Evaluation de la fibrose hépatique dans l'hépatite C chronique (comparaison entre biopsie hépatique et fibroscan)

L'élastométrie impulsionnelle est une technique non-invasive, rapide et reproductible qui permet de mesurer l'élasticité du foie. Cet examen a démontré sa performance diagnostique au cours des maladies chroniques du foie et principalement l'épatite C chronique. Nous avons étudié sa performance dans le suivi de la fibrose des patients porteurs d'hépatite C chronique. 70 patients porteurs d'une hépatite C chronique étaient inclus. Ils étaient évalués à deux reprises par FibroScan et biopsie au cours de leur suivi, à au moins un an d'intervalle. Les aires sous la courbe ROC de l'élastométrie étaient de 0,72 et 0,75 pour F >= 2 et F = 4 à la première évaluation, et de 0,84 et 0,85 à la deuxième évaluation. Respectivement, on retrouvait une concordance entre les deux examens chez 36 et 38 patients, une discordance chez 10 et 5 patients. Au moins un facteur de discordance était présent chez l'ensemble es patients discordants. Ces facteurs pouvaient être un rapport IQR/LSM supérieur à 0,21, une inflammation locale importante, une cholestase, une obésité ou encore une sous-estimation par l'élastométrie d'une cirrhose débutante à activité légère. La répétition de l'examen était associée à une persistance de la concordance chez les patients initialement concordants, et à une amélioration de la performance diagnostique du FibroScan, puisque 90 % des patients discordants ne l'étaient plus à la seconde évaluation. Environ 70 % des patients ayant une diminution du FibroScan ne progressaient pas sur la biopsie. A l'inverse, 94 % de ceux qui avaient une augmentation de l'élastométrie n'avaient pas de diminution de la fibrose sur la biopsie. Les résultats de notre étude prospective suggèrent que l'élastométrie impulsionnelle est un examen fiable pour l'évaluation longitudinale de la fibrose chez les patients porteurs d'une hépatite C chronique.BORDEAUX2-BU Santé (330632101) / SudocSudocFranceF

Early diagnosis of NAFLD-NASH transition using mid infrared spectroscopy.

International audienceNon-alcoholic fatty liver disease (NAFLD) is defined as an excessive accumulation of fat in the liver in the absence of excessive drinking of alcohol. Initially considered as benign and self-limited, NAFLD may progress to the malignant stage of non-alcoholic steatohepatitis (NASH) characterized by degenerate hepatocellular ballooning and lobular inflammation. NASH can lead to hepatic fibrosis and ultimately to cirrhosis and hepatocellular carcinoma. Unfortunately, the transition from NAFLD to NASH is difficult to detect so far. In this paper, we propose to evaluate the characterization of NASH using mid infrared fiber evanescent wave spectroscopy on blood serum. We used an heuristic variable selection method and a generalized linear model to classify NAFLD and NASH spectra. The obtained results proved that this technique is a promising non-invasive and simple diagnosis tool for NASH

Hepatic Steatosis, Carbohydrate Intake, and Food Quotient in Patients with NAFLD

Is steatosis related to the spontaneous carbohydrate intake in patients with NAFLD? We performed dietary records for 24 patients with NAFLD, 3 months after their liver biopsy was performed and before the deliverance of a dietary advice. The food quotient, indicator of the proportion of calories from carbohydrates, was calculated as (1.00×%  calories from carbohydrates/100) + (0.70×%  calories from lipids/100) + (0.81×%  calories from proteins/100). The associations between diet variables and steatosis% on the hepatic biopsies were tested by regression analysis, and diet variables were compared according to the presence of fibrosis. The subjects displayed a large range of steatosis, 50.5% ± 25.5 [10–90], correlated with their energy intake (1993 ± 597 kcal/d, , ) and food quotient (0.85 ± 0.02, , ), which remained significant with both variables by a multivariate regression analysis (, ). For the 17/24 patients with a hepatic fibrosis, the energy intake was lower (fibrosis: 1863 ± 503 versus others: 2382 ± 733 kcal/d, ), and their food quotients did not differ from patients without fibrosis. Hepatic steatosis was related to the energy and carbohydrate intakes in our patients; the role of dietary carbohydrates was detectable in the range of usual carbohydrate intake: 32% to 58% calories

Dynamic and rapid changes in viral quasispecies by UDPS in chronic hepatitis C patients receiving telaprevir-based therapy

International audienceBackground: Telaprevir (TVR) is a protease inhibitor (PI) used in chronic hepatitis C treatment with pegylated interferon plus ribavirin. We analysed the prevalence and kinetic development of TVR resistance upon treatment.Methods: A total of 24 cirrhotic patients (genotype 1a, n=8; genotype 1b, n=16) previously non-responders to standard therapy were treated with TVR-based therapy. The distribution of TVR-resistant variants was assessed at every HCV-RNA-positive time point by 454 ultra-deep pyrosequencing (UDPS) during a mean follow-up period of 9.4 months.Results: A median of 6,837 reads/specimen was studied. Based on control UDPS, we considered mutations as real when present >0.4%. TVR-resistant variants were found at baseline in 8/24 patients (33.3%). Four of the 24 patients (16.7%), all genotype 1a, did not achieve HCV RNA20%), did not always preclude TVR treatment success. The detection of R155K/T/Q at baseline may predict failure in genotype 1a patients. At failure, which occurred in genotype 1a patients, a significant enrichment in V36A/M and R155K/T/Q was observed

Liver transarterial chemoembolization and sunitinib for unresectable hepatocellular carcinoma: Results of the PRODIGE 16 study

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Non-invasive assessment of liver fibrosis with transient elastography (FibroScan®): applying the cut-offs of M probe to XL probe

Background and rationale for the study. Limited studies have aimed to define the cut-offs of XL probe (XL cut-offs) for different stages of liver fibrosis, whereas those of M probe (M cut-offs) may not be applicable to XL probe. We aimed to derive appropriate XL cut-offs in overweight patients. Patients with liver stiffness measurement (LSM) by both probes were recruited. XL cut-offs probe for corresponding M cut-offs were derived from an exploratory cohort, and subsequently validated in a subgroup patients also underwent liver biopsy. The diagnostic accuracy of XL cut-offs to diagnose advanced fibrosis was evaluated.Results. Total 517 patients (63% male, mean age 58) who had reliable LSM by both probes were included in the exploratory cohort. There was a strong correlation between the LSM by M probe (LSM-M) and LSM by XL probe (LSM-XL) (r2 = 0.89, p 25–30 kg/m2 but not > 30 kg/m2.Conclusions. XL cut-offs at 4.8kPa and 10.7kPa were the best estimates of 6.0kPa and 12.0kPa of M probe for patients with BMI > 25–30 kg/m2. Patients with BMI > 30 kg/m2 might use M probe cut-offs for XL probe

Risk of Incident Cancer in Inflammatory Bowel Disease Patients Starting Anti-TNF Therapy While Having Recent Malignancy

International audienceBackground:Patients with inflammatory bowel disease (IBD) and history of malignancy within the last 5 years are usually contraindicated for receiving anti-tumor necrosis factor (anti-TNF) agents. The aim of this study is to assess survival without incident cancer in a cohort of IBD patients exposed to anti-TNF while having previous malignancy within past 5 years.Methods:Data from IBD patients with previous malignancy diagnosed within the last 5 years before starting an anti-TNF agent were collected through a Groupe d'Etude Therapeutiques des Affections Inflammatoires du tube Digestif multicenter survey. Inclusion date corresponded to the first anti-TNF administration after cancer diagnosis.Results:Twenty centers identified 79 cases of IBD patients with previous malignancy diagnosed 17 months (median; range: 1-65) before inclusion. The most frequent cancer locations were breast (n = 17) and skin (n = 15). After a median follow-up of 21 (range: 1-119) months, 15 (19%) patients developed incident cancer (8 recurrent and 7 new cancers), including 5 basal-cell carcinomas. Survival without incident cancer was 96%, 86%, and 66% at 1, 2, and 5 years, respectively. Crude incidence rate of cancer was 84.5 (95% CI, 83.1-85.8) per 1000 patient-years.Conclusions:In a population of refractory IBD patients with recent malignancy, anti-TNF could be used taking into account a mild risk of incident cancer. Pending prospective and larger studies, a case-by-case joint decision taken with the oncologist is recommended for managing these patients in daily practice

Prevalence and Incidence of Subclinical Proximal Tubulopathy (SPT) over 96 Weeks in Chronic Hepatitis B (CHB) Patients Treated with Entecavir (ETV) or Tenofovir Disoproxil (TDF) without Renal Insufficiency (RI) or Hypophosphatemia during the Follow-up

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