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Inoue J, Akahane T, Kobayashi T, Kimura O, Sato K, Ninomiya M, Iwata T, Takai S, Kisara N, Sato T, Nagasaki F, Miura M, Nakamura T, Umetsu T, Sano A, Tsuruoka M, Onuki M, Sawahashi S, Niitsuma H, Masamune A. Usefulness of the Fibrosis-4 index and alanine aminotransferase at 1 year of nucleos(t)ide analog treatment for prediction of hepatocellular carcinoma in chronic hepatitis B patients. Hepatol Res 2024; 54:131-141. [PMID: 37621201 DOI: 10.1111/hepr.13957] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/08/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023]
Abstract
AIM Nucleos(t)ide analogs do not completely prevent hepatocellular carcinoma (HCC) in chronic hepatitis B virus infection. This study aimed to evaluate the dynamics of a non-invasive liver fibrosis marker, the Fibrosis-4 (FIB-4) index, for predicting HCC development. METHODS Among a total of 882 chronically hepatitis B virus infection-infected patients who were treated with nucleos(t)ide analogs, 472 patients without HCC history whose FIB-4 at baseline and 1 year of treatment was obtained were evaluated for the incidence of HCC. RESULTS The median FIB-4 was 2.00 at baseline and was significantly reduced to 1.58 at 1 year (P < 0.001), but the reduction was small at 2 years or later. When a receiver operating characteristic analysis of FIB-4 was performed to predict HCC within 5 years, the area under the curve of FIB-4 at 1 year was higher than that at baseline (0.676 vs. 0.599). The HCC incidence was significantly higher in patients with FIB-4 ≥1.58 than in those with FIB-4 <1.58 (14.8% vs. 3.6% at 10 years, P < 0.001). Additionally, an abnormal alanine aminotransferase (≥31 U/L) at 1 year was an independent risk for HCC. When a fibrosis and alanine aminotransferase-1 (FAL-1) score was evaluated as an applicable number of FIB-4 ≥1.58, and alanine aminotransferase ≥31 as 0, 1, and 2, the HCC risk in patients with score 2 was significantly higher than in those with score 1 or score 0 (24.1% vs. 9.8% vs. 0.7% at 10 years, P < 0.001). CONCLUSIONS FIB-4 ≥1.58 and alanine aminotransferase ≥31 at 1 year of nucleos(t)ide analog was an independent risk factor for HCC development, and a score using these factors stratified the risk of HCC.
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Affiliation(s)
- Jun Inoue
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takehiro Akahane
- Department of Gastroenterology, Japanese Red Cross Ishinomaki Hospital, Ishinomaki, Japan
| | - Tomoo Kobayashi
- Department of Hepatology, Tohoku Rosai Hospital, Sendai, Japan
| | - Osamu Kimura
- Department of Gastroenterology, South Miyagi Medical Center, Ogawara, Japan
| | - Kosuke Sato
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masashi Ninomiya
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomoaki Iwata
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Takai
- Department of Gastroenterology, Iwaki City Medical Center, Iwaki, Japan
| | - Norihiro Kisara
- Department of Gastroenterology, Japan Community Health Care Organization Sendai South Hospital, Sendai, Japan
| | | | - Futoshi Nagasaki
- Department of Gastroenterology, Sendai City Hospital, Sendai, Japan
| | - Masahito Miura
- Department of Gastroenterology, Omagari Kousei Medical Center, Daisen, Japan
| | - Takuya Nakamura
- Department of Gastroenterology, Yamagata City Hospital Saiseikan, Yamagata, Japan
| | - Teruyuki Umetsu
- Department of Internal Medicine, Kesennuma City Hospital, Kesennuma, Japan
| | - Akitoshi Sano
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mio Tsuruoka
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masazumi Onuki
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoko Sawahashi
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hirofumi Niitsuma
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Oh H, Park CH, Jun DW. Impact of l-Carnitine Supplementation on Liver Enzyme Normalization in Patients with Chronic Liver Disease: A Meta-Analysis of Randomized Trials. J Pers Med 2022; 12:jpm12071053. [PMID: 35887550 PMCID: PMC9322040 DOI: 10.3390/jpm12071053] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 11/22/2022] Open
Abstract
The effectiveness of l-carnitine in chronic liver disease remains controversial. We conducted this meta-analysis to assess the efficacy of various forms of l-carnitine in the treatment of chronic liver disease. Methods: We searched the Cochrane Library, EMBASE, KMBASE, and Medline databases for all relevant studies published until April 2022 that examined the ability of l-carnitine or its derivatives to normalize liver enzymes in patients with chronic liver disease. We performed meta-analyses of the proportion of patients with alanine aminotransferase (ALT) normalization and post-treatment serum aspartate aminotransferase (AST) and ALT levels. A random effects model was used for meta-analyses. Results: Fourteen randomized controlled trials (1217 patients) were included in this meta-analysis. The proportion of patients in whom ALT normalized was higher in the carnitine-orotate treatment group than in the control group (pooled odds ratio (OR), 95% confidence interval (CI) = 4.61 (1.48–14.39)). The proportion of patients in whom ALT normalized was also higher among those who received the carnitine-orotate complex, a combination of carnitine-orotate, biphenyl dimethyl dicarboxylate, and other minor supplementary compounds than in those who did not without significant heterogeneity (pooled OR (95% CI) = 18.88 (7.70–46.27); df = 1; p = 0.51; I2 = 0%). l-carnitine supplementation effectively lowered serum ALT levels compared to controls (pooled mean difference (95% CI) = −11.99 (−22.48 to −1.49)). Conclusions: l-carnitine supplementation significantly lowered ALT and AST levels and normalized ALT levels in patients with chronic liver disease.
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Affiliation(s)
- Hyunwoo Oh
- Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu 11690, Korea;
| | - Chan Hyuk Park
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri 11923, Korea
- Correspondence: (C.H.P.); (D.W.J.); Tel.: +82-31-560-2230 (C.H.P.); +82-2-2290-8338 (D.W.J.)
| | - Dae Won Jun
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul 04763, Korea
- Correspondence: (C.H.P.); (D.W.J.); Tel.: +82-31-560-2230 (C.H.P.); +82-2-2290-8338 (D.W.J.)
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Sato K, Inoue J, Akahane T, Kobayashi T, Takai S, Nakamura T, Sato T, Kimura O, Ninomiya M, Iwata T, Sano A, Tsuruoka M, Onuki M, Sawahashi S, Niitsuma H, Masamune A. Switching to Tenofovir Alafenamide Fumarate in Chronic Hepatitis B Patients Who Had Detectable HBV DNA during Treatment with Entecavir. TOHOKU J EXP MED 2022; 258:277-285. [DOI: 10.1620/tjem.2022.j084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Kosuke Sato
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Jun Inoue
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Takehiro Akahane
- Department of Gastroenterology, Japanese Red Cross Ishinomaki Hospital
| | | | - Satoshi Takai
- Department of Gastroenterology, Iwaki City Medical Center
| | - Takuya Nakamura
- Department of Gastroenterology, Yamagata City Hospital Saiseikan
| | | | - Osamu Kimura
- Department of Gastroenterology, South Miyagi Medical Center
| | - Masashi Ninomiya
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Tomoaki Iwata
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Akitoshi Sano
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Mio Tsuruoka
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Masazumi Onuki
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Satoko Sawahashi
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Hirofumi Niitsuma
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
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