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on-treatment monitoring of liver fibrosis with serum hepatitis B core-related antigen in chronic hepatitis B

World Journal of Gastroenterology 2019年第32期25卷 4764-4778页

作者： Xiu-Juan Chang Chao Sun Yan Chen Xiao-Dong Li Zu-Jiang Yu Zheng Dong Wen-Lin Bai Xiao-Dong Wang Zhi-Qin Li Da Chen Wen-Juan Du Hao Liao Qi-Yu Jiang Li-Jun Sun Yin-Yin Li Cui-Hong Zhang Dong-Ping Xu Yong-Ping Chen Qin Li Yong-Ping Yang Chinese PLA Medical School Chinese PLA General HospitalBeijing 100853China Department of Therapeutic Research for Liver Cancer the Fifth Medical Center of Chinese PLA General HospitalBeijing 100039China Peking University 302 Clinical Medical School Beijing 100039China Department of Research for Clinical Medicine the Fifth Medical center of Chinese PLA General HospitalBeijing 100039China Department of Infectious Disease the First Affiliated Hospital of Zhengzhou UniversityZhengzhou 450052Henan ProvinceChina Department of Infectious and Liver Diseases Liver Research Centerthe First Affiliated Hospital of Wenzhou Medical UniversityWenzhou 325000Zhejiang ProvinceChina Fuzhou Infectious Diseases Hospital Fuzhou 350025Fujian ProvinceChina Medical Department Training Graduate Office Chinese PLA General HospitalBeijing 100853China Department of Microbiology&Infectious Disease Center School of Basic Medical SciencesPeking University Health Science CenterBeijing 100191China

BACKGROUND Non-invasive evaluation for liver fibrosis is clinically important,especially in patients with undetectable hepatitis B virus(HBV)DNA treated with nucleoside analogs.AIM To clarify the monitoring power of hepatitis B core-related antigen(HBcrAg)for hepatic histologic changes in patients with chronic hepatitis B(CHB)treated with entecavir.METHODS This prospective multicenter study used multiple ordinal and multivariate logistics regression analysis to assess variables associated with Ishak fibrosis score and regression for fibrosis regression,respectively,in 403 CHB patients,including 374 with entecavir for 72 weeks(291 underwent paired liver biopsy)and 29 as controls.RESULTS Level of HBcrAg correlated negatively with liver fibrosis staging(γ=-0.357,Ptreatment HBcrAg concentration was associated with the regression of hepatic fibrosis and histological improvement.HBcrAg concentration>6.33 log IU/mL at baseline and logarithmic reduction>1.03 log IU/mL at week 72 were associated with a higher chance of regression of liver fibrosis and histological improvement,respectively.CONCLUSION HBcrAg level is associated with liver fibrosis progression.HBcrAg is an excellent monitor of hepatic histological changes,especially in CHB patients treated with nucleoside analogs.

关键词： Hepatitis B core-related antigen Liver fibrosis Cirrhosis on-treatment monitoring

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Clinical outcomes and predictive model of platelet reactivity to clopidogrel after acute ischemic vascular events

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Chinese Medical Journal 2019年第9期132卷 1053-1062页

作者： Qi Ma Guang-Zhong Chen Yu-Hu Zhang Li Zhang Li-An Huang Department of Neurology The First Affiliated HospitalJinan UniversityGuangzhouGuangdong 510632China Guangdong Geriatrics Institute Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdong 510080China Department of Neurosurgery Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdong 510080China Department of Neurology Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdong 510080China

Background:High on-treatment platelet reactivity (HTPR) has been suggested as a risk factor for patients with ischemic vascular disease.We explored a predictive model of platelet reactivity to clopidogrel and the relationship with clinical outcomes.Methods:A total of 441 patients were included.Platelet reactivity was measured by light transmittance aggregometry after receiving dual antiplatelet therapy.HTPR was defined by the consensus cutoff of maximal platelet aggregation >46% by light transmittance aggregometry.CYP2C19 loss-of-function polymorphisms were identified by DNA microarray analysis.The data were compared by binary logistic regression to find the risk factors.The primary endpoint was major adverse clinical events (MACEs),and patients were followed for a median time of 29 months.Survival curves were constructed with Kaplan-Meier estimates and compared by logrank tests between the patients with HTPR and non-HTPR.Results:The rate of HTPR was 17.2%.Logistic regression identified the following predictors of HTPR:age,therapy regimen,body mass index,diabetes history,CYP2C19^*2,or CYP2C19^*3 variant.The area under the curve of receiver operating characteristic for the HTPR predictive model was 0.793 (95% confidence interval:0.738–0.848).Kaplan-Meier analysis showed that patients with HTPR had a higher incidence of MACE than those with non-HTPR (21.1% vs.9.9%;χ^2 = 7.572,P = 0.010).Conclusions:Our results suggest that advanced age,higher body mass index,treatment with regular dual antiplatelet therapy,diabetes,and CYP2C19^*2 or CYP2C19^*3 carriers are significantly associated with HTPR to clopidogrel.The predictive model of HTPR has useful discrimination and good calibration and may predict long-term MACE.

关键词： High on-treatment platelet reactivity Clopidogrel CYP2C19 Light transmittance aggregometry Ischemic vascular events

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Comparing of Light Transmittance Aggregometry and Modified Thrombelastograph in Predicting Clinical Outcomes in Chinese Patients Undergoing Coronary Stenting with Clopidogrel

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Chinese Medical Journal 2015年第6期128卷 774-779页

作者： Xiao-Fang Tang Ya-Ling Han Jia-Hui Zhang Jing Wang Yin Zhang Bo Xu Zhan Gao Shu-Bin Qiao Jue Chen Yuan Wu Ji-Lin Chen Run-Lin Gao Yue-Jin Yang Jin-Qing Yuan Department of Cardiology State Key Laboratory of Cardiovascular Disease Fuwai Hospital National Centre for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China Department of Cardiology Institute of Cardiovascular Research of People's Liberation Army Shenyang Northern Hospital Shenyang Liaoning 110840 China Department of Cardiology Centre for Coronary Heart Disease State Key Laboratory of Cardiovascular DiseaseFuwai Hospita/i National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China

Background:Several platelet function tests are currently used to measure responsiveness to antiplatelet therapy.This study was to compare two tests,light transmittance aggregometry (LTA) and modified thrombelastography (mTEG),for predicting clinical outcomes in Chinese patients after percutaneous coronary intervention (PCI).Methods:Prospective,observational,single-center study of 789 Chinese patients undergoing PCI was enrolled.This study was investigated the correlations between the two tests and performed receiver operating characteristic curve (ROC) analysis for major adverse cardiovascular events (MACEs) at 1-year follow-up.Results:MACEs occurred in 32 patients (4.1％).Correlations were well between the two tests in the adenosine diphosphate induced platelet reactivity (Spearman r =0.733,P ＜ 0.001).ROC-curve analysis demonstrated that LTA (area under the curve [AUC]:0.677; 95％ confidence interval [CI]:0.643-0.710; P =0.0009),and mTEG (AUC:0.684; 95％ CI:0.650-0.716; P =0.0001) had moderate ability to discriminate between patients with and without MACE.MACE occurred more frequently in patients with high on-treatment platelet reactivity (HPR) when assessed by LTA (7.4％ vs.2.7％; P ＜ 0.001),and by TEG (6.7％ vs.2.6％; P ＜ 0.001).Kaplan-Meier analysis demonstrated that HPR based on the LTA and mTEG was associated with almost 3-fold increased risk of MACE at 1-year follow-up.Conclusions:The correlation between LTA and mTEG is relatively high in Chinese patients.HPR measured by LTA and mTEG were significantly associated with MACE in Chinese patients undergoing PCI.

关键词： Clopidogrel High on-treatment Platelet Reactivity Light Transmittance Aggregometry Thrombelastography

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