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Transient elastography in chronic hepatitis B: An Asian perspective

World Journal of Gastroenterology 2010年第41期16卷 5173-5180页

作者： seung up kim Kwang-Hyub Han Sang Hoon Ahn Department of Internal Medicine Institute of Gastroenterology Yonsei University College of Medicine Seoul 120-752 South Korea Liver Cirrhosis Clinical Research Center Seoul 120-752 South Korea Brain Korea 21 Project for Medical Science Seoul 120-752 South Kore

Transient elastography (TE) is a new non-invasive tool for assessing liver stiffness, which is correlated with the histologic stage of liver fibrosis. Many studies have reported a good accuracy of TE in predicting signif icant fibrosis and an optimal accuracy in predicting cirrhosis. Furthermore, the potential role of TE in screening the general population has also been proven. TE thus helps physicians to decide treatment strategies, predict prog-nosis, and monitor disease progression in patients with chronic liver disease and to screen the general popula-tion to identify high risk patients with potential liver disease. However, most data on the clinical roles of TE have been gathered in European patients with chronic hepatitis C (CHC), because TE was first developed in France. Accordingly, much data on the usefulness of TE in patients with CHC has accumulated. Recently, however, vigorous efforts have been made to apply TEto patients with chronic hepatitis B (CHB), and TE has also proved to have acceptable accuracy in diagnosing liver fibrosis and cirrhosis in these patients. Thus, we focused on TE in the Asian population with CHB in comparison with the European population with CHC and found that the diagnostic performance and cutoff values were different between the 2 populations possibly as a result of several different confounders between Asian and European populations (the etiology of chronic liver disease, histologic features, major fluctuation in alanine aminotransferase levels, and the prevalence of high body mass index and metabolic syndrome). Therefore, further studies tailored to the Asian population with CHB should be performed before the widespread application of TE in Asian populations with CHB.

关键词： Asia Chronic hepatitis B Fibroscan Hepatitis B virus Liver stiffness measurement Transient elas-tography

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Non-invasive prediction of forthcoming cirrhosis-related complications

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World Journal of Gastroenterology 2014年第10期20卷 2613-2623页

作者： Wonseok Kang seung up kim Sang Hoon Ahn Department of Internal Medicine Institute of Gastroenterology Yonsei University College of Medicine Seoul 120-752 South Korea Liver Cirrhosis Clinical Research Center Seoul 120-752 South Korea

In patients with chronic liver diseases,identification of significant liver fibrosis and cirrhosis is essential for determining treatment strategies,assessing therapeutic response,and stratifying long-term *** liver biopsy remains the reference standard for evaluating the extent of liver fibrosis in patients with chronic liver diseases,several non-invasive methods have been developed as alternatives to liver *** of these non-invasive methods have demonstrated clinical accuracy for diagnosing significant fibrosis or cirrhosis in many cross-sectional studies with the histological fibrosis stage as a reference ***,non-invasive methods cannot be fully validated through cross-sectional studies since liver biopsy is not a perfect surrogate endpoint ***,recent studies have focused on assessing the performance of non-invasive methods through longterm,longitudinal,follow-up studies with solid clinical endpoints related to advanced stages of liver fibrosis and *** a result,current view is that these alternative methods can independently predict future cirrhosis-related complications,such as hepatic decompensation,liver failure,hepatocellular carcinoma,or liver-related *** clinical role of non-invasive models seems to be shifting from a simple tool for predicting the extent of fibrosis to a surveillance tool for predicting future liver-related *** this article,we will summarize recent longitudinal studies of non-invasive methods for predicting forthcoming complications related to liver cirrhosis and discuss the clinical value of currently available non-invasive methods based on evidence from the literature.

关键词： Non-invasive model Prediction Cirrhosis Complication Liver-related events

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Clinical application of liver stiffness measurement using transient elastography in chronic liver disease from longitudinal perspectives

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World Journal of Gastroenterology 2013年第12期19卷 1890-1900页

作者： Beom Kyung kim James Fung Man-Fung Yuen seung up kim Department of Internal Medicine Institute of Gastroenterology Yonsei University College of Medicine Liver Cirrhosis Clinical Research Center Department of Medicine State Key Laboratory for Liver Research the University of Hong Kong

Accurate determination of the presence and degree of fibrosis in liver is of great importance, because the prognosis and management strategies for chronic liver disease depend mainly on these factors. To date, liver biopsy (LB) remains the "gold standard" for assessing the severity of liver fibrosis; however, LB is often limited by its invasiveness, sampling error, and intra/ inter-observer variability in histological interpretation. Furthermore, repeated LB examinations within a short time interval are indeed ineligible in a real clinical practice. Thus, due to the pressing need for non-invasive surrogates for liver fibrosis, transient elastography (TE),as a novel ultrasound based technology, has allowed a noninvasive measurement of liver stiffness and has gained in popularity over recent years. In the past few years, additional roles for transient TE beyond the initial purpose of a non-invasive surrogate for LB have included the prediction of the most two critical consequences of fibrosis progression: the development of portal hypertension-related complications and hepatocellular carcinoma. This indicates that the role of transient TE is not merely limited to reducing the need for LB, but transient TE can enable the establishment of tailored management strategies by providing more detailed prognostic information. In particular, under the concept in which the clinical course of liver fibrosis is dynamic and bidirectional, especially when appropriate intervention is commenced, transient TE can be used to track the dynamic changes in fibrotic burden during antiviral or antifibrotic treatment. This review discussed extended applications of transient TE in prediction of the development of real clinical endpoints from a longitudinal perspective.

关键词： Liver stiffness Transient elastography Fibroscan Fibrosis Longitudinal Outcome

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Obesity is an important determinant of severity in newly defined metabolic dysfunction-associated fatty liver disease

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Hepatobiliary & Pancreatic Diseases International 2022年第3期21卷 241-247页

作者： Ji Hye Huh Kwang Joon kim seung up kim Bong-Soo Cha Byung-Wan Lee Division of Endocrinology and Metabolism Department of Internal MedicineHallym University Sacred Heart HospitalAnyang 14068Korea Division of Geriatrics Department of Internal MedicineYonsei University College of MedicineSeoul 03722Korea Division of Endocrinology and Metabolism Department of Internal MedicineYonsei University College of MedicineSeoul 03722Korea Institute of Gastroenterology Department of Internal MedicineYonsei University College of MedicineSeoul 03722Korea

Background: The recently proposed definition of metabolic dysfunction-associated fatty liver disease(MAFLD) is based on the co-existence of hepatic steatosis with other metabolic disorders, including obesity and metabolic risk abnormalities such as hyperglycemia, high blood pressure and dyslipidemia. This study aimed to assess MAFLD severity according to the presence of metabolic abnormalities and obesity. Methods: Using transient elastography, hepatic steatosis and fibrosis severity were assessed by measuring the controlled attenuation parameter and liver stiffness measurement. A total of 1163 patients with MAFLD were categorized into the following four groups according to metabolic risk abnormalities and obesity presence: non-obese without metabolic risk abnormality group(Group 1;reference group);nonobese with metabolic risk abnormality group(Group 2);obese without metabolic risk abnormality group(Group 3);and obese with metabolic risk abnormality group(Group 4). A multiple logistic regression analysis was performed to determine severe hepatic steatosis and fibrosis risk in each group in both unadjusted and adjusted models. Results: In the adjusted model, the odds ratios(ORs) [95% confidence interval(CI)] for severe hepatic steatosis in Groups 2, 3, and 4 were 1.07(0.61-1.88), 2.43(1.44-4.08), and 4.07(2.56-6.48), respectively( P trend up 1, Group 2 showed no significant increases in OR, whereas Groups 3 and 4(obese groups) showed significant increases(OR = 4.70, 95% CI: 1.24-17.82 and OR = 6.43, 95% CI: 1.88-22.02, respectively). Conclusions: Obesity, rather than metabolic abnormality, is the principal determinant of severe hepatic steatosis and fibrosis in patients with MAFLD.

关键词： Metabolic dysfunction-associated fatty liver disease Metabolically-healthy obesity Liver fibrosis

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Tenofovir disoproxil fumarate is not associated with a lower risk of hepatocellular carcinoma compared to entecavir in patients with chronic hepatitis B

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Hepatoma Research 2022年第1期8卷 188-192页

作者： Hye Won Lee seung up kim Department of Internal Medicine Yonsei University College of MedicineSeoul 03722Korea Institute of Gastroenterology Yonsei University College of MedicineSeoul 03722Korea Yonsei Liver Center Severance HospitalSeoul 03722Korea

A paper published several years ago suggested that tenofovir disoproxil fumarate(TDF)was superior to entecavir(ETV)for reducing the risk of hepatocellular carcinoma(HCC).Since then,many observational studies have been conducted comparing TDF and *** studies in Asia demonstrated similar HCC risks between ETV and TDF ***,recent studies involving Caucasian and European did not observe any differences in HCC risk between these *** this article,we briefly review studies that compared the incidence rates of HCC between ETV and TDF and discuss potential reasons for the discrepant results.

关键词： Hepatitis B entecavir tenofovir hepatocellular carcinoma

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Successful hemostasis of intractable rectal variceal bleeding using variceal embolization

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World Journal of Gastroenterology 2015年第8期21卷 2558-2562页

作者： Sung Soo Ahn Eun Hye kim Man Deuk kim Won Jae Lee seung up kim Department of Internal Medicine Yonsei University College of Medicine Department of Radiology Research Institute of Radiological Science Yonsei University College of Medicine Seoul Gookgwain School Institute of Gastroenterology Yonsei University College of Medicine Liver Cirrhosis Clinical Research Center

Portal hypertension causes portosystemic shunting along the gastrointestinal tract,resulting in *** varices and their bleeding is a rare complication,but it can be fatal without appropriate ***,because of its rarity,no established treatment strategy is yet *** the setting of intractable rectal variceal bleeding,a transjugular intravenous portosystemic shunt can be a treatment of choice to enable portal decompression and thus achieve ***,in the case of recurrent rectal variceal bleeding despite successful transjugular intravenous portosystemic shunt,alternative measures to control bleeding are ***,we report on a patient with liver cirrhosis who experienced recurrent rectal variceal bleeding even after successful transjugular intravenous portosystemic shunt and was successfully treated with variceal embolization.

关键词： Ectopic varices Rectal varices Transjugular intrav

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Characterization of focal liver masses using acoustic radiation force impulse elastography

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World Journal of Gastroenterology 2013年第2期19卷 219-226页

作者： Hana Park Jun Yong Park Do Young kim Sang Hoon Ahn Chae Yoon Chon Kwang-Hyub Han seung up kim Division of Gastroenterology Department of Internal MedicineCHA Bundang Medical CenterCHA UniversityGyeonggi-do 463-712South Korea Department of Internal Medicine Yonsei University College of MedicineSeoul 120-752South Korea

AIM:To investigate the diagnostic performance of acoustic radiation force impulse(ARFI) elastography for characterizing focal liver mass by quantifying their ***:This prospective study included 62 patients with a focal liver mass that was well visualized on conventional ultrasonography performed in our institution from February 2011 to November *** them,12 patients were excluded for ARFI measurement failure due to a lesion that was smaller than the region of the interest and at an inaccessible location(deeper than 8 cm)(n = 7) or poor compliance to hold their breath as required(n = 5).Finally,50 patients with valid ARFI measurements were *** a patient had multiple liver masses,only one mass of interest was *** masses were diagnosed by histological examination or clinical diagnostic *** ultrasonographic evaluation,stiffness,expressed as velocity,was checked 10 times per focal liver mass and the surrounding liver ***:After further excluding three masses that were non-diagnostic on biopsy,a total of 47 focal mass lesions were tested,including 39(83.0%) malignant masses [24 hepatocellular carcinomas(HCC),seven cholangiocellular carcinomas(CCC),and eight liver metastases] and eight(17.0%) benign masses(five hemangiomas and three focal nodular hyperplasias,FNH).Thirty-seven(74.0%) masses were confirmed by histological *** mean velocity was 2.48 m/s in HCCs,1.65 m/s in CCCs,2.35 m/s in metastases,1.83 m/s in hemangiomas,and 0.97 m/s in *** considerable overlap was still noted between malignant and benign masses,significant differences in ARFI values were observed between malignant and benign masses(mean 2.31 m/s vs 1.51 m/s,P = 0.047),as well as between HCCs and benign masses(mean 2.48 m/s vs 1.51 m/s,P = 0.006).The areas under the receiver operating characteristics curves(AUROC) for discriminating the malignant masses from benign masses was 0.724(95%CI,0.566-0.883,P = 0.048),and the AUROC

关键词： Acoustic radiation force impulse Focal liver mass Hepatocellular carcinoma Hemangioma Focal nodular hyperplasia Cholangiocellular carcinoma Liver metastasis

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Efficacy of switching to telbivudine plus adefovir in suboptimal responders to lamivudine plus adefovir

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World Journal of Gastroenterology 2013年第43期19卷 7671-7679页

作者： Hana Park Jun Yong Park seung up kim Do Young kim Kwang-Hyub Han Chae Yoon Chon Sang Hoon Ahn Department of Internal Medicine CHA Bundang Medical CenterCHA UniversitySeongnam-si 463-712South Korea Department of Internal Medicine Yonsei University College of MedicineSeoul 120-752South Korea Institute of Gastroenterology Yonsei University College of MedicineLiver Cirrhosis Clinical Research CenterSeoul 120-752South Korea Institute of Gastroenterology Yonsei University College of MedicineSeoul 120-752South Korea Liver Cirrhosis Clinical Research Center Seoul 120-752South Korea Brain Korea 21 Project for Medical Science Seoul 120-752South Korea

AIM:To examine the efficacy of telbivudine(LdT)+adefovir(ADV)vs continuation of lamivudine(LAM)+ADV in patients with LAM-resistant chronic hepatitis B(CHB)who show a suboptimal response to LAM+***:This was a randomized,active-control,open-label,single-center,parallel *** eligible patients were enrolled in this study in Severance Hospital,Yonsei University College of Medicine,Seoul,South Korea,between March 2010 and March *** Be antigen(HBeAg)-positive CHB patients whose serum hepatitis B virus(HBV)DNA remained detectable despite at least 6 mo of LAM+ADV therapy were *** patients were randomized to either switching to LdT(600 mg/d orally)plus ADV(10 mg/d orally)(LdT+ADV group)or to continuation with LAM(100 mg/d orally)plus ADV(10 mg/d orally)(LAM+ADV group),and were followed for 48 *** hundred and six patients completed the 48-wk treatment *** HBV DNA,HBeAg status,liver biochemistry and safety were monitored at baseline and week 12,24,36 and ***:The duration of prior LAM+ADV treatment was 18.3(LdT+ADV)and 14.9 mo(LAM+ADV),respectively(P=0.131).No difference was seen in baseline serum HBV DNA between the two groups[3.66(LdT+ADV)vs 3.76(LAM+ADV)log10IU/mL,P=0.729].At week 48,although there was no significant difference in the mean reduction of serum HBV DNA from baseline between LdT+ADV group and LAM+ADV group(-0.81 vs-0.47 log10IU/mL,P=0.167),more patients in the LdT+ADV group had undetectable HBV DNA levels compared to those in the LAM+ADV group(30.2%vs 11.5%,P=0.019).Three patients with LdT+ADV treatment and 2 patients with LAM+ADV treatment achieved HBeAg *** patients in both groups tolerated the treatment well without serious adverse *** proportion of patients with estimated glomerular filtration rate≥90 mL/min per 1.73 m2in the LdT+ADV group increased from 49.1%(26/53)at baseline to 58.5%(31/53)at week 48,while that in the LAM+ADV group decreased from 37.7%(20/53)at baseline to 30.2%(16/53)at

关键词： Chronic hepatitis B Antiviral resistance Suboptimal response Telbivudine Lamivudine

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Factors associated with significant liver fibrosis assessed using transient elastography in general population

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World Journal of Gastroenterology 2015年第4期21卷 1158-1166页

作者： Seng Chan You Kwang Joon kim seung up kim Beom Kyung kim Jun Yong Park Do Young kim Sang Hoon Ahn Won Jae Lee Kwang-Hyub Han Department of Internal Medicine Yonsei University College of MedicineSeoul 120-752South Korea Division of Endocrinology and Metabolism Yonsei University College of MedicineSeoul 120-752South Korea Institute of Gastroenterology Yonsei University College of MedicineSeoul 120-752South Korea Liver Cirrhosis Clinical Research Center Seoul 120-752South Korea Seoul Gookgwain School Seoul 110-521South Korea

AIM: To investigate the prevalence of significant liver fibrosis assessed using transient elastography(TE) and its predictors in asymptomatic general ***: A total of 159 subjects without chronic viral hepatitis who underwent comprehensive medical health check-up between January 2012 and July 2012 were prospectively recruited. Significant liver fibrosis was defined as liver stiffness value > 7.0 k ***: The mean age and body mass index(BMI) of the study population(men 54.7%) was 56.0 years and 24.3 kg/m2. Among the study subjects, 11(6.9%) showed significant liver fibrosis. On univariate analysis, BMI, alanine aminotransferase(ALT), homeostasis model assessment of insulin resistance, carotid intimal media thickness(IMT), number of calcified plaques on carotid ultrasound, and visceral fat area on computed tomography were significantly higher in subjects with significant liver fibrosis than in those without(all P < 0.05). However, on multivariate analysis, BMI [odds ratio(OR) =1.487; P = 0.045], ALT(OR = 1.078; P = 0.014), carotid IMT(OR = 3.244; P = 0.027), and the number of calcified carotid plaques(OR = 1.787; P = 0.031) were independent predictors of significant liver fibrosis. CONCLUSION: The prevalence of significant liver fibrosis assessed using TE was 6.9% in apparently healthy subjects. High BMI, high ALT, thicker carotid IMT, and higher numbers of calcified carotid plaqueswere independently associated with the presence of significant liver fibrosis.

关键词： Transient elastography Healthy subjects Fibroscan

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Role of surgical resection for multiple hepatocellular carcinomas

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World Journal of Gastroenterology 2013年第3期19卷 366-374页

作者： Sung Hoon Choi Gi Hong Choi seung up kim Jun Yong Park Dong Jin Joo Man Ki Ju Myoung Soo kim Jin Sub Choi Kwang Hyub Han Soon Il kim Department of Surgery Yonsei University College of MedicineSeoul 120-752South Korea Department of Internal Medicine Yonsei University College of MedicineSeoul 120-752South Korea

AIM:To clarify the role of surgical resection for multiple hepatocellular carcinomas(HCCs)compared to transarterial chemoembolization(TACE)and liver transplantation(LT). METHODS:Among the HCC patients who were managed at Yonsei University Health System between January 2003 and December 2008,160 patients who met the following criteria were retrospectively enrolled:(1) two or three radiologically diagnosed HCCs;(2)no radiologic vascular invasion;(3)Child-Pugh class A;(4) main tumor smaller than 5 cm in diameter;and(5) platelet count greater than 50 000/***-term outcomes were compared among the following three treatment modalities:surgical resection or combined radiofrequency ablation(RFA)(n=36),TACE(n=107), and LT(n=17).The survival curves were computed using the Kaplan-Meier method and compared with a log-rank *** identify the patients who gained a survival benefit from surgical resection,we also investigated prognostic factors for survival following surgical *** analyses of the prognostic factors for survival were performed using the Cox proportional hazard model. RESULTS:The overall survival(OS)rate was significantly higher in the surgical resection group than in the TACE group(48.1%vs 28.9%at 5 years,Pup,although the difference was not statistically significant(80.2%vs 48.1%at 5 years,P=0.447).The disease-free survival rates were also significantly higher in the LT group than in the surgical resection group(88.2%vs 11.2%at 5 years, Pup and 93.5%(100/107)in the TACE *** were 19 major and 17 minor resections. En bloc resection was performed in 23 patients,multisite resection was performed in 5 patients,and combined resection with RFA was performed in 8 patients. In the TACE

关键词： Hepatocellular carcinoma Hepatectomy Liver transplantation Chemoembolization Cirrhosis

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