Ekaterina Liusina is currently a PhD fellow in Gastroenterology. Her professional interests include Portal hypertension, Viral hepatitis, Liver cirrhosis and Statistical methods in medicine. She is the member of Russian Scientific Liver Society, Russian Gastroenterology Association and European association for the study of the liver.
Background: Elimination of the etiological agent responsible for the progression of chronic liver injury has been shown as one of the important prognostic factor for survival in cirrhotic patient. Portal hypertension is a main complication of liver cirrhosis. Measurement of hepatic venous pressure gradient (HVPG) is currently recommended for detection of portal hypertension but its wide use in the clinical practice is limited by its expensiveness and invasiveness. Colecchia et al. in 2012 published predictive model for HVPG values included spleen (SS) and liver stiffness (LS) measured by transient elastography in cohort of patients with HCV-related liver cirrhosis. Aims: To establish the prognostic predictive value of HVPG model (calculated with SS and LS) for presence of esophageal varices and risk of bleeding. To evaluate clinical significance of spleen and liver stiffness measurements in 3 cohort of patients: HCV-related cirrhosis before and after antiviral treatment, HCV-related liver cirrhosis follow-up and in patients with alcoholic cirrhosis before and after period of abstinence. Methods: We plan to enroll consequently in the study one hundred patient with HCV and alcohol-related cirrhosis. Patients undergo baseline blood test sampling, upper endoscopy for detecting esophageal varices, ultrasound, liver stiffness measurement with Fibroscan (LS), spleen stiffness measurement with Fibroscan (SS) during a week of hospitalization. HVPG calculates according to predictive model HVPG =-4.44+0.241LS+0.226хSS. For all patient with alcoholic cirrhosis will be given recommendation for abstinence. HCV-patient who will meet inclusion criteria will be treated in clinical trials with different antiviral regimes. All baseline procedures will be repeated in 6-12 month after baseline. Complication during follow-up period will be registered. At the moment enrolled 41 patients (26 patients with HCV – related cirrhosis, 15 patients with alcoholic cirrhosis) Results: LS and SS in the group with varices are significantly higher than without (p=0.003). Median of LS in varices group is 32.4 kPa (IQR 24.8-48) vs. 20.6 kPa (IQR 16.9 – 27.5). Median of SS in varices group is 58.2 kPa (IQR 38.6-75) vs. 36.3 kPa (IQR 29.4-63.9). Levels of portal pressure calculated with predictive model are significantly higher: in varices group (p=0.009) is 16.8(IQR 11-23) vs. 9.4 (IQR 7-13) respectively. Sensitivity HVPG predictive model for detection EV is 92%, specificity is 61%. For predicting esophageal varices in our group (regardless etiology) PPV is 83%, NPV is 80%, LR+ 2.3, LR-0.14 respectively. In addition a statistically significant difference is observed when compare patients with alcohol-related cirrhosis (median LS is 45,4kPa (IQR 25-75) to HCV-related group (median LS is 24 kPa (IQR 16-27) (p=0.004). Conclusion: We plan to investigate the diagnostic test accuracy of HVPG predictive model for esophageal varices depending on the etiology of liver cirrhosis (HCV or alcohol) in separate.
Dr. Shi-Bing Su, Medicine Doctor (Ph.D.-medicine), is a Professor of Integrative Medicine and Traditional Chinese Medicine (TCM), director of the center for complex systems, Shanghai University of TCM, leading scientist of TCM System Science Discipline, distinguished researcher of Shanghai TCM internal Medicine E-institute, visiting professor of Nanjing University of TCM, guest professor of Henan college of TCM, academic Journal editor for Integrative Medicine International, Journal of Integrative Medicine, Journal of TCM Science, etc. He got his B Sc in TCM at Nanjing University of TCM, M Sc in Pharmacy and Medicine Doctor degree in Gastroenterology at Cancer Institute, Kanazawa University, and Docent at China Pharmaceutical University. Currently Dr. Shi-Bing Su research focus on TCM syndrome classification-based treatment in clinical and basic studies applied by system biology. He has published 160 papers and 10 books in academic Journals.
Background: Liver cirrhosis is a critical state in the natural course of hepatocellular carcinoma (HCC). Chronic hepatitis B (CHB) is a major cause of liver cirrhosis in China. To find biomarkers for the diagnosis of CHB caused cirrhosis (HBC), we examined the cytokines profiling of CHB and HBC. Methods: Serum samples of 15 health controls (HC) and 15 CHB patients and 15 HBC patients were collected to detect the profiles of 48 cytokines by multiplex biometric ELISA-based immunoassay. Partial least squares discriminant analysis (PLS-DA) was used to analyze the significant cytokines, and they were validated using independent cohort of 60 CHB patients, 60 HBC patients and 35 HC samples. Results: There were 22 differential expressed cytokines of CHB and HBC. Three differential expression cytokines including interleukin (IL)-9, IL-2 receptor subunit alpha (IL2Rα) and Granulocyte-macrophage colony-stimulating factor (GM-CSF) were found by PLS-DA, and their significant changes of serum levels were further validated. The Receiver-operator characteristic (ROC) analysis demonstrated that three cytokines and their logistic regression panel potentially to be the potential biomarkers for CHB and HBC differentiation (P<0.001, AUC=0.876). Furthermore, a functional pathway analysis showed that differential regulation of cytokine production in macrophages, T Helper Cells and intestinal epithelial cells by IL-17A and IL-17F were enriched in the 22 differentially expressed cytokines. They were also enriched in pathway of hepatic fibrosis / hepatic stellate cell activation. Conclusions: There were particular cytokines profiles of CHB and HBC. Besides, IL-9, IL2Rα and GM-CSF may be involved in the differentiation of CHB and HBC.These findings may give further insight into the pathobiology of HBC.