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国际医学放射学杂志 2011年第2期 198-199页

作者： M.lewin l.fartoux A.Vignaud l.Arrivé Y.Menu O.Rosmorduc 唐光健 Service de Radiologie Hpital Saint Antoine

目的确定索菲拉尼治疗中进展期肝细胞癌(HCC)病人的总表观扩散系数(ADC)、单纯扩散系数(D)与灌注分数(f)。材料与方法前瞻性分析12例病人于治疗前(作为

关键词：扩散系数灌注分数肝细胞癌抗血管生成索菲拉尼治疗反应评价

胰岛素抵抗是慢性丙型肝炎患者肝脂肪变性和肝纤维化进展的一个诱发因素

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世界核心医学期刊文摘（胃肠病学分册） 2005年第10期1卷 34-35页

作者： fartoux l. Poujol-Robert A. Guéchot J. l. Serfaty 程欣 Service d'Hépatologie Hopital Saint-Antoine 184 rue du Faubourg Saint-Antoine 75571 Paris Cedex 12 France Dr.

Background: Insulin resistance is a frequent feature of chronic hepatitis C. Whether insulin resistance could be the cause or consequence of steatosis and fibrosis is unknown. The ability of HCV genotype 3 to promote steatosis by itself provides an unique opportunity to answer this question. Aims: The aim of the present study was to assess the relationships between insulin resistance, steatosis, and fibrosis according to genotype in 141 non-diabetic patients with biopsy proven noncirrhotic chronic hepatitis C. Methods: All patients had fasting serum glycaemia and insulinaemia measurements. Insulin resistance was evaluated using the homeostasis model assessment (HOMA IR) method. liver steatosis was determined according to hepatitis C virus genotype (1 or 3). logistic regression and multivariate regression analysis were used to identify variables independently associated with insulin resistance, fatty liver, and fibrosis. Results: Although steatosis and fibrosis were more severe in genotype 3 patients, median HOMA IR was significantly higher in patients with genotype 1 related steatosis than in those with genotype 3 related steatosis (2.1 v 1; p = 0.001). Independent risk factors for steatosis were insulin resistance in genotype 1 patients (p = 0.001) and viral load in genotype 3 patients (p = 0.003). Among genotype 1 patients, independent parameters associated with insulin resistance were age (p = 0.04) and steatosis (p = 0.004). Steatosis was associated with more severe fibrosis whatever the genotype (p = 0.002). Among genotype 1 patients, although there was a significant relationship between circulating insulin level and fibrosis stage (p = 0.006), only steatosis and inflammatory score were independently associated with fibrosis. Conclusion: This study shows that insulin resistance is the cause rather than the consequence of steatosis and fibrosis in genotype 1 patients and that increased circulating insulin is a risk factor for fibrosis through insulin resistance

关键词：慢性丙型肝炎肝脂肪变性胰岛素抵抗肝纤维化血清胰岛素空腹血糖硬化性多变量回归病毒载量独立参数

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脂肪变性对轻度丙型肝炎患者纤维化进程的影响

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世界核心医学期刊文摘（胃肠病学分册） 2005年第5期1卷 39-40页

作者： fartoux l. Chazouilléres O. Wendum D. l. Serfaty 杨雪娟 Service d’Hépatologie Hpital Saint-Antoine 184 Rue Du Faubourg Saint-Antoine 75571 Paris Cedex 12 France

In patients with mild hepatitis C, the usefulness of antiviral therapy is subject of debate, as a low risk for progression of fibrosis is assumed. Several studies have shown that steatosis is a strong and independent predictor of the severity as well as the progression of fibrosis in chronic hepatitis C. Therefore, this study assessed the impact of steatosis on the progression of fibrosis between paired liver biopsies in untreated patients with mild hepatitis on index biopsy. One hundred thirty-five untreated patients (mean age, 38 years; M/Fsex ratio, 1.43) with one known risk factor of infection (68 transfusions, 67 injecting drug use) had 2 liver biopsies after a median interval of 61 months (18-158). All had METAVIR score of A1F1 or lower at first liver biopsy. Unequivocal progression of fibrosis was considered if patients had a fibrosis score of 3 or 4 at the second liver biopsy. The probability of progression of fibrosis was estimated by using the Kaplan-Meier method. During followup, progression of fibrosis occurred in 21 patients (16%) after a median delay of 65 months. Cumulative probabilities of the progression of fibrosis at 4 and 6 years were 5.2%and 19.8%, respectively. In multivariate analysis, steatosis was the only independent factor predictive of progression of fibrosis (RR, 4.8; CI, 1.3-18.3). Probability of progression of fibrosis was significantly related to the percentage of hepatocytes with steatosis. In conclusion, steatosis is a major determinant of the progression of fibrosis in mild hepatitis C, regardless of the genotype. Our results argue for antiviral treatment in the subgroup of patients with mild hepatitis and steatosis.

关键词：丙型肝炎患者纤维化进程脂肪变性肝纤维化慢性丙型肝炎抗病毒疗法肝活检轻度肝炎纤维化进展肝组织活检

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经皮注射醋酸治疗小的肝细胞癌:法国的一项单中心试验

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世界核心医学期刊文摘（胃肠病学分册） 2006年第6期2卷 25-26页

作者： fartoux l. Arrive l. Andreani T. O.Rosmorduc 王晓君(译) 史敏(校) 不详 Service d'Hepatologie Hopital Saint-Antoine Universite Pierre et Marie Curie 184 rue du Faubourg Saint-Antoine 77571 Paris Cedex 12

Percutaneous ablation using acetic acid is an attractive method because of its low morbidity and low number of sessions required to induce complete tumor necrosis. Moreover, the real-time fluoroscopy CT scan could improve the technique by improving distribution of the necrotizing agent within the tumor. Aim-To determine the feasibility and the long-term results of the acetic acid percutaneous injection under CT fluoroscopy guidance in a series of cirrhotic patients with small hepatocellular carcinoma in a single French center. Methods-One hundred and two patients with hepatocellular carcinoma were evaluated for treatment between 1999 and 2000. The selection criteria for fluoroscopy CT scan-directed percutaneous acetic acid ablation were: 1) one to three nodules ld-Pugh class 40%and platelet count > 50000 per mm3 and 4) contraindication to both resection and liver transplantation. Post treatment follow-up included ultrasonography, magnetic resonance and alphafetoprotein levels every 3 months. Recurrence and survival rates were estimated using the Kaplan-Meier method. Results-Forty-nine patients (48%) could benefit from a curative treatment, most of them (37/49) being eligible for fluoroscopy CT scan-directed percutaneous acetic acid. The mean follow up was 24.4 ≥2.7 months. Complete tumor necrosis was achieved in 28 patients (76%) after a mean of 1.6 sessions. In these 28 patients, the recurrence rates were 34%and 48%and survival rates were 76%and 70%, at 24 and 36 months, respectively. No serious complications occurred during or after the treatment Conclusions-Percutaneous ablation using acetic acid using CT fluoroscopy guidance may be considered as a short term efficient, low risk treatment and can be applied even in patients with ascites or severe hemostatic abnormalities. However, the high rate of recurrence and the early occurrence of multifocal hepatocellular carcinoma underline the limits of this method as we

关键词：注射醋酸治疗经皮注射肝细胞癌法国肝硬化患者 CT引导肿瘤坏死实时荧光试验

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