(n=3) false negative and 44.31%(n=70) were recorded as true negative, sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate was computed as 96.43%, 94.59%, 95.29%, 95.89% and 95.57% respectively. Conclusion: The results of the study reveal that diagnostic accuracy of AST to platelet ratio for detection of significant fibrosis in chronic Hepatitis C patients was satisfactory and it may be used for the avoidance of invasive liver biopsy to initiate the antiviral therapy in these patients.

Prediction of hepatocellular carcinoma using fibro markers in Egyptian patients with chronic liver disease

Objective The aim was to evaluate inflammatory and fibrosis markers as predictors for hepatocellular carcinoma (HCC) development among patients with chronic liver disease (CLD). Background Progression of liver fibrosis in chronic hepatitis C is closely associated with the high risk of HCC development. Patients and methods This study was conducted on 100 patients suffering from liver cirrhosis as group A and 100 patients suffering from liver cirrhosis with HCC as group B from January 2018 to April 2019. Diagnosis of CLD was based on clinical, laboratory, and imaging evidence of CLD with and without hepatic decompensation or portal hypertension. Results Child–Pugh C patients was significantly more prevalent in HCC (37 vs 10% in liver cirrhosis cases). Serum hemoglobin, albumin, and leukocytic count were significantly lower in HCC cases. Also, α-fetoprotein, bilirubin international normalized ratio, and blood urea were highly significantly higher in the HCC group than the non-HCC group. King's score, fibro-quotient (Fibro Q), and FIB-4 scores were significantly higher in HCC than in cirrhotic cases, while blood red cells and Fibro-α scores were highly significantly higher in group B than in group A. Conclusion Our findings have shown the possibility to predict HCC development in Egyptian patients suffering from chronic hepatitis C by using noninvasive scores, (Fibro markers) as they performed well, cheap, and easy to perform.

Study of the effect of direct acting antivirals (DAAs) on fibrosis in chronic hepatitis C patients using transient elastography

Study of the effect of direct acting antivirals (DAAs) on fibrosis in chronic hepatitis C patients using transient elastography

Intrahepatic TLR3 and IFNL3 Expressions Are Associated with Stages of Fibrosis in Chronic Hepatitis C.

An inefficient immune response against the hepatitis C virus (HCV), combined with viral evasion mechanisms, is responsible for the chronicity of infection. The need to evaluate the innate mechanisms of the immune response, such as TLR3 and IFN-λ3, and their relationship with the virus–host interaction is important for understanding the pathogenesis of chronic hepatitis C. The present study aimed to investigate the gene expressions of TRL3 and IFNL3 in liver tissue, seeking to evaluate whether these could be potential biomarkers of HCV infection. A total of 23 liver biopsy samples were collected from patients with chronic HCV, and 8 biopsies were collected from healthy control patients. RNA extraction, reverse transcription and qPCR were performed to quantify the relative gene expressions of TLR3 and IFNL3. Data on the viral load; AST, ALT, GGT and AFP levels; and the viral genotype were collected from the patients′ medical records. The intrahepatic expression of TLR3 (p = 0.0326) was higher in chronic HCV carriers than in the control group, and the expression of IFNL3 (p = 0.0037) was lower in chronic HCV carriers than in the healthy control group. The expression levels of TLR3 (p = 0.0030) and IFNL3 (p = 0.0036) were higher in the early stages of fibrosis and of necroinflammatory activity in the liver; in contrast, TLR3 and IFNL3 expressions were lower in the more advanced stages of fibrosis and inflammation. There was no correlation between the gene expression and the serum viral load. Regarding the initial METAVIR scale scores, liver transaminase levels were lower in patients with advanced fibrosis when correlated with TLR3 and IFNL3 gene expressions. The results suggest that in the early stages of the development of hepatic fibrosis, TLR3 and IFN-λ3 play important roles in the antiviral response and in the modulation of the tolerogenic liver environment because there is a decrease in the intrahepatic expressions of TLR3 and IFNL3 in the advanced stages of fibrosis, probably due to viral evasion mechanisms.

Doppler Ultrasound and Fibroscan Parameters Versus Liver Biopsy ‎in Evaluation of Hepatic Fibrosis in Egyptian Patients with Chronic ‎Hepatitis C‎

Background and study aim: Liver biopsy is the gold standard method to assess hepatic ‎inflammation and fibrosis in chronic hepatitis C infection (HCV). The ‎non-invasive assessment of liver fibrosis is the key target that has ‎inspired many new methods because of the limitations of liver biopsy. ‎The aim of the work was to improve the efficiency of non-invasive liver ‎fibrosis assessment in Egyptian patients with chronic hepatitis C by ‎comparing Doppler ultrasound (US) of hepatic blood flow and ‎fibroscan with liver biopsy‎. Patients and Method: ‎ In this retrospective analysis, 78 patients with HCV had already ‎undergone liver biopsies as part of work panel prior to HCV treatment. ‎Fibroscan examination, abdominal ultrasonography and Doppler ‎ultrasound were done to the patients by experienced operators‎‎.‎ Results: There was a strong positive‏ ‏correlation between the degree of liver ‎fibrosis by fibroscan and the degree of inflammation in the ‎histopathological analysis. Receiver Operator Characteristic (ROC) ‎curve analysis revealed that fibroscan failed to detect FII fibrosis. ‎However, fibroscan was more accurate in detecting FIII ‎fibrosis.The Doppler ultrasound parameter ROC curve analysis, ‎the portal vein blood flow volume (PVBFV) was shown to be ‎more accurate in detecting lower grades of fibrosis than ‎higher‎. Conclusion: For detection higher degrees of fibrosis, Fibroscan has a strong match ‎with liver biopsy; however, Doppler US is more sensitive in detecting ‎lower grades of fibrosis in patients infected with HCV‎ ‎‎‎.

Study of the effect of direct acting antivirals (DAAs) on fibrosis in chronic hepatitis C patients using transient elastography

Back ground: As DAA agents are leading to enormous cure rates, so identifying and monitoring patients who remain at a high complication risk after achieving SVR continue to be a critical issue. Numerous validated methods for noninvasive measurement of liver fibrosis can be used in the management of HCV infection. Methods study: A total of 50 Egyptian chronic HCV patients eligible for treatment with DAAs were enrolled in this prospective study. All subjects selected from Virology Unit of Tropical Medicine Department, Faculty of Medicine, Beni-Suef University received DAAs (SOV DCV) the endpoint was a sustained virologic response at 12 (SVR12) weeks post-treatment. All participants were evaluated non-invasively by Liver Stiffness Measurement (LSM) by Fibro Scan before DAAs treatment, and 6 months post-treatment. Results: SVR achieved by DAAs therapy was 96 % and was associated with significant improvement (p ˂0.05) of non-invasive fibrosis markers (FIB-4, APRI score, and LSM by Fibro Scan) from baseline compared to 6 months post-treatment. Using fibro scan regression of fibrosis in 30/45 patients (66%). Liver inflammation and synthetic functions also improved on follow up 12w and 6m post treatment. Conclusion: Regression of Liver inflammation and fibrosis in chronic hepatitis C patients post treatment with SOF DCV.

Assessment of liver fibrosis with liver and spleen stiffness measured by sound touch elastography, serum fibrosis markers in patients with chronic hepatitis B.

To evaluate the performance of liver stiffness (LS) and spleen stiffness (SS) by using the sound touch elastography (STE) technique and compare with those of the splenic index, aspartate transaminase-to-platelet ratio index (APRI), fibrosis-4 (FIB-4) index, King's score and combined models for diagnosing and staging fibrosis in chronic hepatitis B (CHB). One hundred patients with CHB underwent STE and serological tests. LS and SS values were measured with STE technique, and splenic index was calculated. Staging of fibrosis was determined with liver biopsy. Correlations between the individual parameters and the stage of fibrosis were evaluated with the Spearman correlation analysis. The area under the receiver operating characteristic curve (AUROC) was calculated to analyze the performance of all methods. Among all individual parameters, LS showed the highest AUROC for diagnosing fibrosis of ≥S2, ≥S3, and S4 stages (AUROC: 0.70, 0.86, and 0.96, respectively; all P < 0.05). The AUROC of combined model 1 (LS and SS) and 2 (LS, SS, APRI, FIB-4 index, King's score) for diagnosing ≥S2, ≥S3, and S4 fibrosis were 0.70, 0.86, 0.97, and 0.70, 0.86, 0.96, respectively, which were higher than those of APRI, FIB-4 index and the King's score (P < 0.05). No significant differences were found between two combined models and LS for staging fibrosis (P > 0.05). LS measurement is reliable for diagnosing and staging fibrosis in CHB, with a better performance than SS, splenic index and serum biomarkers. It is also comparable with the performance of combined models.

Impact of diabetes on liver fibrosis in chronic hepatitis C

Impact of diabetes on liver fibrosis in chronic hepatitis C