فهرست مطالب
Hepatitis Monthly
Volume:20 Issue: 1, Jan 2020
- تاریخ انتشار: 1398/11/20
- تعداد عناوین: 5
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Page 1Context
Patients with hepatitis C virus (HCV) genotype 3 are regarded as a difficult-to-cure population in an era of direct-acting antiviral treatment.
ObjectivesThis meta-analysis aimed to evaluate sustained virologic response rates resulting from a fixed-dose combination of sofosbuvir (SOF) and velpatasvir (VEL), also known as Epclusa® (Gilead, Forster City, CA) in patients with HCV genotype 3.
MethodsIn this study, we searched PubMed/MEDLINE, Embase, and the Cochrane Library for relevant studies from inception until May 3rd, 2019. The primary outcome measure used was the rate of the sustained virological response at week-12 (SVR12) post-treatment. The heterogeneity of results was evaluated, and influence analyses were performed using the R software. In addition, publication bias was assessed using the funnel and Egger tests.
ResultsEleven trials (n = 2246 patients) were included in this meta-analysis. The pooled SVR12 rate in patients with HCV-genotype 3 (GT3) was 94.6% with a random effect model by inverse method (95% Cl 92.5% - 96.1%, I2 = 53%, P = 0.02). A subpopulation analysis indicated that the pooled SVR12 rates were 96.3% in GT3 patients with compensated cirrhosis and 94.0% in GT3 patients with prior anti-HCV treatment. Moreover, influence analysis suggested that the most significant source of heterogeneities resulted from one trial, which enrolled most patients with HCV subtype 3b.
ConclusionsOur meta-analysis showed a high SVR12 rate of SOF/VEL in GT3 patients regardless of compensated cirrhosis the status and/or a history of previous interferon-based treatments. These results highlight the need for more trials investigating the effectiveness of the SOF/VEL regimen in patients with HCV subtype 3b.
Keywords: Meta-Analysis, HCV, Sofosbuvir, Cirrhosis, SVR12, Velpatasvir, Genotype 3 -
Page 2Background
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in modern human life. Serum protease and protease inhibitor concentrations can be potentially considered the important risk factors for NAFLD, together with the main risk factors of this disorder, such as diabetes, obesity, and dyslipidemia.
ObjectivesThe present study aimed to investigate the plasma level of a neutral serine protease family called neutrophil elastase (NE), as well as its inhibitor, alpha1-antitrypsin (A1AT), in NAFLD patients compared to normal subjects. Additionally, the most common deficient variants of A1AT (S and Z) were determined in both patient and healthy groups.
MethodsThe study included 54 consecutive unrelated NAFLD patients and 120 matched healthy subjects as controls over two years. Plasma concentrations of A1AT and neutrophil elastase activity were determined for all patients and controls using the enzyme immunoassay and alpha1-proteinase inhibitor-immunoglobulin A complex, respectively. The A1AT variants of PiZ (rs28929474) and PiS (rs17580) were analyzed by the polymerase chain reaction.
ResultsThe NAFLD patient group had more plasma elastase activity than the healthy control group (1.7 (0.5) vs. 1.3 (0.5) (U/mL), P < 0.01). Furthermore, the plasma A1AT level was significantly lower in NAFLD patients than in controls (216.1 (171.3) vs. 244.6 (152.9) (mg/dL), P = 0.01). The heterozygous carriages of PiS and PiZ variants were not statistically different between NAFLD patients and controls.
ConclusionsHigher elastase activity and lower A1AT concentration in plasma can be considered the potential prognostic and diagnostic biomarkers in patients with NAFLD.
Keywords: Non-Alcoholic Fatty Liver Disease (NAFLD), rs28929474, rs17580, A1-Antitrypsin (A1AT), Elastase Activity -
Page 3Background
The role of immune system in natural course of viral hepatitis has been drawn some attention. One of the main diagnostic markers of the immune system function in different diseases might be the ratio of CD4+ to CD8+ T lymphocytes (CD4+/CD8+ ratio).
ObjectivesThis research aimed to measure and compare CD4+/CD8+ ratio in the patients with chronic hepatitis B (CHB) and control group.
MethodsIn this cross-sectional study, thirty-three CHB patients and thirty age and sex-matched healthy controls were included. Immunophenotyping of isolated T cells was performed using specific anti-CD4 and anti-CD8 antibodies by flow cytometry. Consequently, CD4+, CD8+ and the ratio of CD4+/CD8+were counted and compared between the two groups.
ResultsCD4+ counts (%) were considerably reduced in patients with CHB compared to the healthy controls (51.22 ± 10.5 vs. 63.14 ± 9.9, P = 0.00), whereas CD8+ counts (%) were higher in the patients with CHB than healthy controls (48.8 ± 10.5 vs. 36.85 ± 9.86, P = 0.00). Moreover, CD4+/CD8+ ratio remarkably decreased in the patients with CHB (1.15 ± 0.5) than healthy controls (1.93 ± 0.9) (P = 0.00). Area under curve (AUC) of 0.79 (SE = 0.06, CI = 0.68 - 0.90, P value = 0.05) was reported for CD4+/CD8+ ratio with a sensitivity of 72.73% and specificity of 73.33% in 1.35 cut-off (likelihood ratio = 2.72).
ConclusionsThe research indicated an impaired balance between T cell subsets associated with a higher proportion of CD8+ T cells and a lower proportion of CD4+ T cells and CD4+/CD8+ ratio in patients with CHB.
Keywords: Immune System, Hepatitis B, CD4-CD8 Ratio -
Page 4Background
Adenosine Deaminase (ADA) has been found to be involved in autoimmune disease progression.
ObjectivesWe aimed to evaluate the diagnostic value of serum ADA activity in Autoimmune Liver Disease (AILD).
MethodsThe study included 50 AILD patients, 33 viral hepatitis patients, and 60 healthy subjects. The serum levels of total Adenosine Deaminase (tADA) and its isoenzymes (ADA1 and ADA2) were determined. The Receiver Operating Characteristic (ROC) curve analysis was used to evaluate the diagnostic performance of serum ADA activity.
ResultsOur results showed that the serum tADA and ADA2 levels were significantly higher in AILD patients (tADA: 19 (IQR 14 - 24) U/L; ADA2: 16 (IQR 10 - 19) U/L) than in healthy controls (tADA: 9 (IQR 7 - 11) U/L; ADA2: 7 (IQR 6 - 9) U/L), while there was no significant difference in serum ADA1 activity between AILD and healthy subjects. Based on the ROC curves analysis, the optimal cutoff values of serum tADA and ADA2 activity were 11.5 and 9.5 U/L, respectively. At this level, the highest diagnostic values of tADA (specificity: 83.3%; sensitivity: 88%) and ADA2 (specificity: 85.0%; sensitivity: 82%) were obtained. Moreover, our results showed no significant difference in serum tADA, ADA1, and ADA2 levels between AILD and viral hepatitis patients (P = 0.049; P = 0.29; P = 0.054).
ConclusionsSerum ADA activity can be used to distinguish AILD patients from healthy subjects, but it cannot be used in the differential diagnosis of AILD and viral patients.
Keywords: Diagnosis, Viral Hepatitis, Isoenzymes, Autoimmune Liver Diseases, Adenosine Deaminase