The Relations of Serum Alphafetoprotein Level and Prognosis in Severe Viral Hepatitis
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Abstract:
Objective:The objective of this study was to explore the relations of quantitatively measures of serum alphaferoprotein(AFP)and prognosis in severe viral hepatitis.Methods:The level of blood serum AFP was determined by radioimmunassay in 368 cases with gravis type viral hepatitis,and its change was observed in a dynamic rate.Results:The abnormity rate of AFP was 71.19%,the abnormity rate of AFP in acute severe hepatitis patients was significantly less than that in sub-acute severe hepatitis and chronic severe hepatitis(p0.01),the death rate of patients with AFP20μg/L,AFP20-400μg/L and AFP400μg/L was 79.24%,45.84% and 34.054% respectively,the survival severe hepatitis patients were 170 cases with AFP(282.31±56.32)μg/L in 368 cases,198 cases with AFP(90.42土38.88)μg/L died(p0.01).Conclusion:The blood serum AFP determination in gravis type viral hepatitis can be used as a sensitive index for prognosis.A high level of AFP indicates that hepatitis cells regeneration is active and the prognosis is relatively better.Keywords:
Viral Hepatitis
Acute hepatitis
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Elevated serum alpha-fetoprotein (AFP) in patients with chronic hepatitis C is not uncommonly seen, but the pathogenesis of this phenomenon remains unclear. The aims of this study were to assess the prevalence of elevated serum AFP in patients with chronic hepatitis C and to evaluate the clinical, virologic, and histopathologic significance of this phenomenon. One hundred and fifteen Chinese patients with a histologic diagnosis of chronic hepatitis C were enrolled. None had evidence of hepatocellular carcinoma by image study at enrollment and for at least 2 years' follow-up. Of the 115 patients, 33 (29%) had elevated serum AFP (more than 12 ng/mL). There was a significantly lower mean serum albumin (4.0 ± 0.1 vs. 4.3 ± 0.1 gm/dL, p <0.001) and higher mean scores for periportal necroinflammation (3.3 ± 0.3 vs. 2.3 ± 0.2, p = 0.007) and fibrosis (2.3 ± 0.2 vs. 1.1 ± 0.1, p < 0.001) in patients with elevated serum AFP when compared with patients without elevated serum AFP. Patients with elevated serum AFP had significantly more incidences of genotype 1b infection when compared with patients without elevated serum AFP (77% vs. 51%, p = 0.021). Mean serum hepatitis C virus (HCV) RNA titer showed no significant difference between the two groups. Multivariate logistic regression analysis showed that as serum albumin of less than 4.2 gm/dL, a histology fibrotic score of more than 3, and HCV genotype 1b infection were significantly independent predictors associated with elevated serum AFP. In conclusion, elevated serum AFP levels were significantly correlated with lower serum albumin levels, advanced fibrosis/cirrhosis, and genotype 1b infection in patients with chronic hepatitis C.
Alpha-fetoprotein
Clinical Significance
Hepatitis C
Pathogenesis
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Liver cancer is one of the leading causes of cancer death in Mongolia. Since 1982-1986 , when HCC became the most frequent cancer among the Mongolian population, the rate has been increasing continuously. In the period 2000-2005 years 35.3%of all newly registered cancer cases were liver cancers, with an incidence rate of 51.3 per 100,000 population. Compared to the previous 5 year period, the rate increased by 11%. The objective here was to analyze hepatitis B (HBV) and C virus (HCV)-related HCC cases and to evaluate the possibility of tumor marker (AFP) testing for early detection in Mongolia. Sera from a total of 513 patients with chronic liver diseases, liver cirrhosis and HCC were analyzed for liver function (ALAT, ASAT) and hepatitis virus markers (HBsAg, anti-HCV). Sera from 316 patients were also examined for alpha-fetoprotein (AFP) levels. The overall incidence of HBsAg or anti-HCV were very high ( 95.3%) among all patients. Some 33.5% (66/197) of patients with HCC were positive for HBsAg and 45.2% (89/197) for anti-HCV. Moreover, 17.3% ( 34/197) of HCC patients demonstrated co-infection with HBV and HCV. AFP levels were elevated in 4.6% (11/238) and 29.5% (23/78) of chronic hepatitis and cirrhosis patients, respectively. In HCC cases, 84.3% (166) of patients had increased level of AFP ranging from 32 ng/ml to more than 400 ng/ml. We conclude that HBV/HCV infection is the main factor related to development of HCC in Mongolia and that testing for AFP serum levels is a useful tool for early detection and diagnosis.
Liver Cancer
Liver function
Hepatitis B
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Levothyroxine
Phototype
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Citations (1)
Alpha-fetoprotein
Hepatitis C
Hepatitis B
Milan criteria
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Citations (8)
The serological markers of hepatitis B virus and serum alpha-fetoprotein (AFP) levels have been studied in 28 consecutive cases of fulminant hepatitis, correlating the data with survival. On admission, 20 patients were found to be positive for HBsAg and eight for anti-HBs. All anti-HBs-positive cases showed high titers of anti-HBc, and six patients were positive for specific anti-HBc-IgM. DNA polymerase activity was detected in serum of 11 HBsAg-positive (55%) and four anti-HBs-positive (50%) patients. HBeAg was detected in six (21.4%) subjects (five HBsAg-positive and one anti-HBs-positive), whereas anti-HBe was present in nine (32.1%) subjects (six HBsAg-positive and three anti-HBs-positive). AFP levels greater than 60 ng/ml were found in sera of 14 patients (50%). No significant difference was evidenced in the survival rate between HBsAg-positive and anti-HBs-positive and between HBeAg-positive and HBe Ag-negative patients. However, a statistically significant difference (P less than 0.05) in the survival rate was found in patients positive and negative for DNA polymerase activity and in those with AFP levels higher and lower than 60 ng/ml (P less than 0.005). Pathogenetic and prognostic significance of these findings are discussed.
HBeAg
Fulminant hepatitis
Alpha-fetoprotein
Fulminant
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Abstract Serum alphafetoprotein (AFP) levels were measured using a sensitive radioimmunoassay in 108 hepatitis B surface antigen (HBsAg)‐positive subjects and 695 controls. The concentrations were significantly higher in the HBsAg‐positives. Within this group, the highest levels were found in those with active HBV infection. In those without evidence of acute infection, the levels were higher in the high‐risk than in the low‐risk subjects. It is concluded: 1) that measurement of serum AFP might be a useful additional index of infectivity and prognosis in HBsAg‐positive subjects; and 2) that in the light of the association between chronic HBV infection, hepatocellular carcinoma, and raised AFP in non‐European populations, consideration should be given to regular monitoring of AFP levels in HBsAg‐positive subjects in the United Kingdom.
Infectivity
Hepatitis B
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In this study, we aim to determine the hepatic pathological changes in HBV DNA-negative chronic Hepatitis B (CHB) patients after 12-month antiviral therapy.Blood routine indicators including platelet count (PLT) and white blood cell (WBC) were determined. The coagulation function was evaluated by determining the prothrombin time (PT) and prothrombin time activity (PTA), together with the HBV DNA quantification and alpha fetoprotein (AFP). The virology data included hepatitis B surface antigen (HBsAg)/antibodies against hepatitis B surface antigen (anti-HBs), hepatitis B e antigen (HBeAg)/antibodies against hepatitis B e antigen (anti-HBe) and antibodies against hepatitis B core antigen (anti-HBc) were tested. Pathological assay was performed to the liver puncture tissues. Based on the HBV DNA data in the 12-month follow-up of the cases that received anti-viral therapy during this time, the experimental group was divided into group A (HBV DNA negative at the baseline level, HBV DNA negative after 12 months, N = 79) and group B (HBV DNA negative at the baseline level, HBV DNA turning to be positive after 12 months, N = 13). Statistical analysis was performed on the each test index of the two groups.The inflammation grade of group A showed significant improvement after 12-month treatment (P < 0.05). The pathological inflammation grade of group B was increased after one year, and the liver function indices and the PTA (P < 0.05) levels were all increased. Pathological results indicated that the proportion of disease progression in group A was decreased after 12-month follow-up while that proportion was increased in group B. Significant differences were noticed in AFP levels between the patients with progression in group A and those with progression in group B.Negative HBV DNA does not mean a controlled hepatitis B. Hepatitis B patients transferred to HBV DNA positivity during the anti-viral therapy are easily to show disease progression, and then special attention should be paid to the HBV DNA monitoring. Meanwhile, close monitoring to the changes of liver function, PTA and AFP levels may help to detect changes on the disease in a timely manner.
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Objective
To investigate the expression and clinical significance of serum miR-125b-5p in patients with hepatitis B related liver diseases.
Methods
159 cases of hepatitis B related liver disease (case group) and 64 cases of health examinees (control group) in our hospital were selected. The case group was further divided into three subgroups according to the disease type, namely, chronic hepatitis B (CHB) group (n=40), hepatitis B virus associated liver cirrhosis (HBV-LC) group (n=65) and HBV associated hepatocellular carcinoma (HBV-HCC) group (n=54). Then the levels of miR-125b-5p, albumin (ALB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), HBV-DNA, total bilirubin (TBIL), total cholesterol (TC), alpha fetoprotein (AFP), triglyceride (TG) and prothrombin time (PT) were measured in each group.
Results
The levels of ALT, AST, HBV-DNA, TBIL, PT, AFP, TC and TG in the case group were higher than those in the control group (P 0.05); The expression level of serum miR-125b-5p was positively correlated with the pathological grade, tumor node metastasis (TNM) stage, lymphatic vascular infiltration, lymph node metastasis and recurrence (P 0.01), which were all smaller than miR-125b-5p combined with AFP (χ2=12.657, 13.052, P<0.01).
Conclusions
Serum miR-125b-5p is elevated in hepatitis B related liver diseases, such as CHB, HBV-LC, HBV-HCC, and is associated with disease progression; High levels of miR-125b-5p, HBV-DNA, and AFP are risk factors for adverse prognosis outcomes in patients with hepatitis B-related liver disease; The sensitivity and specificity of combined detection of miR-125b-5p and AFP in the diagnosis of HBV-HCC are relatively high, so the combined detection of the two indicators can be widely applied in clinical practice.
Key words:
MicroRNAs; Hepatitis B, chronic; Liver cirrhosis; Liver neoplasms
Hepatitis B
Prothrombin time
Liver disease
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To analyse the association between serum alpha-foetoprotein (AFP) levels and sustained virological response (SVR) in treated patients.One-hundred patients with chronic hepatitis C were treated with pegylated interferon alpha-2a plus ribavirin for 48 weeks. The primary endpoint was SVR. Linear regression analysis was performed to identify clinical, biological, and histological factors affecting baseline AFP levels. The association between pretreatment serum AFP and SVR was assessed by multivariate logistic regression analysis.Of 100 patients, 95 were infected with genotype 4, one with genotype 1, and four with undetermined genotype. The median serum AFP level was 4.5 ng/ml and AFP values ranged from 1.2 to 49.8 ng/ml. In multivariate analysis, higher fibrosis stage and higher steatosis score were independently associated with higher serum AFP levels. SVR rate was 61.0% (61/100), and was lower for patients with AFP levels above rather than below the median value (40.8% versus 80.4%, respectively, P < 0.001). In multivariate analysis, including adjustment for age, gender, body mass index, steatosis score, fibrosis stage, ALT level, haemoglobin level, clotting time, HCV RNA viral load, and treatment dose received, a baseline serum AFP level above the median value was associated with a lower SVR rate (OR [95% CI]=0.10 [0.03-0.42], P < 0.001). None of the seven patients with increased (above 15 ng/ml) pretreatment AFP achieved SVR.In this study, higher baseline serum AFP levels independently predicted a lower SVR rate among patients with chronic hepatitis C. If confirmed with genotypes other than 4, these findings would suggest adding serum AFP to the list of factors predictive of treatment response.
Steatosis
Pegylated interferon
Clinical endpoint
Hepatitis C
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Hepatitis C virus (HCV) infection represents an important risk factor for hepatocellular carcinoma (HCC). Alpha-fetoprotein (AFP) is a widely used biomarker for HCC. However, elevated serum AFP levels in different statuses of chronic hepatitis C (CHC) is not well defined. This study aimed to evaluate the relationship between AFP levels and HCV viral load in CHC patients. We also analyzed the correlation between three liver func-tion enzyme levels (AST, ALT, GGT) and HCV RNA viral load in CHC patients.A total of 279 patients infected with HCV were included in this study. Patients were divided into two groups: HCV RNA positive and HCV RNA negative group. Serum HCV RNA load was measured by Quantitative Real-time PCR. Electrochemiluminescence assay (ECLA) was used to determine the serum AFP levels. The differences between two groups in AFP levels and biochemical profile (AST, ALT, GGT) was evaluated.The HCV RNA-positive group had significantly higher serum AFP levels than the negative groups (12.61 vs. 4.72 ng/mL, p < 0.0001). There was no correlation between AFP levels and HCV RNA viral load in HCV infection patients (p = 0.92). A significant correlation was observed between serum ALT (r = 0.243, p = 0.005), GGT (r = 0.212, p = 0.016) levels and HCV RNA viral load. Poor correlation (r = 0.148, p = 0.093) was found between AST levels and HCV RNA viral load. Interestingly, there was a positive correlation (r = 0.337, p < 0.001) between ALT and AFP levels in the whole study population.We concluded that serum HCV RNA positive patients were candidates for therapeutic prevention of HCC and liver inflammation regardless of the HCV RNA viral load. Furthermore, higher burden of HCV viral load was associated with more severe liver damage.
Alpha-fetoprotein
Hepatitis C
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Citations (8)