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Chronic liver diseases can progress to liver fibrosis and cirrhosis and may lead to portal hypertension and even hepatocellular carcinoma. In recent years, more and more studies have shown that statins can improve liver histology, delay progression to liver fibrosis, and reduce the risk of decompensation and hepatocellular carcinoma in patients with nonalcoholic fatty liver disease. This article introduces the advances in the application of statins in patients with chronic liver diseases, so as to provide a basis for the prevention and treatment of chronic liver diseases.
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Inflammatory bowel disease (IBD) is often accompanied by chronic liver diseases in a variety of situations. Due to the overlapping factors in the pathogenesis of IBD and autoimmune liver diseases including primary sclerosing cholangitis (PSC), primary biliary cholangitis, and autoimmune hepatitis, the co-existence of these diseases is not uncommon, among which PSC with IBD has the highest probability of more than 80%. The probability of IBD with chronic hepatitis B virus (HBV)/hepatitis C virus (HCV) infection is associated with local infection rate, and if the screening for HBV/HCV infection is ignored before the application of immunosuppressive agents, there may be a risk of aggravated HBV/HCV infection or HBV reactivation. Long-term treatment with antibiotics, steroids, and immunosuppressants may cause drug-induced liver injury in patients with IBD. Although IBD patients often have weight loss due to the factors including diarrhea and absorption disorders, these patients may have a higher probability of nonalcoholic fatty liver disease than the general population.
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The American Association for the Study of Liver Diseases and the Infectious Diseases Society of America published the hepatitis C guidance in 2015, then updated in 2018, the recommendation of antiviral therapy was emphasized. A major update of the HCV guidance was released electronically in November 2019. This article summarizes the recommendations of the latest updated guide.
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Recently, the International Club of Ascites (ICA) has developed a new expert consensus on the diagnosis and treatment of acute kidney injury (AKI) in patients with liver cirrhosis, which reflects the new concept of AKI management in patients with liver cirrhosis. This consensus emphasizes the increase in the absolute value of serum creatinine (SCr) and establishes a new staging system for AKI, which may help to evaluate disease progression and recovery. In addition, the new management concept also emphasizes that when AKI progresses to stage 2/3 or still progresses after comprehensive treatment, a diagnosis can be made and vasoconstrictors and albumin can be used as long as the patient meets the other diagnostic criteria for hepatorenal syndrome, regardless of SCr level.
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Primary biliary cirrhosis (PBC) is a chronic autoimmune cholestatic liver disease. The paper introduces the progress in etiology, pathogenesis, clinical characteristics, and treatment of PBC, which has great significance for early diagnosis, disease surveillance, guiding standardized treatment, and improving the quality of life and prognosis in patients with PBC.
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Primary biliary cirrhosis (PBC) is a chronic autoimmune cholestatic liver disease. The paper introduces the progress in etiology, pathogenesis, clinical characteristics, and treatment of PBC, which has great significance for early diagnosis, disease surveillance, guiding standardized treatment, and improving the quality of life and prognosis in patients with PBC.
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Objective To observe the efficacy of cumulative dose of polyethylene glycol-interferon (Peg-IFN)α-2a combined with ribavirin in patients with decompensated hepatitis C virus (HCV)-related liver cirrhosis , and to evaluate the effects of anti-virus therapy on the progress of the disease . Methods From January 2005 to March 2009 ,patients with decompensated HCV-related liver cirrhosis were enrolled ,also included patients received partial splenic embolization .Peg-IFNα-2a combined with ribavirin therapy was given to patients whose blood cell met interferon (IFN) therapy standards .The dosage of Peg-IFNα-2a and ribavirin was adjusted according to the tolerance of the patients .After the treatment ,the patients were followed-up for 24 weeks .The patients whose blood cell did not meet IFN therapy standards and the patients unwilling to receive anti-virus therapy were assigned to control group and were followed-up for 96 weeks .The total amount of medication was calculated according to cumulative exposure dose . Sustained virological response (SVR ) , recurrence rate , liver function and disease progression were observed .The t test or Chi-square test was performed for comparison between groups and rate of disease progression was analyzed with Kaplan Meier curve .Results After anti-virus therapy , SVRs of patients with cumulative dose of Peg-IFNα-2a and ribavirin over 60% (include 60% ) were 27 .3%(12/44) and 27 .7% (13/47) ,respectively ;the recurrence rates were 7/19 and 35 .0% (7/20) ,respectively . In patients with cumulative dose less than 60% ,SVRs were 1/7 and 1/4 ,respectively ,and the recurrence rates were both 1/2 ;the differences of different doses was not statistically significant (all P>0 .05) .At the 24th week of follow-up after therapy ,the Child-Pugh score of combined therapy group was 7 .9 ± 1 .4 , which was lower than that before treatment (8 .5 ± 1 .2) ,and the difference was statistically significant (t=2 .33 ,P=0 .02) .At the 96th week of follow-up ,the Child-Pugh score of control group was 10 .0 ± 1 .6 ,which was higher than that before treatment (8 .5 ± 1 .4) ,and the difference was statistically significant (t=5 .82 , P<0 .01) .The disease progression rate of combined therapy group was 15 .7% , which was lower than that of control group (32 .4% ) ,and the difference was statistically significant (χ2=4 .34 ,P= 0 .04) .Conclusion The application of non-standard dosage of Peg-IFNα-2a combined with ribavirin in the patients with decompensated HCV-related liver cirrhosis can achieve virological response once the cumulative dose reached certain standards ,improve Child-Pugh scores of patients and slow disease progression .
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Objective To investigate the prevalence of Helicobacter pylori (H .pylori)infection in type 2 diabetic patients and its effects on diabetic gastroparesis.Methods Prospective clinical case-control study was applied.From January 2011 to December 2013,125 hospitalized patients with type 2 diabetes and 142 healthy controls without dyspeptic symptoms were enrolled.The prevalence of H .pylori infection and the incidence of gastroparesis in 125 patients with diabetes were investigated in both two groups.The patients with type 2 diabetes were divided into groups according to the course of the disease,and the prevalence of gastroparesis and H .pylori infection of each group were analyzed.The patients with type 2 diabetes and healthy controls confirmed with H .pylori infection were treated with eradication therapy,the rate of eradication of two groups was compared.The improved symptoms of gastroparesis before and after eradication therapy of patients with type 2 diabetes were compared.The chi-square test was performed for statistical analysis.Results The prevalence of H .pylori infection in type 2 diabetic patients was 66.4%(83/125),which was significantly higher than that of healthy control group (51 .4%,73/142 )(χ2 =5 .549,P <0.05).The prevalence of gastroparesis in diabetic patients with the disease course less than 10 years,10 to 20 years and more than 20 years was 33.8% (27/80 ),47.1 % (16/34 )and 8/11 , respectively.The difference was statistically significant (χ2 = 6.554,P < 0.05).The prevalence of H .pylori infection in patients with gastroparesis was 78.4% (40/51 ),which was significantly higher than that of patients without gastroparesis (58.1 %,43/74)(χ2 =4.716,P <0.05).The eradication rate of H .pylori infection in patients with type 2 diabetes was 68.7% (57/83),which was lower than that of healthy control group (87.8%,36/41),and the difference was statistically significant (χ2 =4.385 ,P <0.05).The incidence of epigastric pain and distension,early satiety and apocleisis before H .pylori eradication in type 2 diabetes patients was 75 .9% (63/83 ),66.3% (55/83 )and 67.5 % (56/83 ), respectively,while after eradication which was 44.6%(37/83),37.3%(31/83)and 39.8%(33/83)after eradication,respectively.The differences were statistically significant (χ2 =15 .720,12.764 and 11 .724;all P <0.01).Conclusions The prevalence of H .pylori infection is significantly higher in type 2 diabetic patients,and gastroparesis in type 2 diabetic patients may be correlated with H .pylori infection.The eradication rate in type 2 diabetic patients was lower,and H .pylori eradication therapy can efficiently improve the symptoms of dyspepsia in diabetic patients with gastroparesis.
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<p><b>INTRODUCTION</b>Helicobacter (H.) hepaticus infection causes chronic active hepatitis and induces hepatocellular tumours in A/JCr mice, but evidence of this in humans is scarce. This study aimed to demonstrate the correlation between H. hepaticus and human primary hepatocellular carcinoma (HCC).</p><p><b>METHODS</b>The sera of 50 patients with primary HCC were tested for the presence of anti-H. pylori and anti-H. hepaticus immunoglobulin G (IgG) antibodies. The liver tissues of patients who tested positive for serum antibody were analysed for H. hepaticus-specific 16S rRNA, H. hepaticus cdtB, H. pylori cagA, H. pylori vacA and H. pylori ureC genes using polymerase chain reaction.</p><p><b>RESULTS</b>After the anti-H. pylori antibodies in the serum samples were absorbed by H. pylori antigen, the anti-H. hepaticus IgG serum antibody detection rate was 50.0% in patients with primary HCC. This was significantly higher (p < 0.001) than the detection rate in the benign liver tumour (7.7%) and normal liver tissue (6.3%) groups. Of the 25 primary HCC samples that tested positive for anti-H. hepaticus IgG serum antibody, the H. hepaticus-specific 16S rRNA gene was detected in nine (36.0%) samples. Sequencing showed that the polymerase chain reaction-amplified product exhibited 95.5%-100% homology to the H. hepaticus-specific 16S rRNA gene. Among these nine primary HCC tissue samples, the H. hepaticus cdtB gene was detected in four (44.4%) samples, while no such expression was observed in the benign liver tumour or normal liver tissue groups.</p><p><b>CONCLUSION</b>The present study identified the presence of H. hepaticus infection in patients with primary HCC using serological and molecular biological detection, suggesting that H. hepaticus infection may be involved in the progression of HCC.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , Carcinoma, Hepatocellular , Microbiology , DNA, Bacterial , Genetics , Helicobacter Infections , Genetics , Microbiology , Helicobacter hepaticus , Genetics , Helicobacter pylori , Genetics , Immunoglobulin G , Blood , Liver Neoplasms , Microbiology , Polymerase Chain ReactionABSTRACT
Objective To compare the Helicobacter pylori (Hp) eradication rate of different therapies and to explore the effects of Hp eradication on the clinical characteristics of chronic obstructive pulmonary disease (COPD).Methods From December 2006 to December 2009,at China-Japan Union Hospital of Jilin University 89 stable COPD patients with Hp infection were divided into eradication group and non-eradication group.The eradication group was divided into clarithromycin sub group and moxifloxacin sub group.The patients of these three groups all received regular COPD treatment.Esomeprazole,amoxicillin,clarithromycin and colloidal bismuth citrate were used in clarithromycin group.Esomeprazole,amoxicillin,moxifloxacin and colloidal bismuth citrate were used in moxifloxacin sub group.Patients received pulmonary function test,exercise tolerance evaluation,dyspnea scoring and health-related quality of life scoring at recruitment and 12 months after recruitment.The onset frequenly of acute exacerbation of COPD in one year was counted.The data were analyzed by x2 test and t test.Results The Hp eradication rate of clarithromycin sub group (48.4 ％,15/31) was lower than that of moxifloxacin sub group (87.1％,27/31),and the difference was statistically significant (x2 =4.22,P=0.032).There was no significant difference percentage of forced expiratory volume in first second to forced vital capacity in (FEV1％) predicted value between 27 cases in non-eradication group and 53 patients with successful Hp eradication (t=0.677,P=0.265).Of 53 patients with successful Hp eradication,the 6-min walking distance,Borg dyspnea score and saint George's respiratory questionnaire (SGRQ) score were improved significantly (t =1.884,1.877 and 1.773 respectively; P=0.032,0.025 and 0.034 respectively),and there was no improvement in 27 non-eradication patients.There was significant difference in the frequency of COPD acute attack between 53 patients with successful Hp eradication (1.2 times) and non-eradication group (1.9 times) (t=1.812,P =0.034).Conclusions Hp eradication therapy with moxifloxacin in COPD patients reached higher Hp eradication rate.Hp eradication in COPD patients with Hp infection can improve the exercise tolerance of patients,relieve dyspnea,improve quality of life and reduce the frenquency of acute attacks.
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ObjectiveTo obtain stable animal models and observe Helicobacter hepaticas (Hh)colonization and pathological claracteristics,through infecting different mice strains with Hh.Methods SPF-class male BABL/c Cr,SCID/Cr and C57BL/6 Cr mice were inoculated 0.2 ml Hh standard strain ATCC51450 bacterial suspension (1 × 108CUF/ml),inoculated for 3 times with 48 hours intervals,the control group was fed with the same volume of PBS.Mice were executed at 4 weeks,8weeks and 16 weeks since last Hh inoculation,and mice esophagus,stomach,jejunum,ileum,cecum,colon,liver and pancreas tissue were taken for histopathology examination,Micro-aerobic bacteria isolation,culture and identification and Hh specific 16S rRNA gene amplification.Results The colonization rates of Hh in cecum after inoculated in BALB/c Cr mice and SCID/Cr mice at 4 weeks,8 weeks and 16 weeks were all 8/8,colonization rates in colon at 4 weeks,8 weeks and 16 weeks were 4/8,5/8,5/8 and 3/8,6/8,5/8 respectively,colonization rates in ileum and jejunum at 16 weeks were 1/8,colonization rates in liver at 8 weeks and 16 weeks were 2/8,3/8 and 2/8,2/8respectively.The colonization rates of Hh in cecum after inoculated in C57BL/6 Cr mice at 4 weeks,8weeks and 16 weeks were 1/8,2/8 and 2/8 respectively,colonization rates in colon at 8 weeks and 16weeks were 1/8,2/8 respectively.Compared with C57BL/6 Cr mice,the inflammatory changes in liver,cecum and colon were more significant in Hh infected BALB/c Cr and SCID/Cr mice (P＜0.01),and histological scores gradually increased as infection time extended (P＜0.05,P＜ 0.01 ).The histological scores were significantly higher in those with colon and liver Hh bacterial colonization than those without Hh bacterial colonization (P＜0.05).The histopathological score of cecal tissue was positively correlated with the density of Hh colonization.ConclusionDifferent mice strains are with different susceptibility to Hh,and better Hh infection model can be obtained in Hh inoculated BALB/c Cr and SCID/Cr mice.
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Objective To investigate the potential effects of Lactobacillus acidophilus strain L6 on prevention and treatment of Helicobacter pylori (H. pylori) infection in animal models. Methods A total of 200 hundred C57BL/6 mice were used in the study. ① Sixty mice were divided into control group (infected with H. pylori) and prevention group (previously treated with L6 and followed by infection with H. pylori) with 30 each. The incidence of H. pylori infection was compared between two groups.② Sixty mice were divided into control group (infected with H. pylori) and treatment group (infected with H. pylori for 4 weeks and followed by treatment with L6) with 30 each. Thechanges of H. pylori infection was compared between tow groups. ③ Eighty mice previously infected with H. pylori were orally administrated with L6 in the water supply over a period of 9 months. Of which, 40 H. pylori negative mice were either continuously or discontinuously treated with L6. The re-infection of H. pylori was compared between two groups. The H. pylori infection, gastric mucosal inflammatory and serum anti-H. pylori-lgG titer was measured by using urea breath test, histopathology and ELISA, respectively. Results The positive rate of H. pylori infection was 100% in control group and 20% in prevention group (pre-treated with L6 for 1 week). Whereas there was no H. pylori infection in the rest mice of prevention group pre-treated with L6 for 2 or 4 weeks. There was significant difference in H. pylori infection between two groups (P<0. 05).The serum anti-H. pylori IgG titer was lower in treatment group than in control group (P<0. 05).The reinfection of H. pylori in mice continuously treated with L6 was significantly lower than those discontiously treated with L6 (P<0. 05). Conclusions Preventively feeding L6 can significantly reduce the H. pylori infection in C57BL/6 mice, whereas the inhibition of H. pylori re-infection can also be achieved with long-term administration of L6.
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Objective To investigate the prevalence of Helicobacter hepaticus (H. hepaticus)infection in various species of mice from different regions of China in order to find the role of H. hepaticus in development of hepatitis, liver cancer and tumors in lower digestive tract in mice.Methods One hundred and fourteen mice, including C57BL/6 mice (n= 39), BABL/C mice (n=45),SCID mice (n=14) and C3H mice (n=18), were collected from different regions of China. The serum anti-H, hepaticus-IgG and fecal H. hepaticus antigen were determined by using ELISA. Polymerase chain reaction analysis (PCR) was used to screen Helicobacter genus-specific 16SrRNA and H. hepaticus species-specific 16SrRNA. The feces were cultured and identitied for Helicobacter infection in 114 mice. The H. he paticus infection was identified as one of above tests being positive.Results Of 114 mice, 25 (21.9%) mice were infected with Helicobacter species. The mice infected with H. hepaticus accounted for 44. 0% (11/25) with SCID and C3H mice in high prevelence.Meanwhile, the PCR examination revealed that the rest 56.0% (14/25) mice were infected with other Helicobacter species. Conclusion Besides H. hepaticus infection, the other Helicobacter species infections are also existed in China.
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Objective To analyze the seroprevalence of Helicobacter pylori (H. pylori) infection and its specific genes in liver tissues of chronic hepatitis B virus (HBV) infected patients, and to investigate the effect of H. pylori on development of chronic HBV infected liver diseases. Methods Five hundred and two patients infected with HBV and 429 sex-and age matched healthy controls were enrolled in the case-control study. All subjects were tested for presence of antibodies against H. pylori using ELISA. Fifty-six liver biopsy samples were amplified by polymerase chain reaction (PCR) using Helicobacter genus-specific 16S rRNA primers. The positive samples were further amplified using specific primers of H. pylori cagA, vacA and glmM genes. Results H. pylori infection was accounted for 63.9% in HBV infected patients, which was higher than that in healthy controls (43.4%,P<0.05). Moreover, the seroprevalence of H. pylori in patients with hepatocellular carcinoma (HCC, 29/36,80.6%) or cirrhosis (64/83,77.1%) was higher than that in patients with chronic hepatitis (228/383,59.5%, P<0.01). Helicobacter genus-specific 16S rRNA was found in 17,7 or 11 of patients with cirrhosis, HCC or chronic hepatitis. Twenty-one samples were confirmed as H. pylori DNA by PCR. Conclusions The seroprevalence of antibody against H. pylori was higherHelicobacter can be detected in liver tissues of HBV infected patients. H. pylori might play the role in the development in HBV infected patients compared with healthy controls. Besides H. pylori, other of chronic hepatitis to cirrhosis and HCC.
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Objective To evaluate a somatostaitn analogue (Octreotide) in the treatment of hepatocellular carcinoma (HCC). Methods In this study 62 HCC patients were divided into therapy group (30 cases) and control group (32 cases) based on patients' own will. Patients in treatment group were assigned to receive an average dosage of 339.43±165.53 mg of octreotide. Treatment results and patients' life quality were evaluated on 3rd and 6th month. Result (1) The average live time of the treatment group was (12.89±6.21) months much longer than that of the control group (5.36±6.36) months (P < 0.05). The 6 month, 12 month survival rate of treatment group (73.3% ,50.0% ) was better than that of the control group(40.6% ,9.37% ) (χ2 =4.02 ,χ2 =9.67,all P <0.05). (2) Appetite was improved in 21 patients, body weight increased in 12 patients. Debility ameliorated in 17 patients in therapy group. (3) Tumor grew larger in 8 cases in control group on the sixth month based on liver CT and 6 of them had extrahepatic metastasis. While in therapy group tumor size decreased in 6 cases; did not change in 9 cases; 3 grew larger, and 1 had extrahepatic metastasis. (4) As for side-effects of octreotide therapy, 6 patients had diarrhea at the beginning, as the treatments continued, the symptoms disappeared within one month. Conclusion Octreotide prolongs the surviving time of patients with hepatocellular carcinoma, increases the 6 and 12 months survival rate, causing mild side-effects, and improves the life quality of patients with hepatocellular carcinoma.
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Objective To observe the curative effects of octreotide on gastrointestinal cancer and its influenee on the serum level of IGF-1.Methods 33 patients diagnosed as advanced gastrointestinal cancer were randomized into 2 groups.15 cases in therapy group received octreotide 400μg/d subcutaneous injection or intravenous injection,other patients were taken as control.Curative effects of octreotide and serum level of IGF-1 on different time were observed before and after therapy.Results 4 cases in therapy group kept stable condition during treatment,all 18 cases in control group deteriorated gradually.The median survival time of octreotide therapy was 6.9 months,longer than that of control group(2.3 months)(P＜0.05),the feeling of well being in therapy group was reported a remarkable improvement.Serum level of IGF-1 decreased obviously after octreotide injection(P＜0.05),but no significant difference in control group.Conclusion Octreotide can prolong the survival duration and improve living quality of patients with advanced gastrointestinal tumors.The mechanism of antitumor is probably through suppression of IGF-1.
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Objective To investigate the genetic susceptibility to inflammatory bowel disease in China.Methods The pedigree of 5 probands with inflammatory bowel disease (2 with Crohn's disease and 3 with ulcerative colitis) were analyzed including familial history,clinical features,radiographic,endoscopic and pathological findings.A detailed family pedigree and information of the whereabouts of each relative were obtained.Results Crohn's disease was found in 2 families,each with two affected patients (two brothers or mother and a child).Ulcerative colitis was i'ound in 3 families,each with two or more affected patients (an elder sister and younger brother in the first family,mother and a child in the second family and grandparent and 2 grandchildren in the third family ).First-degree relatives were susceptibility to inflammatory bowel disease and siblings were affected more frequently.The member of the later generation was younger at diagnosis than the preceding generation. Offsprings had an earlier onset and more severe than affected parents. A high concordance for type and localization was found between males and females.Conclusions The patients with inflammatory bowel disease have genetic susceptibility and a few member may affect.It may result from multigene or autosomal recessive inheritance.
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0.05).Conclusion Among the DM patients,the incidence rate of PC is obviously increasing,and with the course of DM elongating,the risk of PC is increasing.There is no obvious difference between sexes.Compared with common people,the incidence rate of PC in DM patients is higher.Type 2 diabetes mellitus might be initial symptom of PC.
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Objective To analyze the synergistic effects between H.pyloriinfection and non-steroidal anti-inflammatory drugs use in peptic ulcer patients and upper gastrointestinal bleeding patients induced by peptic ulcer.Methods The peptic ulcer group consisted of 803 peptic ulcer patients,208 patients with gastrointestinal hemorrhage,and they were compared with 2 061 patients with non-peptic ulcer.Results H.pyloriinfection and NSAIDs use could increase the risk of peptic ulcer,and NSAIDs use in coordination with H.pyloriinfection in gastric ulcer morbility,but it's not significant coordination in the duodenal ulcer mortility.Pure NSAIDs use could increase the risk of bleeding gastric and duodenal ulcer,but pure H.pyloriinfection didn't increase the risk of bleeding peptic ulcer obviously,but the risk of bleeding peptic ulcer was not different in the patients of occasional,frequent and long-term NSAIDs use.Conclusion Detection of H.pyloriin the patients with long-term NSAIDs use is necessary,and eradication is needed in the patients infected with H.pylori.The NSAIDs use in peptic ulcer patients complicated with upper gastrointestinal bleeding should be payed attention and given timely treatment.
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Objective To research the role of Helicobacter pylori(Hp) on chronic hepatitis B.Methods The seroprevalence of Hp infection and the quantity and genotyping of HBV DNA in 376 patients with chronic hepatitis B,including chronichepatitis group,cirrhosis group and HBV-related hepatocellular carcinoma(HCC) group,were detected,and compared with control and gastritis groups.Results Hp seropositivities in chronic hepatitis B group(56.2%),cirrhosis group(69.9%),HCC group(75.0%) were higher than that in control group(43.4%)(P0.05),the Hp seropositivities in cirrhosis and HCC groups were higher than that in chronic hepatitis group(P0.05).Conclusion Seroprevalence of antibodies to Hp in patients with chronic hepatitis B increases significantly,and Hp seropositivity increases with the pathological changes of chronic hepatitis B.