BACKGROUND Hepatitis delta virus(HDV)infection is the most severe form of chronic viral hepatitis,yet sex-based clinical differences remain poorly defined.Understanding these differences may inform disease management ...BACKGROUND Hepatitis delta virus(HDV)infection is the most severe form of chronic viral hepatitis,yet sex-based clinical differences remain poorly defined.Understanding these differences may inform disease management and guide research.AIM To investigate sex-related differences in demographic and clinical characteristics of patients with chronic HDV infection in a nationwide,real-world Italian setting.METHODS We analyzed demographic,clinical,and virological data from 513 hepatitis B surface antigen/anti-HDV-positive patients,consecutively enrolled between 2019 and 2024,across 58 liver clinics in the Italian PITER HDV cohort.A propensity score-weighted logistic regression model evaluated the association between sex and cirrhosis and/or hepatocellular carcinoma.RESULTS Among 513 patients(61.6%male),median age(56.0 years)and age distribution were similar by sex(P=0.41).Cirrhosis was frequent:73.4%vs 66.0%(anti-HDV-positive)and 77.8%vs 74.2%(HDV RNA-positive)in males and females,respectively.HDV RNA levels were comparable(P=0.93).The highest proportion of females with cirrhosis(33.8%)was in the 56-60-year group,similar to males(34.9%).Among patients with cirrhosis aged≤40 years,females,(80.9%of whom of non-Italian origin),were more represented than males(16.1%vs 6.5%respectively,P<0.05).Male sex was associated with cirrhosis(odds ratio=1.85;95%confidence interval:1.004-3.40).Among HDV RNA-positive patients,males more often had hepatocellular carcinoma,elevated gammaglutamyl transpeptidase,alcohol use,diabetes,hypertension,steatotic liver disease,and hepatitis C virus/human immunodeficiency virus coinfection.Interferon eligibility was similar.CONCLUSION HDV-infected females develop cirrhosis earlier,without liver disease cofactors,while males show advanced liver disease with multiple cofactors.Tailored care for young migrant women and cofactor-guided management for men may improve HDV outcomes,promoting equity.展开更多
AIM： To investigate the usefulness of transient elastography by Fibroscan （FS）, a rapid non-invasive technique to evaluate liver fibrosis, in the management of chronic hepatitis B virus （HBV） carriers. METHODS： ...AIM： To investigate the usefulness of transient elastography by Fibroscan （FS）, a rapid non-invasive technique to evaluate liver fibrosis, in the management of chronic hepatitis B virus （HBV） carriers. METHODS： In 297 consecutive HBV carriers, we studied the correlation between liver stiffness （LS）, stage of liver disease and other factors potentially influencing FS measurements. In 87 chronic hepatitis B （CriB） patients, we monitored the FS variations according to the spontaneous or treatment-induced variations of biochemical activity during follow-up. RESULTS： FS values were 12.3 ± 3.3 kPa in acute hepatitis, 10.3 ± 8.8 kPa in chronic hepatitis, 4.3 ± 1.0 kPa in inactive carriers and 4.6 ± 1.2 kPa in blood donors. We identified the cut-offs of 7.5 and 11.8 kPa for the diagnosis of fibrosis ≥S3 and cirrhosis respectively, showing 93.9% and 86.5% sensitivity, 88.5% and 96.3% specificity, 76.7% and 86.7% positive predictive value （PPV）, 97.3% and 96.3% negative predictive value （NPV） and 90.1% and 94.2% diagnostic accuracy. At multivariate analysis in 171 untreated carriers, fibrosis stage （t = 13.187,P 〈 0.001）, active vs inactive HBV infection （t = 6.437, P 〈 0.001）, alanine aminotransferase （ALT） （t = 4.740, P 〈 0.001） and HBV-DNA levels （t = -2.046, P = 0.042） were independently associated with FS. Necroinflammation score （t = 2.158, 〉 10/18 vs ≤ 10/18, P = 0.035） and ALT levels （t = 3.566, P =0.001） were independently associated with LS in 83 untreated patients without cirrhosis and long-term biochemical remission （t = 4.662, P 〈 0.001） in 80 treated patients. During FS monitoring （mean followup 19.9 ± 7.1 mo） FS values paralleled those of ALT in patients with hepatitis exacerbation （with 1.2 to 4.4-fold increases in Crib patients） and showed a progressive decrease during antiviral therapy. CONCLUSION： FS is a non-invasive tool to monitor liver disease in chronic HBV carriers, provided that the pattern of biochemical activity is taken into account. In the inactive carrier, it identifies non-HBV-related causes of liver damage and transient reactivations. In CHB patients, it may warrant a more appropriate timing of control liver biopsies.展开更多
Aim:Simple,rapid,and non-invasive methods for the early diagnosis of non-alcoholic steatohepatitis(NASH)in patients with fatty liver are an unmet need in clinical practice.Transient elastography(TE),commonly used for ...Aim:Simple,rapid,and non-invasive methods for the early diagnosis of non-alcoholic steatohepatitis(NASH)in patients with fatty liver are an unmet need in clinical practice.Transient elastography(TE),commonly used for measuring liver stiffness(LS),which is significantly influenced by both liver fibrosis and inflammation is a promising tool.Methods:We studied retrospectively the impact of TE in a cohort of 98 consecutive asymptomatic patients with fatty liver who underwent a liver biopsy[21 non-alcoholic fatty liver(NAFL)and 77 NASH]and TE on the same day at the Hepatology Unit of University Hospital of Pisa.Patients positive for HBsAg,anti-HCV,HIV,autoantibodies,drug-induced liver disease,Wilson’s disease,hemochromatosis,alpha-1 antitrypsin deficiency,type 2 diabetes,or neoplasia were excluded.Results:NAFL patients were younger(42.5 years vs.47.7 years,P=0.02)and with lower BMI(25.5 kg/m^(2) vs.28.8 kg/m^(2),P<0.001)than NASH patients.TE was higher in NASH than NAFL patients(8.1 kPa vs.5.4 kPa,P=0.01).Age,BMI,TE,and total/LDL cholesterol were statistically significantly different between NAFL and NASH patients,but with multivariate analysis only BMI(P=0.009)and TE(P=0.031)were independent predictors of NAFL/NASH with AUROCs of 0.771 and 0.754,respectively.A score combining TE and BMI(TE*BMI)showed the best AUROC(0.817,by De Long test,P=0.01)to differentiate NAFL/NASH(P=0.005).Conclusion:Ultrasound based LS measure qualifies as a candidate tool for the early screening of NASH in fatty liver patients provided that its measure is properly standardized and tested in large prospective studies enrolling patients with different clinical and histological features.展开更多
基金Supported by the Investigator Sponsored Research Grant from Gilead Sciences,No.IN-IT-980-6816the Fondazione Italiana per la Ricerca sul Cancro(AIRC),No.IG 2020 ID 24858.
文摘BACKGROUND Hepatitis delta virus(HDV)infection is the most severe form of chronic viral hepatitis,yet sex-based clinical differences remain poorly defined.Understanding these differences may inform disease management and guide research.AIM To investigate sex-related differences in demographic and clinical characteristics of patients with chronic HDV infection in a nationwide,real-world Italian setting.METHODS We analyzed demographic,clinical,and virological data from 513 hepatitis B surface antigen/anti-HDV-positive patients,consecutively enrolled between 2019 and 2024,across 58 liver clinics in the Italian PITER HDV cohort.A propensity score-weighted logistic regression model evaluated the association between sex and cirrhosis and/or hepatocellular carcinoma.RESULTS Among 513 patients(61.6%male),median age(56.0 years)and age distribution were similar by sex(P=0.41).Cirrhosis was frequent:73.4%vs 66.0%(anti-HDV-positive)and 77.8%vs 74.2%(HDV RNA-positive)in males and females,respectively.HDV RNA levels were comparable(P=0.93).The highest proportion of females with cirrhosis(33.8%)was in the 56-60-year group,similar to males(34.9%).Among patients with cirrhosis aged≤40 years,females,(80.9%of whom of non-Italian origin),were more represented than males(16.1%vs 6.5%respectively,P<0.05).Male sex was associated with cirrhosis(odds ratio=1.85;95%confidence interval:1.004-3.40).Among HDV RNA-positive patients,males more often had hepatocellular carcinoma,elevated gammaglutamyl transpeptidase,alcohol use,diabetes,hypertension,steatotic liver disease,and hepatitis C virus/human immunodeficiency virus coinfection.Interferon eligibility was similar.CONCLUSION HDV-infected females develop cirrhosis earlier,without liver disease cofactors,while males show advanced liver disease with multiple cofactors.Tailored care for young migrant women and cofactor-guided management for men may improve HDV outcomes,promoting equity.
基金Educational grants from the Italian Ministry of Health,"ERASMO" 2005
文摘AIM： To investigate the usefulness of transient elastography by Fibroscan （FS）, a rapid non-invasive technique to evaluate liver fibrosis, in the management of chronic hepatitis B virus （HBV） carriers. METHODS： In 297 consecutive HBV carriers, we studied the correlation between liver stiffness （LS）, stage of liver disease and other factors potentially influencing FS measurements. In 87 chronic hepatitis B （CriB） patients, we monitored the FS variations according to the spontaneous or treatment-induced variations of biochemical activity during follow-up. RESULTS： FS values were 12.3 ± 3.3 kPa in acute hepatitis, 10.3 ± 8.8 kPa in chronic hepatitis, 4.3 ± 1.0 kPa in inactive carriers and 4.6 ± 1.2 kPa in blood donors. We identified the cut-offs of 7.5 and 11.8 kPa for the diagnosis of fibrosis ≥S3 and cirrhosis respectively, showing 93.9% and 86.5% sensitivity, 88.5% and 96.3% specificity, 76.7% and 86.7% positive predictive value （PPV）, 97.3% and 96.3% negative predictive value （NPV） and 90.1% and 94.2% diagnostic accuracy. At multivariate analysis in 171 untreated carriers, fibrosis stage （t = 13.187,P 〈 0.001）, active vs inactive HBV infection （t = 6.437, P 〈 0.001）, alanine aminotransferase （ALT） （t = 4.740, P 〈 0.001） and HBV-DNA levels （t = -2.046, P = 0.042） were independently associated with FS. Necroinflammation score （t = 2.158, 〉 10/18 vs ≤ 10/18, P = 0.035） and ALT levels （t = 3.566, P =0.001） were independently associated with LS in 83 untreated patients without cirrhosis and long-term biochemical remission （t = 4.662, P 〈 0.001） in 80 treated patients. During FS monitoring （mean followup 19.9 ± 7.1 mo） FS values paralleled those of ALT in patients with hepatitis exacerbation （with 1.2 to 4.4-fold increases in Crib patients） and showed a progressive decrease during antiviral therapy. CONCLUSION： FS is a non-invasive tool to monitor liver disease in chronic HBV carriers, provided that the pattern of biochemical activity is taken into account. In the inactive carrier, it identifies non-HBV-related causes of liver damage and transient reactivations. In CHB patients, it may warrant a more appropriate timing of control liver biopsies.
文摘Aim:Simple,rapid,and non-invasive methods for the early diagnosis of non-alcoholic steatohepatitis(NASH)in patients with fatty liver are an unmet need in clinical practice.Transient elastography(TE),commonly used for measuring liver stiffness(LS),which is significantly influenced by both liver fibrosis and inflammation is a promising tool.Methods:We studied retrospectively the impact of TE in a cohort of 98 consecutive asymptomatic patients with fatty liver who underwent a liver biopsy[21 non-alcoholic fatty liver(NAFL)and 77 NASH]and TE on the same day at the Hepatology Unit of University Hospital of Pisa.Patients positive for HBsAg,anti-HCV,HIV,autoantibodies,drug-induced liver disease,Wilson’s disease,hemochromatosis,alpha-1 antitrypsin deficiency,type 2 diabetes,or neoplasia were excluded.Results:NAFL patients were younger(42.5 years vs.47.7 years,P=0.02)and with lower BMI(25.5 kg/m^(2) vs.28.8 kg/m^(2),P<0.001)than NASH patients.TE was higher in NASH than NAFL patients(8.1 kPa vs.5.4 kPa,P=0.01).Age,BMI,TE,and total/LDL cholesterol were statistically significantly different between NAFL and NASH patients,but with multivariate analysis only BMI(P=0.009)and TE(P=0.031)were independent predictors of NAFL/NASH with AUROCs of 0.771 and 0.754,respectively.A score combining TE and BMI(TE*BMI)showed the best AUROC(0.817,by De Long test,P=0.01)to differentiate NAFL/NASH(P=0.005).Conclusion:Ultrasound based LS measure qualifies as a candidate tool for the early screening of NASH in fatty liver patients provided that its measure is properly standardized and tested in large prospective studies enrolling patients with different clinical and histological features.
