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Zhang L, Yang L, Gao Y, Bi X, Lin Y, Deng W, Jiang T, Lu Y, Hao H, Wan G, Yi W, Xie Y, Li M. Nomogram for evaluating obvious liver inflammation in treatment-naïve HBeAg positive chronic hepatitis B virus infection patients with normal ALT. Virulence 2023; 14:2158710. [PMID: 36600180 PMCID: PMC9828634 DOI: 10.1080/21505594.2022.2158710] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The purpose of this study was to develop an effective and non-invasive nomogram for evaluating liver obvious inflammation in untreated HBeAg positive patients with chronic hepatitis B virus (HBV) infection. A nomogram was established on a model cohort of 292 treatment-naïve HBeAg positive patients with normal alanine aminotransferase (ALT ≤40 U/L) at Beijing Ditan Hospital from January 2008 to March 2018. Then the nomogram was prospectively validated in a cohort of 88 patients from July 2019 to May 2021. Calibration curves and Concordance index were used to evaluate the accuracy of prediction and identification performance of the model. In untreated HBeAg positive chronic hepatitis B virus infection patients with normal ALT, the formula for predicting liver inflammation was Logit (P) =-0.91-0.41×log10 (qHBeAg)+0.11×AST-0.01×PLT. The nomogram had C-index of 0.751 (95% CI, 0.688-0.815), indicating a good consistency between prediction and real observation on the model cohort. The validation cohort confirmed its good performance. In this study, liver inflammation nomograms based on HBeAg, AST, and PLT were established and verified in treatment-naïve HBeAg positive chronic HBV patients with normal ALT.
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Affiliation(s)
- Lu Zhang
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Liu Yang
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yuanjiao Gao
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xiaoyue Bi
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yanjie Lin
- Department of Medical Record Statistics, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Wen Deng
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Tingting Jiang
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yao Lu
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Hongxiao Hao
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Gang Wan
- Department of Gynecology and Obstetrics, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Wei Yi
- Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China,Wei Yi
| | - Yao Xie
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China,Department of Medical Record Statistics, Beijing Ditan Hospital, Capital Medical University, Beijing, China,CONTACT Yao Xie
| | - Minghui Li
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China,Department of Medical Record Statistics, Beijing Ditan Hospital, Capital Medical University, Beijing, China,Minghui Li
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2
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Lin YJ, Bi XY, Yang L, Deng W, Jiang TT, Li MH, Xie Y. CLINICAL CURE OF A CHRONIC HEPATITIS B PATIENT WITH NORMAL SERUM ALANINE AMINOTRANSFERASE TREATED WITH PEGYLATED INTERFERON ALFA-2A: A CASE REPORT. Gastroenterol Nurs 2023; 46:153-159. [PMID: 36399392 DOI: 10.1097/sga.0000000000000697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 07/08/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Yan-Jie Lin
- Yan-Jie Lin, MM, is from the Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China
- Xiao-Yue Bi, MM, is from the Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Liu Yang, MM, is from the Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Wen Deng, MM, is from the Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Ting-Ting Jiang, MM, is from the Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Ming-Hui Li, MD, is Professor, Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China; and Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Yao Xie, MD, is Professor, Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China; and Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xiao-Yue Bi
- Yan-Jie Lin, MM, is from the Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China
- Xiao-Yue Bi, MM, is from the Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Liu Yang, MM, is from the Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Wen Deng, MM, is from the Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Ting-Ting Jiang, MM, is from the Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Ming-Hui Li, MD, is Professor, Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China; and Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Yao Xie, MD, is Professor, Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China; and Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Liu Yang
- Yan-Jie Lin, MM, is from the Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China
- Xiao-Yue Bi, MM, is from the Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Liu Yang, MM, is from the Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Wen Deng, MM, is from the Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Ting-Ting Jiang, MM, is from the Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Ming-Hui Li, MD, is Professor, Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China; and Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Yao Xie, MD, is Professor, Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China; and Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Wen Deng
- Yan-Jie Lin, MM, is from the Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China
- Xiao-Yue Bi, MM, is from the Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Liu Yang, MM, is from the Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Wen Deng, MM, is from the Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Ting-Ting Jiang, MM, is from the Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Ming-Hui Li, MD, is Professor, Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China; and Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Yao Xie, MD, is Professor, Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China; and Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Ting-Ting Jiang
- Yan-Jie Lin, MM, is from the Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China
- Xiao-Yue Bi, MM, is from the Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Liu Yang, MM, is from the Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Wen Deng, MM, is from the Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Ting-Ting Jiang, MM, is from the Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Ming-Hui Li, MD, is Professor, Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China; and Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Yao Xie, MD, is Professor, Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China; and Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Ming-Hui Li
- Yan-Jie Lin, MM, is from the Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China
- Xiao-Yue Bi, MM, is from the Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Liu Yang, MM, is from the Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Wen Deng, MM, is from the Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Ting-Ting Jiang, MM, is from the Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Ming-Hui Li, MD, is Professor, Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China; and Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Yao Xie, MD, is Professor, Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China; and Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yao Xie
- Yan-Jie Lin, MM, is from the Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China
- Xiao-Yue Bi, MM, is from the Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Liu Yang, MM, is from the Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Wen Deng, MM, is from the Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Ting-Ting Jiang, MM, is from the Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Ming-Hui Li, MD, is Professor, Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China; and Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Yao Xie, MD, is Professor, Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China; and Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
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Wang L, Liu S, Wang C, Zhu M, Guo Y, Zhao P. Hepatocyte proliferation favours viral clearance in young children with chronic hepatitis B virus infection. Acta Paediatr 2023; 112:305-310. [PMID: 36239417 DOI: 10.1111/apa.16572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/05/2022] [Accepted: 10/13/2022] [Indexed: 01/20/2023]
Abstract
AIM The aim of this study is to explore the correlation between hepatocyte proliferation and hepatitis B virus (HBV) clearance in young children with chronic HBV infection. METHODS We collected liver biopsy samples and clinical data corresponding to paediatric patients with chronic HBV infection. Ki-67 expression in liver tissues was evaluated by immunohistochemical staining. RESULTS Eighteen patients were included and were divided into two groups based on different antiviral outcomes. Group I achieved hepatitis B surface antigen (HBsAg) loss within 48 weeks. Group II did not develop seroconversion from hepatitis B e (HBe) antigen to anti-HBe after 48 weeks. There were 10 patients in Group I and 8 in Group II, respectively. Demographical data and baseline virological and biochemical characteristics in serum across Group I and Group II were not statistically different. Histologically, mean Ki-67 expression index in Group I was 15%, while the mean index in Group II was 5%. There was a significant difference between the two groups (p < 0.01). CONCLUSION High Ki-67 expression can contribute to viral clearance in young children with chronic HBV infection. This is the first confirmation of the association between hepatocyte proliferation and HBV clearance in vivo and has implications for novel therapeutic strategies against hepatitis B.
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Affiliation(s)
- Limin Wang
- Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Shuhong Liu
- The Fifth Medical Center (formerly Beijing 302 Hospital), Chinese PLA General Hospital, Beijing, China
| | - Chunya Wang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Min Zhu
- The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yupeng Guo
- College of Public Health, Mudanjiang Medical University, Mudanjiang, China
| | - Pan Zhao
- The Fifth Medical Center (formerly Beijing 302 Hospital), Chinese PLA General Hospital, Beijing, China
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4
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Zhang L, Bi X, Chen X, Zhang L, Xiong Q, Cao W, Lin Y, Yang L, Jiang T, Deng W, Wang S, Wu S, Liu R, Gao Y, Shen G, Chang M, Hao H, Xu M, Hu L, Lu Y, Li M, Xie Y. A nomogram based on HBeAg, AST, and age to predict non-minimal liver inflammation in CHB patients with ALT <80 U/L. Front Immunol 2023; 13:1119124. [PMID: 36741383 PMCID: PMC9892180 DOI: 10.3389/fimmu.2022.1119124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/28/2022] [Indexed: 01/21/2023] Open
Abstract
Objective Precise assessment of liver inflammation in untreated hepatitis B e antigen (HBeAg)-positive patients with chronic hepatitis B virus (HBV) infection can determine when to initiate antiviral therapy. The aim of this study was to develop and validate a nomogram model for the prediction of non-minimal liver inflammation based on liver pathological injuries combined with age and alanine aminotransferase (ALT), aspartate aminotransferase (AST), hepatitis B surface antigen (HBsAg), HBeAg, and HBV DNA quantification. Methods We retrospectively included 735 HBeAg-positive chronic hepatitis B (CHB) patients with ALT < 80 U/L as the primary cohort and prospectively enrolled 196 patients as the validation cohort. Multivariate logistic regression analysis identified independent impact factors. A nomogram to predict significant liver inflammation was developed and validated. Results Multivariate logistic regression analysis showed that HBeAg, AST, and age were independent risk factors for predicting non-minimal liver inflammation in untreated CHB patients. The final formula for predicting non-minimal liver inflammation was Logit(P) = -1.99 - 0.68 × Log10HBeAg + 0.04 × Age + 0.06 × AST. A nomogram for the prediction of non-minimal liver inflammation was established based on the results from the multivariate analysis. The predicted probability of the model being consistent with the actual probability was validated by the calibration curves, showing the best agreement in both the primary and validation cohorts. The C-index was 0.767 (95%CI = 0.734-0.802) in the primary cohort and 0.749 (95%CI = 0.681-0.817) in the prospective validation cohort. Conclusions The nomogram based on HBeAg, AST, and age might help predict non-minimal liver inflammation in HBeAg-positive CHB patients with ALT < 80 U/L, which is practical and easy to use for clinicians.
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Affiliation(s)
- Lu Zhang
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xiaoyue Bi
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xiaoxue Chen
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Luxue Zhang
- Infectious Disease Department, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qiqiu Xiong
- Department of General Surgery, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Weihua Cao
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China,Department of Infectious Diseases, Miyun Teaching Hospital, Capital Medical University, Beijing, China
| | - Yanjie Lin
- Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China
| | - Liu Yang
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Tingting Jiang
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Wen Deng
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Shiyu Wang
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Shuling Wu
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Ruyu Liu
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yuanjiao Gao
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Ge Shen
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Min Chang
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Hongxiao Hao
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Mengjiao Xu
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Leiping Hu
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yao Lu
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Minghui Li
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China,Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China,*Correspondence: Minghui Li, ; Yao Xie, ,
| | - Yao Xie
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China,Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China,*Correspondence: Minghui Li, ; Yao Xie, ,
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5
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Zhang L, Jiang T, Yang Y, Deng W, Lu H, Wang S, Liu R, Chang M, Wu S, Gao Y, Hao H, Shen G, Xu M, Chen X, Hu L, Yang L, Bi X, Lin Y, Lu Y, Jiang Y, Li M, Xie Y. Postpartum hepatitis and host immunity in pregnant women with chronic HBV infection. Front Immunol 2023; 13:1112234. [PMID: 36685527 PMCID: PMC9846060 DOI: 10.3389/fimmu.2022.1112234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/16/2022] [Indexed: 01/06/2023] Open
Abstract
In order to develop immune tolerant to the fetal, maternal immune system will have some modification comparing to the time before pregnancy. Immune tolerance starts and develops at the maternal placental interface. In innate immunity, decidual natural killer (dNK) cells, macrophages and dendritic cells play a key role in immue tolerance. In adaptive immunity, a moderate increase of number and immune inhibition function of regulatory T cells (Treg) are essential for immune tolerance. The trophoblast cells and immune cells expressing indoleamine 2,3-dioxygenase (IDO), the trophoblast cells expressing HLA-G, and Th1/Th2 shifting to Th2 dominant and Th17/Treg shifting to Treg domiant are in favor of maternal fetal immune tolerance. Steroids (estrogen and progesterone) and human chorionic gonadotropin (HCG) also participate in immune tolerance by inducing Treg cells or upregulating immunosuppressive cytokines. Most of the patients with chronic HBV infection are in the "HBV immune tolerance period" before pregnancy, and the liver disease is relatively stable during pregnancy. In chronic HBV infection women, after delivery, the relative immunosuppression in vivo is reversed, and Th1 is dominant in Th1/Th2 and Th17 is dominant in Th17/Treg balance. After delivery, the number of Treg decrease and NK cells increase in quantity and cytotoxicity in peripheral blood. Liver NK cells may cause liver inflammation through a non-antigen specific mechanism. After delivery, the number of CD8+ T cells will increase and HBV specific T cell response recovers from the disfunction in pregnancy. Under the background of postpartum inflammation, the rapid decrease of cortisol after delivery, and especially the enhancement of HBV specific T cell response induced by HBV DNA and cytokines, are the main reasons for postpartum hepatitis. HBeAg positive, especially HBeAg<700 S/CO, and HBV DNA>3-5Log10IU/ml are risk factors for postpartum hepatitis. Antiviral treatment in late pregnancy can reduce the incidence of mother to child transmission (MTCT) in chronic HBV infection women. Chronic HBV infection women have hepatitis both during pregnancy and more often in 12 weeks postpartum. It is generally agreed that postpartum hepatitis is mild symptoms and self-limited. Delaying drug withdrawal to 48 weeks can increase the seroconversion rate of HBeAg in delivery women with elevated alanine aminotransferase (ALT) in pregnancy.
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Affiliation(s)
- Lu Zhang
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Tingting Jiang
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Ying Yang
- Hepatology Department 2, Xingtai Second Hospital, Xingtai, China
| | - Wen Deng
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Huihui Lu
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China,Department of Obstetrics and Gynecology, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shiyu Wang
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Ruyu Liu
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Min Chang
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Shuling Wu
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yuanjiao Gao
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Hongxiao Hao
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Ge Shen
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Mengjiao Xu
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xiaoxue Chen
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Leiping Hu
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Liu Yang
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xiaoyue Bi
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yanjie Lin
- Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China
| | - Yao Lu
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China,*Correspondence: Yao Lu, ; Yuyong Jiang, ; Minghui Li, ; Yao Xie,
| | - Yuyong Jiang
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China,*Correspondence: Yao Lu, ; Yuyong Jiang, ; Minghui Li, ; Yao Xie,
| | - Minghui Li
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China,Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China,*Correspondence: Yao Lu, ; Yuyong Jiang, ; Minghui Li, ; Yao Xie,
| | - Yao Xie
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China,Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China,*Correspondence: Yao Lu, ; Yuyong Jiang, ; Minghui Li, ; Yao Xie,
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6
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Li MH, Lu Y, Sun FF, Chen QQ, Zhang L, Lu HH, Zeng Z, Yi W, Xie Y. Transforming growth factor β as a possible independent factor in chronic hepatitis B. Arch Virol 2021; 166:1853-1858. [PMID: 33871695 DOI: 10.1007/s00705-021-05062-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 02/17/2021] [Indexed: 11/25/2022]
Abstract
To investigate the association between immune-cell-related cytokines and the development of chronic hepatitis B (CHB), patients with chronic hepatitis B virus (HBV) infection in the immunotolerant (IT) phase (n = 30) or hepatitis B envelope antigen (HBeAg)-positive CHB (n = 250) were enrolled in this study. Serological indicators and plasma cytokine levels were measured at the time of enrollment. The results showed that there were significant differences in the median age of the patients (27 vs. 31 years), alanine aminotransferase levels (ALT, 29.85 vs. 234.70 U/L), alanine aminotransferase levels (AST, 23.40 vs. 114.90 U/L), HBsAg levels (4.79 vs. 3.88 log10 IU/ml), HBeAg levels (1606.36 vs. 862.47 S/CO), and the HBV DNA load (8.17 vs. 6.71 log10 IU/ml) between the IT and CHB groups (all P < 0.01). The median values of Fms-like tyrosine kinase 3 ligand (FLT3-L), interferon-gamma (IFN-γ), interleukin- 17A (IL-17A), and transforming growth factor beta (TGF-β1) were significantly higher in the IT group than in the CHB group (FLT3-L, 41.62 vs. 27.47 pg/ml; IFN-γ, 42.48 vs. 33.18 pg/ml; IL-17A, 15.66 vs. 8.90 pg/ml; TGF-β1, 4921.50 vs. 2234 pg/ml; all P < 0.01). The median IFN-α2, TGF-β3 and IL-10 levels in the IT group were significantly lower than those in the CHB group (IFN-α2, 15.24 vs. 35.78 pg/ml, P = 0.000; TGF-β3, 131.69 vs. 162.61 pg/ml, P = 0.025; IL-10, 5.02 vs. 7.9 pg/ml, P = 0.012). Multivariate logistic regression analysis indicated that TGF-β 1 (OR = 0.999, 95% CI 0.999-1.000, P < 0.001) and TGF-β2 levels (OR = 1.008, 95%CI 1.004-1.012, P < 0.001) were modestly but significantly associated with the incidence of CHB. The results suggest that TGF-β level might be an independent factor related to the occurrence of CHB.
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Affiliation(s)
- Ming-Hui Li
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China.,Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, 100015, China
| | - Yao Lu
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China
| | - Fang-Fang Sun
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China
| | - Qi-Qi Chen
- Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, 100015, China
| | - Lu Zhang
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China
| | - Hui-Hui Lu
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China
| | - Zhan Zeng
- Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, 100015, China
| | - Wei Yi
- Department of Gynecology and Obstetrics, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China.
| | - Yao Xie
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China. .,Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, 100015, China.
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7
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AST and HBeAg Level Can Help to Distinguish Non-Minimal Liver Inflammation in Persistently Normal Alanine Aminotransferase of Chronic HBV Infection. HEPATITIS MONTHLY 2020. [DOI: 10.5812/hepatmon.99580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Objectives: The current study aimed to investigate the characteristics of HBV serum markers (HBsAg, HBeAg), biochemical indicators, HBV DNA, and the age to distinguish minimal from non-minimal liver histological inflammation group in HBeAg-positive chronic HBV-infected patients with ALT≤ 1ULN (40U/L). Methods: The HBeAg-positive patients with treatment-naïve hospitalized at Ditan hospital from January 2008 to January 2017 are investigated. Patients were separated into two groups of minimal and non-minimal (mild and moderate) histological inflammation group by liver biopsy specimens. Data were analyzed using the SPSS package. Results: There were both positive (age, ALT, and AST) and negative correlation factors (serum HBsAg, HBeAg, or HBV DNA quantitation) to the liver inflammation grades. Multivariate regression analysis indicated that HBeAg (P < 0.001, b = -0.554, Exp (B) = 0.575) and AST (P = 0.003, b = 0.074, Exp (B) = 1.077) were independent influential factors. The cutoff values of HBeAg and AST were separately 2.85 Log10S/CO (AUC0.724, Sensitivity64%, Specificity79%), 28U/L (AUC0.726, Sensitivity68%, Specificity 78%) to distinguish Minimal from Non-minimal liver histological inflammation in chronic HBV-infected patients with ALT ≤ 1 ULN (40U/L). Conclusions: In total, 31.34% (115/367) of patients with chronic HBV infection who had non-minimal (mild and moderate) liver histological inflammation reached the required inflammation levels for antiviral treatment in HBeAg-positive patients with persistently normal ALT. HBeAg (cutoff < 2.85 Log10S/CO) and AST (cutoff > 28 U/L) were the independent influential factors of predicting non-minimal liver inflammation with ALT ≤ 1 ULN (40U/L).
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Li MH, Chen QQ, Zhang L, Lu HH, Sun FF, Zeng Z, Lu Y, Yi W, Xie Y. Association of cytokines with hepatitis B virus and its antigen. J Med Virol 2020; 92:3426-3435. [PMID: 32662892 DOI: 10.1002/jmv.26301] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 06/02/2020] [Accepted: 07/09/2020] [Indexed: 12/14/2022]
Abstract
To investigate the characteristics of cytokines in patients with different HBV infection status and their correlation with HBV DNA, HBsAg, and HBeAg levels. Peripheral blood samples were collected from patients with chronic HBV infection in immune tolerance phase (IT), HBeAg-positive chronic hepatitis B (CHB), and acute hepatitis B (AHB) groups, and levels of cytokines were detected by Luminex technique, and analyzed by FLEXMAP 3D analyzer. The correlation between cytokines and HBV DNA load, HBsAg, HBeAg, and alanine aminotransferase (ALT) level in patients with chronic HBV infection was analyzed. In total 312 subjects (184 males and 128 females) were enrolled in the study. There were significant differences among IT, CHB, and AHB groups in Flt-3L value (P = .003; H = 12.312), IFN-γ (P = .001; H = 11.723), IL-10 (P = .001; H = 18.736), IL-17A ((P = .001; H = 12.735), and TGF-β1 (P = .001; Z = 48.571). IFN-α2 levels in CHB group were significantly higher than those in IT and AHB groups (15.24 vs 35.78 pg/mL, P = .000; Z = 3.727; 13.88 vs 35.78 pg/mL, P = .024; Z = -2.258. In CHB group, the levels of HBsAg and ALT were positively correlated with the levels of IL-10 (r = .173; P = .006; r = 0.176; P = .006, respectively), while HBeAg level was positively correlated with the IFN-α2 level (r = .153; P = .016). In AHB group, the HBsAg level was positively correlated with Flt-3L, IFN-α2, IL-10, and IL-6 (r = .402; P = .023; r = .436; P = .016; r = .524, P = .002; r = .405; P = .022, respectively). HBeAg level was positively correlated with IFN-γ and IL-17A levels (r = .400; P = .023; r = .373; P = .036, respectively), and ALT level was positively correlated with IL-6 levels (r = .367; P = .039). In either AHB or CHB group, HBV DNA load was only related to TGF-β level (r = .493; P = .004; r = -.218, P = 0.009 respectively). The correlation between Flt-3L and HBsAg (F = 7.422; P = .007); IL-17, IL-6, and HBeAg (F = 5.757; P = .017; F = 6.156; P = .014) were statistically significant. There was significant correlation between TGF-β2 and HBV DNA (F = 11.795; P = .001), and between ALT and HBsAg, HBV DNA (F = 26.089; P = .000; F = 4.724; P = .031). HBsAg, HBeAg, and HBV DNA were correlated with cytokines and ALT in patients with HBV infection. The level of IFN-α2 was significantly higher in patients with CHB. HBV DNA load was only correlated with the level of TGF-β in acute or CHB.
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Affiliation(s)
- Ming-Hui Li
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China
| | - Qi-Qi Chen
- Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China
| | - Lu Zhang
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Hui-Hui Lu
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Fang-Fang Sun
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Zhan Zeng
- Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China
| | - Yao Lu
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Wei Yi
- Department of Gynecology and Obstetrics, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yao Xie
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing, China
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Li MH, Lu Y, Zhang L, Wang XY, Ran CP, Hao HX, Zhang D, Qu XJ, Shen G, Wu SL, Cao WH, Qi TL, Liu RY, Hu LP, Chang M, Hua WH, Liu SA, Wan G, Xie Y. Association of Cytokines with Alanine Aminotransferase, Hepatitis B Virus Surface Antigen and Hepatitis B Envelope Antigen Levels in Chronic Hepatitis B. Chin Med J (Engl) 2018; 131:1813-1818. [PMID: 30058578 PMCID: PMC6071474 DOI: 10.4103/0366-6999.237394] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background Cytokines play an important role in occurrence and recovery of hepatitis B virus (HBV) infection. The aim of this study was to investigate the changes of cytokines concentration and its correlation to alanine aminotransferase (ALT), HBV deoxyribonucleic acid (HBV-DNA), hepatitis B envelope antigen (HBeAg), and HBV surface antigen (HBsAg) in the development of chronic hepatitis B (CHB). Methods Thirteen healthy individuals (HI), 30 chronic HBV-infected patients in immune tolerant (IT) phase, and 55 CHB patients were enrolled between August 2015 and May 2017. The peripheral blood samples were collected from all individuals. The levels of interferon (IFN)-α2, interleukin (IL)-10, transforming growth factor (TGF)-β1, HBV-DNA, HBsAg, and HBeAg and liver function were measured. The quantitative determinations of cytokines levels, including IFN-α2, IL-10, and TGF-β1 were performed using Luminex multiplex technology. The correlation of cytokines to ALT, HBV-DNA, HBsAg, and HBeAg was analyzed by linear regression analysis. Results IFN-α2 levels were similar between HI and IT groups (15.35 [5.70, 67.65] pg/ml vs. 15.24 [4.07, 30.73] pg/ml, Z = -0.610, P = 0.542), while it elevated significantly in CHB group (35.29 [15.94, 70.15] pg/ml vs. 15.24 [4.07, 30.73] pg/ml; Z = -2.522, P = 0.012). Compared with HI group (3.73 [2.98, 11.92] pg/ml), IL-10 concentrations in IT group (5.02 [2.98, 10.11] pg/ml), and CHB group (7.48 [3.10, 18.00] pg/ml) slightly increased (χ2 = 2.015, P = 0.365), and there was no significant difference between IT and CHB group (Z = -1.419, P = 0.156). The TGF-β1 levels among HI (3.59 ± 0.20 pg/ml), IT (3.62 ± 0.55 pg/ml), and CHB groups (3.64 ± 0.30 pg/ml) were similar (χ2 = 2.739, P = 0.254). In all chronic HBV-infected patients (including patients in IT and CHB groups), the elevation of IFN-α2 level was significantly associated with ALT level (β= 0.389, t = 2.423, P = 0.018), and was also negatively correlated to HBV-DNA load (β = -0.358, t = -2.308, P = 0.024), HBsAg (β = -0.359, t = -2.288, P = 0.025), and HBeAg contents (β = -0.355, t = -2.258, P = 0.027). However, when both ALT level and cytokines were included as independent variable, HBV-DNA load, HBsAg, and HBeAg contents were only correlated to ALT level (β = -0.459, t = -4.225, P = 0.000; β = -0.616, t = -6.334, P = 0.000; and β = -0.290, t = -2.433, P = 0.018; respectively). Conclusions IFN-α2 elevation was associated with ALT level in patients with chronic HBV infection. However, in CHB patients, only ALT level was correlated to HBV-DNA, HBsAg and HBeAg contents.
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Affiliation(s)
- Ming-Hui Li
- Liver Diseases Center, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Yao Lu
- Beijing Key laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Lu Zhang
- Liver Diseases Center, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Xing-Yue Wang
- Liver Diseases Center, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Chong-Ping Ran
- Liver Diseases Center, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Hong-Xiao Hao
- Liver Diseases Center, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Dan Zhang
- Liver Diseases Center, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Xiao-Jing Qu
- Liver Diseases Center, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Ge Shen
- Liver Diseases Center, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Shu-Ling Wu
- Liver Diseases Center, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Wei-Hua Cao
- Liver Diseases Center, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Tian-Lin Qi
- Liver Diseases Center, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Ru-Yu Liu
- Liver Diseases Center, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Lei-Ping Hu
- Liver Diseases Center, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Min Chang
- Liver Diseases Center, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Wen-Hao Hua
- Clinical Test Center, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Shun-Ai Liu
- Beijing Key laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Gang Wan
- Liver Diseases Center, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Yao Xie
- Liver Diseases Center, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
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A Noninvasive Score to Predict Liver Fibrosis in HBeAg-Positive Hepatitis B Patients with Normal or Minimally Elevated Alanine Aminotransferase Levels. DISEASE MARKERS 2018; 2018:3924732. [PMID: 30405859 PMCID: PMC6204156 DOI: 10.1155/2018/3924732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 09/01/2018] [Accepted: 09/09/2018] [Indexed: 12/17/2022]
Abstract
Noninvasive fibrosis tests are highly needed but have not been well studied in chronic hepatitis B patients with normal or minimally elevated alanine aminotransferase (ALT) levels. This study is aimed at developing a noninvasive score system to predict liver fibrosis in these patients. HBeAg-positive chronic hepatitis B patients with ALT levels of <80 IU/l and liver histology (n = 290) were assigned to training (n = 203) or validation (n = 87) groups. Training group patients were divided into nonsignificant (F0–1) and significant fibrosis (F2–4) according to METAVIR stages. Logistic regression was performed to identify factors for liver fibrosis and develop a score system. The capacity of the score to identify the severity of fibrosis was displayed by receiver operating characteristic curve (ROC) and area under ROC (AUROC) values. Multivariate logistic regression showed that HBeAg (ratios of the sample to the cutoff values (S/CO)) and liver stiffness measurement (LSM; kilopascals (kPa)) were independent factors of liver fibrosis. A score system composed of HBeAg and LSM by assigning a point of 1, 2, or 3 to different HBeAg and LSM levels, respectively, was developed. The scores 2-3, 4, and 5-6 of the sum of HBeAg and LSM points indicated nonsignificant, indeterminate, and significant fibrosis, respectively. The score system had an AUROC of 0.880 and showed similar performance in validation group patients. The accuracy for identifying significant and nonsignificant fibrosis was 77.14% in validation group patients and 71.26% in the entire group of patients. It is suggested that this noninvasive score system can accurately predict hepatic fibrosis and may reduce the need for liver biopsy in HBeAg-positive patients with normal or minimally elevated ALT levels.
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