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Prospective study of hepatitis B and D epidemiology and risk factors in Romania:A 10-year update

World Journal of Hepatology 2024年第4期16卷 640-649页

作者： Speranta Iacob Liana Gheorghe Mirela Onica Laura Huiban Corina Silvia Pop Ciprian Brisc roxana sirli Carmen Ester Cristina Mihaela Brisc Sorina Diaconu Ion Rogoveanu Larisa Sandulescu Deiana Vuletici Anca Trifan Department of Gastroenterology Carol Davila University of Medicine and PharmacyBucharest 050474Romania Department of Gastroenterology and Hepatology Fundeni Clinical InstituteBucharest 022328Romania Department of Gastroenterology Grigore T Popa University of Medicine and PharmacyIasi 700115Romania Institute of Gastroenterology and Hepatology Saint Spiridon County HospitalIasi 700111Romania Department of Gastroenterology and Medical Oncology University Emergency Clinical HospitalBucharest 050098Romania Faculty of Medicine and Pharmacy University of OradeaOradea 410087Romania Department of Gastroenterology Emergency County HospitalOradea 410169Romania Center for Advanced Research in Gastroenterology and Hepatology Department of Gastroenterology and Hepatology“Victor Babeş”University of Medicine and PharmacyTimisoara 300041Romania Department of Gastroenterology and Hepatology TimişCounty Emergency Clinical Hospital"Pius Branzeu"Timisoara 300723Romania Department of Internal Medicine II and Gastroenterology University Emergency Clinical HospitalBucharest 050098Romania Department of Gastroenterology University of Medicine and PharmacyCraiova 200349Romania Department of Cardiology Emergency County HospitalCraiova 200642Romania Department of Gastroenterology Research Center of Gastroenterology and HepatologyUniversity of Medicine and PharmacyCraiova 200349Romania Department of Gastroenterology Emergency County HospitalCraiova 200642Romania Department of Gastroenterology Faculty of MedicineGrigore T Popa University of Medicine and PharmacyIasi 700115Romania

BACKGROUND The global burden of hepatitis D virus(HDV)infection represents a major medical challenge and a public health crisis ***,there is a lack of accurate data on the epidemiology and risk factors for *** B virus(HBV)and HDV coinfection causes the most severe form of viral hepatitis,leading to a higher cumulative incidence of liver-related events compared with HBV monoinfection,including the need for liver transplantation and *** To investigate the epidemiology,natural history,risk factors and clinical management of HBV and HDV coinfection in Romanian *** This prospective study was conducted between January and July 2022 in six tertiary gastroenterology and hepatology referral centres in *** consecutive adults admitted for any gastroenterology diagnosis who were HBV-positive were *** with acute hepatitis or incomplete data were *** the 25390 individuals who presented with any type of gastroenterology diagnosis during the study period,963 met the inclusion *** for anti-HDV antibodies and HDV RNA was performed for all *** and risk factor data were collected by investigators using medical charts and patient *** data were stored in an anonymized online database during the *** The prevalence of HBV was 3.8%;among these patients,the prevalence of HBV/HDV coinfection was 33.1%.The median age of the study population was 54.0 years,and it consisted of 55.1%men.A higher prevalence of HBV/HDV coinfection was observed in patients 50–69 years *** with HBV/HDV coinfection were significantly older than those with HBV monoinfection(P=0.03).Multivariate multiple regression analysis identified female gender(P=0.0006),imprisonment(P<0.0001),older age at diagnosis(P=0.01)and sexual contact with persons with known viral hepatitis(P=0.0003)as significant risk factors for *** This study shows that HDV infection among those with HBV re

关键词： Epidemiology Hepatitis B Hepatitis D Natural history Risk factors Romania

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Why,who and how should perform liver biopsy in chronic liver diseases

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World Journal of Gastroenterology 2008年第21期14卷 3396-3402页

作者： Ioan Sporea Alina Popescu roxana sirli Department of Gastroenterology University of Medicine and PharmacyTimisoara 700736Romania

Chronic viral hepatitis is a common disease in the general *** chronic hepatitis,the prognosis and clinical management are highly dependent on the extent of liver *** fibrosis evaluation can be performed by FibroTest(using serological markers),by Elastography or FibroScan(a noninvasive percutaneous technique using the elastic properties of the hepatic tissue) and by liver biopsy(LB),considered to be the "gold standard".Currently,there are three techniques for performing LB:percutaneous,transjugular and *** percutaneous LB can be performed blind,ultrasound(US) guided or US *** are two main categories of specialists who perform LB:gastroenterologists(hepatologists) and radiologists,and the specialty of the individual who performs the LB determines if the LB is performed under ultrasound guidance or *** are two types of biopsy needles used for LB:cutting needles(Tru-Cut,Vim-Silverman) and suction needles(Menghini,Klatzkin,Jamshidi).The rate of major complications after percutaneous LB ranges from 0.09% to 2.3%,but the echo-guided percutaneous liver biopsy is a safe method for the diagnosis of chronic diffuse hepatitis(cost-effective as compared to blind biopsy) and the rate of complications seems to be related to the experience of the physician and the type of the needle used(Menghini type needle seems to be safer).Maybe,in a few years we will use non-invasive markers of fibrosis,but at this time,most authorities in the field consider that the LB is useful and necessary for the evaluation of chronic hepatopathies,despite the fact that it is not a perfect test.

关键词： Chronic hepatitis Liver biopsy Fibrosis Ultrasound guidance

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Value of transient elastography for the prediction of variceal bleeding

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World Journal of Gastroenterology 2011年第17期17卷 2206-2210页

作者： Ioan Sporea Iulia Ratiu roxana sirli Alina Popescu Simona Bota Department of Gastroenterology University of Medicine and Pharmacy TimiSoara300482 TimiSoaraRomania

AIM:To determine if liver stiffness(LS) measurements by means of transient elastography(TE) correlate with the presence of significant esophageal varices(EV) and if they can predict the occurrence of variceal ***:We studied 1000 cases of liver cirrhosis divided into 2 groups:patients without EV or with grade 1 varices(647 cases) and patients with significant varices(grade 2 and 3 EV)(353 cases).We divided the group of 540 cases with EV into another 2 subgroups:without variceal hemorrhage(375 patients) and patients with a history of variceal bleeding(165 cases).We compared the LS values between the groups using the unpaired t-test and we established cut-off LS values for the presence of significant EV and for the risk of bleeding by using the ROC ***:The mean LS values in the 647 patients without or with grade 1 EV was statistically significantly lower than in the 353 patients with significant EV(26.29 ± 0.60 kPa vs 45.21 ± 1.07 kPa,P < 0.0001).Using the ROC curve we established a cut-off value of 31 kPa for the presence of EV,with 83% sensitivity(95%CI:79.73%-85.93%) and 62% specificity(95% CI:57.15%-66.81%),with 76.2% positive predictive value(PPV)(95% CI:72.72%-79.43%) and 71.3% negative predictive value(NPV)(95% CI:66.37%-76.05%)(AUROC 0.7807,P < 0.0001).The mean LS values in the group with a history of variceal bleeding(165 patients) was statistically significantly higher than in the group with no bleeding history(375 patients):51.92 ± 1.56 kPa vs 35.20 ± 0.91 kPa,P < 0.0001).For a cut-off value of 50.7 kPa,LS had 53.33% sensitivity(95% CI:45.42%-61.13%) and 82.67% specificity(95% CI:78.45%-86.36%),with 82.71% PPV(95% CI:78.5%-86.4%) and 53.66% NPV(95% CI:45.72%-61.47%)(AUROC 0.7300,P < 0.0001) for the prediction of esophageal bleeding.

关键词： Liver stiffness Transient elastography Esophageal varices Variceal bleeding

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Is it better to use two elastographic methods for liver fibrosis assessment?

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World Journal of Gastroenterology 2011年第33期17卷 3824-3829页

作者： Ioan Sporea roxana sirli Alina Popescu Simona Bota Radu Badea Monica Lupsor Mircea Focsa Mirela Danila Department of Gastroenterology and Hepatology University of Medicine and Pharmacy Timisoara10 Iosif Bulbuca Bv.300736 TimisoaraRomania Department of Medical Imaging 3rd Medical ClinicUniversity of Medicine and PharmacyClujNapoca2123 Croitorilor str.400162 ClujNapocaRomania Department of Biophysics and Medical Informatics University of Medicine and Pharmacy Timisoara14 Tudor Vladimirescu str.300173 TimisoaraRomania

AIM:To find out if by combining 2 ultrasound based elastographic methods:acoustic radiation force impulse(ARFI)elastography and transient elastography(TE),we can improve the prediction of fibrosis in patients with chronic hepatitis ***:Our study included 197 patients with chronic hepatitis *** each patient,we performed,in the same session,liver stiffness(LS)measurements by means of TE and ARFI,respectively,and liver biopsy(LB),assessed according to the Metavir score.10 LS measurements were performed both by TE and ARFI;median values were calculated and expressed in kilopascals(kPa)and meters/second(m/s),*** TE and ARFI measurements with IQR<30%andSR≥60%were considered ***:On LB 13(6.6%)patients had F0,32(16.2%) had F1,52(26.4%)had F2,47(23.9%)had F3,and 53(26.9%)had F4.A direct,strong correlation was found between TE measurements and fibrosis(r=0.741),between ARFI and fibrosis(r=0.730)and also between TE and ARFI(r=0.675).For predicting significant fibrosis(F≥2),for a cutoff of 6.7 kPa,TE had 77.5% sensitivity(Se)and 86.5%specificity(Sp)[area under the receiver operating characteristic curve(AUROC)0.87] and for a cutoff of 1.2 m/s,ARFI had 76.9%Se and 86.7%Sp(AUROC 0.84).For predicting cirrhosis(F=4),for a cutoff of 12.2 kPa,TE had 96.2%Se and 89.6% Sp(AUROC 0.97)and for a cutoff of 1.8 m/s,ARFI had 90.4%Se and 85.6%Sp(AUROC 0.91).When both elastographic methods were taken into consideration,for predicting significant fibrosis(F≥2),(TE≥6.7 kPa and ARFI≥1.2 m/s)we obtained 60.5%Se,93.3% Sp,96.8%positive predictive value(PPV),41.4%negative predictive value(NPV)and 68%accuracy,while for predicting cirrhosis(TE≥12.2 kPa and ARFI≥1.8 m/s) we obtained 84.9%Se,94.4%Sp,84.9%PPV,94.4% NPV and 91.8%***:TE used in combination with ARFI is highly specific for predicting significant fibrosis;therefore when the two methods are concordant,liver biopsy can be avoided.

关键词： Transient elastography Acoustic radiation force impulse elastography Liver stiffness Combined methods

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Liver stiffness measurements in patients with HBV vs HCV chronic hepatitis:A comparative study

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World Journal of Gastroenterology 2010年第38期16卷 4832-4837页

作者： Ioan Sporea roxana sirli Alexandra Deleanu Adriana Tudora Alina Popescu Manuela Curescu Simona Bota Department of Gastroenterology and Hepatology University of Medicine and Pharmacy(Timisoara) Department of Infectious Diseases University of Medicine and Pharmacy(Timisoara)

AIM:To assess the values of liver stiffness (LS) in pa-tients with hepatitis B virus (HBV) chronic hepatitis and to compare them with those in patients with hepatitis C virus (HCV) chronic hepatitis. METHODS: The study included 140 patients with HBV chronic hepatitis, and 317 patients with HCV chronic hepatitis, in which LS was measured (FibroScan-Echo-sens) and liver biopsy was performed in the same session (assessed according to the Metavir score). RESULTS:According to the Metavir score of the 140 HBV patients: one had F0,32 had F1, 67 had F2,33 had F3 and 7 had F4. Of the 317 HCV patients:5 had F0, 34 had F1, 146 had F2, 93 had F3 and 39 had F4. For the same severity of fibrosis, the mean values of LS in HBV patients were similar to those in HCV patients:F1,6.5±1.9 kPa vs 5.8±2.1 kPa (P=0.0889); F2,7.1±2 kPa vs 6.9±2.5 kPa (P = 0.3369); F3,9.1±3.6 kPa vs 9.9±5 kPa (P=0.7038); F4,19.8± 8.6 kPa vs 17.3±6.1 kPa (P=0.6574). A signif icant direct correlation between LS measurements and fibrosis was found in HCV patients (Spearman’s r=0.578, P<0.0001), as well as in HBV patients (r=0.408, P<0.0001). The correlation was more signif icant in HCV than in HBV patients (Fisher’s Z-test,Z= 2.210,P=0.0271). CONCLUSION:In our group, the mean values of LS in patients with chronic B hepatitis were similar to those in patients with chronic HCV hepatitis, for the same stage of f ibrosis. Also, LS was correlated with the severity of fibrosis both in HBV and HCV chronic hepatitis patients.

关键词： Chronic B hepatitis Chronic C hepatitis Fibrosis Transient elastography Liver biopsy

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Ultrasound-based elastography for the diagnosis of portal hypertension in cirrhotics

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World Journal of Gastroenterology 2015年第41期21卷 11542-11551页

作者： roxana sirli Ioan Sporea Alina Popescu Mirela Danila Department of Gastroenterology and Hepatology "Victor Babes" University of Medicine and Pharmacy

Progressive fibrosis is encountered in almost all chronicliver diseases. Its clinical signs are diagnostic in advanced cirrhosis, but compensated liver cirrhosis is harder to diagnose. Liver biopsy is still considered the reference method for staging the severity of fibrosis, but due to its drawbacks(inter and intra-observer variability, sampling errors, unequal distribution of fibrosis in the liver, and risk of complications and even death), non-invasive methods were developed to assess fibrosis(serologic and elastographic). Elastographic methods can be ultrasound-based or magnetic resonance imaging-based. All ultrasoundbased elastographic methods are valuable for the early diagnosis of cirrhosis, especially transient elastography(TE) and acoustic radiation force impulse(ARFI) elastography, which have similar sensitivities and specificities, although ARFI has better feasibility. TE is a promising method for predicting portal hypertension in cirrhotic patients, but it cannot replace upper digestive endoscopy. The diagnostic accuracy of using ARFI in the liver to predict portal hypertension in cirrhotic patients is debatable, with controversial results in published studies. The accuracy of ARFI elastography may be significantly increased if spleen stiffness is assessed, either alone or in combination with liver stiffness and other parameters. Two-dimensional shearwave elastography, the Elast PQ technique and strain elastography all need to be evaluated as predictors of portal hypertension.

关键词： Portal hypertension Transient elastography Acoustic radiation force impulse elastography Two-dimensional shear-wave elastography

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ARFI elastography for the evaluation of diffuse thyroid gland pathology:Preliminary results

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World Journal of Radiology 2012年第4期4卷 174-178页

作者： Ioan Sporea roxana sirli Simona Bota Mihaela Vlad Alina Popescu Ioana Zosin Department of Gastroenterology and Hepatology University of Medicine and Pharmacy Timisoara300736 TimisoaraRomania Department of Endocrinology University of Medicine and Pharmacy Timisoara300736 TimisoaraRomania

AIM: To assess whether acoustic radiation force impulse (ARFI) elastography can differentiate normal from pathological thyroid parenchyma. METHODS: We evaluated 136 subjects (mean age 45.8 ± 15.6 years, 106 women and 30 men): 44 (32.3%) without thyroid pathology, 48 (35.3%) with Basedow-Graves’ disease (GD), 37 (27.2%) with chronic autoimmune thyroiditis (CAT; diagnosed by specific tests), 4 (2.9%) with diffuse thyroid goiter and 3 (2.2%) cases with thyroid pathology induced by amiodarone. In all patients, 10 elastographic measurements were made in the right thyroid lobe and 10 in the left thyroid lobe, using a 1-4.5 MHZ convex probe and a 4-9 MHz linear probe, respectively. Median values were calculated for thyroid stiffness and expressed in meters/second (m/s). RESULTS: Thyroid stiffness (TS) assessed by means of ARFI in healthy subjects (2 ± 0.40 m/s) was significantly lower than in GD (2.67 ± 0.53 m/s) (P < 0.0001) and CAT patients (2.43 ± 0.58 m/s) (P = 0.0002), but the differences were not significant between GD vs CAT patients (P = 0.053). The optimal cut-off value for the prediction of diffuse thyroid pathology was 2.36 m/s. For this cut-off value, TS had 62.5% sensitivity, 79.5% specificity, 87.6% predictive positive value, 55.5% negative predictive value and 72.7% accuracy for the presence of diffuse thyroid gland pathology (AUROC = 0.804). There were no significant differences between the TS values obtained with linear vs convex probes and when 5 vs 10 measurements were taken in each lobe (median values). CONCLUSION: ARFI seems to be a useful method for the assessment of diffuse thyroid gland pathology.

关键词： Acoustic radiation force impulse elastography Thyroid stiffness Thyroid pathology

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Severe adverse events during antiviral therapy in hepatitis C virus cirrhotic patients: A systematic review

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World Journal of Hepatology 2013年第3期5卷 120-126页

作者： Simona Bota Ioan Sporea roxana sirli Alina Popescu Adriana Maria Neghinǎ Mirela Dǎnilǎ Mihnea Strǎin Department of Gastroenterology and Hepatology University of Medicine and Pharmacy Department of Biochemistry and Pharmacology University of Medicine and Pharmacy

AIM: To identify severe adverse events (SAEs) leading to treatment discontinuation that occur during antiviral therapy in hepatitis C virus (HCV)-infected cirrhotic patients. METHODS: We identified all the articles published prior to December 2011 in the PubMed, Medline, Lilacs, Scopus, Ovid, EMBASE, Cochrane and Medscape databases that presented these data in cirrhotic patients. These studies evaluated the rate of SAEs leading to discontinuation of standard care treatment: Pegylated interferon (PegIFN) alpha 2a (135-180 μg/wk) or PegIFN alpha 2b (1 or 1.5 μg/kg per week) and ribavirin (800-1200 mg/d). Patients with genotype 1 + 4 underwent treatment for 48 wk, whereas those with genotypes 2 + 3 were treated for 24 ***: We included 17 papers in this review, comprising of 1133 patients. Treatment was discontinued due to SAEs in 14.5% of the patients. The most common SAEs were: severe thrombocytopenia and/or neutropenia (23.2%), psychiatric disorders (15.5%), decompensation of liver cirrhosis (12.1%) and severe anemia (11.2%). The proportion of patients who needed to discontinue their therapy due to SAEs was significantly higher in patients with Child-Pugh class B and Cvs those with Child-Pugh class A: 22%vs 11.4% (P = 0.003). A similar discontinuation rate was found in cirrhotic patients treated with PegIFN alpha 2a and those treated with PegIFN alpha 2b, in combination with ribavirin: 14.2%vs 13.7% (P = 0.96). The overall sustained virological response rate in cirrhotic patients was 37% (95%CI: 33.5-43.1) but was significantly lower in patients with genotype 1 + 4 than in those with genotype 2 + 3: 20.5% (95%CI: 17.9-24.8) vs 56.5% (95%CI: 51.5-63.2), (P < 0.0001). CONCLUSION: Fourteen point five percent of HCV cirrhotic patients treated with PegIFN and ribavirin needed early discontinuation of therapy due to SAEs, the most common cause being hematological disorders.

关键词： Liver cirrhosis Hepatitis C virus Adverse events Sustained virological response

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Value of acoustic radiation force impulse elastography for the assessment of ascites syndrome

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World Journal of Radiology 2011年第8期3卷 205-209页

作者： Simona Bota Ioan Sporea roxana sirli Alina Popescu Mirela Dǎnilǎ Mǎdǎlina Sendroiu Department of Gastroen-terology and Hepatology University of Medicine and Pharmacy

AIM:To assess the feasibility of performing acoustic radiation force impulse(ARFI) elastography in patients with ascites and its predictive value for the cirrhotic or non-cirrhotic etiology of ***:Our study included 153 patients with ascites,mean age 58.8 ± 13.1 *** hundred and fifteen(75.2%) patients had ascites in the context of cirrhosis,29(18.9%) had non-cirrhotic ascites(diagnosed by clinical,ultrasound,endoscopic and/or laparoscopic criteria) and in 9(5.9%) cases we could not establish the etiology of *** performed 10 ARFI measurements and the median value was calculated and expressed in meters/second(m/s).Among the 29 patients with non-cirrhotic ascites were included:20 laparoscopically demonstrated peritoneal carcinomatosis with histological confirmation,7 acute pancreatitis with ascites which later resolved,and one case each of lymphatic ascites and ascites in the context of a liver *** 11 of the 20 patients with peritoneal carcinomatosis,the liver structure was homogenous in the ultrasound examination and in 9 patients the ultrasound exam revealed liver ***:We could not obtain valid ARFI measurements in 5 patients(3.2%).The mean liver stiffness measurements by means of ARFI were statistically significantly higher in patients with cirrhotic ascites than in those with non-cirrhotic ascites:3.04 ± 0.70 vs 1.45 ± 0.59 m/s(P < 0.001).For a cut-off value of 1.8 m/s for predicting cirrhosis(and ascites in the context of cirrhosis),as obtained in a previous study,ARFI had 98.1% sensitivity,86.2% specificity,96.4% positive predictive value,92.5% negative predictive value and 95.6% accuracy for predicting cirrhotic *** a cut-off value of 1.9 m/s the accuracy was 94.9% and for a 2 m/s cut-off value it was 92.8%.CONCLUSION:ARFI elastography is feasible in most patients with ascites and has a very good predictive value for the cirrhotic or non-cirrhotic etiology of ascites.

关键词： Ascites Liver stiffness Liver cirrhosis Acoustic radiation force impulse Elastography

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Is ARFI elastography reliable for predicting fibrosis severity in chronic HCV hepatitis?

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World Journal of Radiology 2011年第7期3卷 188-193页

作者： Ioan Sporea roxana sirli Simona Bota Carmen Fierbinteanu-Braticevici Alina Popescu Radu Badea Monica Lupsor Ana Petrisor Mirela Dnil Department of Gastroenterology and Hepatology University of Medicine and Pharmacy Timi oara10 Iosif Bulbuca Bv.300736 TimisoaraRomania IInd Medical Clinic and Gastroenterology University Hospital169 Independen ei AvenueSector 5050098 BucharestRomania Department of Medical Imaging 3rd Medical ClinicUniversity of Medicine and PharmacyClujNapoca21-23 Croitorilor Str.400162Cluj-NapocaRomania

AIM:To determine whether acoustic radiation force impulse(ARFI) elastography is a reliable method for predicting fibrosis severity in patients with chronic hepatitis C virus(HCV) ***:We performed a multicenter study including 274 subjects with HCV chronic hepatitis in which we compared ARFI with liver biopsy(LB).In each patient we performed LB(evaluated according to the Metavir score) and ARFI measurements(using a Siemens Acuson S2000TM ultrasound system:10 valid measurements were performed and median values were calculated and expressed in meters/second(m/s).RESULTS:A direct,strong,correlation(Spearman r = 0.707) was found between ARFI measurements and fibrosis(P < 0.0001).For predicting the presence of fibrosis(F ≥ 1 Metavir),significant fibrosis(F ≥ 2),severe fibrosis(F ≥ 3) and cirrhosis(F = 4),the cutoff values of 1.19,1.21,1.58 and 1.82 m/s were determined,respectively,liver stiffness measurements had 73%,84%,84% and 91% Se respectively;93%,91%,94%,90% Sp,respectively;with AUROCs of 0.880,0.893,0.908 and 0.937,***:ARFI measurement is a reliable method for predicting the severity of fibrosis in HCV

关键词： Acoustic radiation force impulse elastography Chronic HCV hepatitis Cirrhosis Liver fibrosis Liver stiffness

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